0000000001151396

AUTHOR

Joost Dekker

showing 19 related works from this author

Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteo…

2013

Background Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis. Methods A minimum of 80 volunteers who meet the inclusion criteria will b…

Cartilage ArticularTime FactorsAquatic exerciseKnee JointSports medicineContrast MediaOsteoarthritisNORMAL HYALINE CARTILAGEKnee JointSeverity of Illness Indexlaw.inventionStudy ProtocolAbsorptiometry PhotonSwimming Pools0302 clinical medicineRandomized controlled triallawSurveys and QuestionnairesImmersionOrthopedics and Sports Medicine10. No inequalityFinlandPain MeasurementAUTOLOGOUS CHONDROCYTE TRANSPLANTATIONmedicine.diagnostic_testMiddle AgedOsteoarthritis KneeMagnetic Resonance ImagingBiomechanical Phenomena3. Good healthPostmenopauseTreatment OutcomeResearch DesignBody CompositionFemaleT-2 RELAXATION-TIMEELDERLY-WOMENmedicine.medical_specialtydGEMRICMIDDLE-AGED ADULTSeducationGADOLINIUM-ENHANCED MRIPhysical examination03 medical and health sciencesRheumatologyPredictive Value of TestsInternal medicineSeverity of illnessOsteoarthritismedicineHumansMODERATE RUNNING EXERCISET2 relaxation timeEVIDENCE-BASED RECOMMENDATIONSBonePhysical ExaminationAged030203 arthritis & rheumatologybusiness.industryResistance Training030229 sport sciencesQuantitative MRIARTICULAR-CARTILAGEmedicine.disease3126 Surgery anesthesiology intensive care radiologyRheumatologyOrthopedic surgeryPhysical therapyLAND-BASED EXERCISETomography X-Ray Computedbusiness
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Are changes in pain, cognitive appraisals and coping strategies associated with changes in physical functioning in older adults with joint pain and c…

2019

Background As the population ages, the number of people with chronic diseases increases. Frequently, older people suffer from joint pain together with other chronic diseases, which can lead to decreased physical functioning. Aims To investigate the associations of the changes in cognitive appraisals, coping strategies and pain with the change in physical functioning in older people, who have chronic pain and chronic diseases. Methods Elderly persons (n = 407, mean age 77 years, and 62% female), with self-reported joint pain and at least two chronic diseases, filled in questionnaires about cognitive appraisals, coping strategies, pain intensity and physical functioning at baseline, at 6- and…

MaleAgingPopulationfyysinen toimintakykyComorbiditycoping strategiesGee03 medical and health sciences0302 clinical medicineCognitionPhysical functioningAdaptation PsychologicalMedicineHumans030212 general & internal medicineeducationkrooniset tauditGeneralized estimating equationolder adultsAgedcognitive appraisalseducation.field_of_studybusiness.industryselviytyminenChronic painkipuCognitionPhysical Functional Performancemedicine.diseaseComorbidityArthralgiaJoint painChronic Diseasekrooninen kipuFemaleGeriatrics and Gerontologymedicine.symptombusiness030217 neurology & neurosurgeryikääntyneetClinical psychologyAging Clinical and Experimental Research
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Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

2017

Objective: To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities. Methods: In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ≥30 kg/m2), with severity score ≥2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities…

030203 arthritis & rheumatologymedicine.medical_specialtyWOMACRehabilitationbusiness.industryStrength trainingmedicine.medical_treatmentOsteoarthritismedicine.diseaseComorbiditylaw.invention03 medical and health sciences0302 clinical medicineRheumatologyRandomized controlled triallawmedicinePhysical therapy030212 general & internal medicineExercise physiologybusinessBody mass indexArthritis Care & Research
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Proposal for an Update of the Definition and Scope of Behavioral Medicine

2017

Purpose: We aim to provide an update of the definition and scope of behavioral medicine in the Charter of ISBM, as the present version was developed more than 25 years ago. Methods: We identify issues which need clarification or updating. This leads us to propose an update of the definition and scope of behavioral medicine. Results: Issues in need of clarification or updating include the scope of behavioral medicine (biobehavioral mechanisms, clinical diagnosis and intervention, and prevention and health promotion); research as an essential characteristic of all three areas of behavioral medicine; the application of behavioral medicine; the terminology of behavioral medicine as a multidisci…

medicine.medical_specialty030505 public healthScope (project management)business.industryScopeAlternative medicineCharterDefinitionArticle03 medical and health sciencesHealth psychology0302 clinical medicineBehavioral medicinemedicineEngineering ethics030212 general & internal medicine0305 other medical sciencebusinessApplied PsychologyBehavioral medicineInternational Journal of Behavioral Medicine
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Effectiveness of a 12-month home-based exercise program on trunk muscle strength and spine function after lumbar spine fusion surgery:a randomized co…

2022

Purpose: The effectiveness of a 12-month home-exercise program on trunk muscle strength after lumbar spine fusion surgery was evaluated. Materials and methods: Three months postoperatively, 98 patients were randomized either to the exercise group (EG), with a progressive 12-month home-based exercise program, or to usual care group (UCG), with one guidance session for light home-exercises. Maximal trunk muscle strength was measured by a strain-gauge dynamometer and trunk extensor endurance was measured by Biering-Sørensen’s test at baseline and after the intervention. Results: The mean change in extension strength during the intervention was 75 N in EG and 58 N in UCG. Flexion strength impro…

musculoskeletal diseases030506 rehabilitationmedicine.medical_specialtyLumbar spine fusionspondylolisteesimedicine.medical_treatmentfysioterapiarehabilitationlaw.inventionspine surgery03 medical and health sciences0302 clinical medicineselkärankaRandomized controlled triallawmedicineHumansMuscle StrengthMuscle SkeletalHome based exerciselääkinnällinen kuntoutusphysiotherapyspondylolisthesisRehabilitationexercisebusiness.industryRehabilitationTorsomedicine.diseaseSpondylolisthesisExercise TherapySurgerySpine (zoology)Spinal Fusionmuscle strengthMuscle strengthlumbar spine fusionlihaskunto0305 other medical scienceTrunk musclebusiness030217 neurology & neurosurgeryliikuntahoito
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Is a model of stratified exercise therapy by physical therapists in primary care feasible in patients with knee osteoarthritis? : a mixed methods stu…

2020

OBJECTIVES: To explore the feasibility of a newly developed model of stratified exercise therapy in primary care for patients with knee osteoarthritis (OA).DESIGN: Mixed method design (process, outcome and qualitative evaluation).SETTING: Six physical therapy practices in primary care around Amsterdam.PARTICIPANTS: Fifty eligible patients with knee OA, visiting one of the participating physical therapists (PTs).INTERVENTION: Patients were allocated to a subgroup based on a simple stratification tool and received subgroup-specific, protocolized, 4-month, exercise therapy.MAIN OUTCOME MEASURES: Feasibility of this model of stratified exercise therapy was explored by multiple process parameter…

Male030506 rehabilitationmedicine.medical_specialtynivelrikkomedicine.medical_treatmentExercise therapyPhysical Therapy Sports Therapy and RehabilitationPrimary careOsteoarthritisknee osteoarthritissubgroups03 medical and health sciences0302 clinical medicineSDG 3 - Good Health and Well-beingIntervention (counseling)medicineHumans030212 general & internal medicineDepression (differential diagnoses)AgedPain MeasurementRehabilitationPrimary Health Carebusiness.industrySubgroupsphenotypesFeasibilityExercise therapyMiddle AgedOsteoarthritis Kneemedicine.diseaseLow back painPhysical TherapistsPhenotypesKnee painPhysical therapyFeasibility Studies/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_beingFemaleKnee osteoarthritismedicine.symptom0305 other medical sciencebusinessPhysical therapyfeasibilityliikuntahoitofysikaalinen hoito
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Disability and health-related quality of life in patients undergoing spinal fusion: a comparison with a general population sample

2013

Background. The aim of the present study was to compare one-year-follow-up data on disability and health-related quality of life (HRQoL) between spinal fusion patients and age- and sex-matched general population. Methods. The data on fusion patients were collected prospectively using a spinal fusion data base in two Finnish hospitals. A general population sample matched for age, sex and residential area was drawn from the Finnish Population Register. All participants completed a questionnaire and the main outcome measures were the Oswestry Disability Index (ODI) and the Short Form-36 questionnaire (SF-36). Results. Altogether 252 (69% females) fusion patients and 682 (67% females) populatio…

Malemedicine.medical_specialtyDatabases FactualSports medicineHealth-related quality of lifeHealth Statusmedicine.medical_treatmentPopulationDisability EvaluationvammaisuusPostoperative ComplicationsRheumatologyQuality of lifetoimintakykyEpidemiologymedicineHumansOrthopedics and Sports MedicineProspective StudiesRegistrieseducationProspective cohort studyOswestry disability indexeducation.field_of_studyRehabilitationbusiness.industryselän jäykistysleikkausMiddle AgedLumbar fusionOswestry Disability IndexSpinal FusionSpinal fusionPreoperative PeriodQuality of LifePhysical therapyFemalebusinesslihasvoimaResearch ArticleGeneral population sampleBMC Musculoskeletal Disorders
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Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

2012

Abstract Background Lumbar spine fusion (LSF) effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes. Methods/design In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after su…

Quality of lifemedicine.medical_specialtylcsh:Diseases of the musculoskeletal systemSports medicinemedicine.medical_treatmentPainLumbar vertebraelaw.inventionDisability EvaluationYoung AdultStudy ProtocolPhysical medicine and rehabilitationPostoperative ComplicationsRheumatologyQuality of lifeRandomized controlled triallawOutcome Assessment Health CaremedicineHumansOrthopedics and Sports MedicineExercisePain MeasurementRehabilitationLumbar VertebraeDisabilitybusiness.industryRehabilitationLow back painCombined Modality TherapyHome Care ServicesLumbar fusionSpineExercise TherapySelf Caremedicine.anatomical_structureSpinal FusionTreatment OutcomeResearch DesignSpinal fusionOrthopedic surgeryPhysical therapyExercise Movement Techniquesmedicine.symptomlcsh:RC925-935businessLow Back Pain
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Prognosis of Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Systematic Review and Meta-Analysis

2016

Objective To systematically summarize the literature on the course of pain in patients with knee osteoarthritis (OA), prognostic factors that predict deterioration of pain, the course of physical functioning, and prognostic factors that predict deterioration of physical functioning in persons with knee OA. Methods A search was conducted in PubMed, CINAHL, Embase, Psych-INFO, and SPORTDiscus up to January 2014. A meta-analysis and a qualitative data synthesis were performed. Results Of the 58 studies included, 39 were of high quality. High heterogeneity across studies (I(2) >90%) and within study populations (reflected by large SDs of change scores) was found. Therefore, the course of pain a…

030203 arthritis & rheumatologymedicine.medical_specialtybusiness.industryOsteoarthritisCINAHLKnee Jointmedicine.diseaseComorbidityPreferred walking speed03 medical and health sciences0302 clinical medicineKnee painPhysical medicine and rehabilitationRheumatologyMeta-analysisPhysical therapyMedicine030212 general & internal medicinemedicine.symptombusinessPsychosocialArthritis Care & Research
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Course and Predictors of Pain and Physical Functioning in Patients with Hip Osteoarthritis: Systematic Review and Meta-Analysis

2016

Objective: To systematically summarize the literature on: (i) the course of pain and physical functioning; and (ii) predictors of deterioration of pain and physical functioning in patients with osteoarthritis of the hip. Methods: A literature search was conducted in PubMed, CINAHL, Embase, PsychINFO and SPORTDiscus up to July 2015. Meta-analyses and qualitative data syntheses were performed. Results: Eleven of the 15 included studies were of high quality. With regard to the course of pain and physical functioning, high heterogeneity was found across studies (I2 >71%) and within study populations (reflected by large standard deviations of change scores). Therefore, the course of pain and phy…

pijnmedicine.medical_specialtyHealth Behaviorreviewfyysinen toimintakykyPhysical Therapy Sports Therapy and RehabilitationComorbidityOsteoarthritisCINAHLResearch SupportOsteoarthritis Hip03 medical and health sciences0302 clinical medicinePhysical medicine and rehabilitationPhysical functioningmedicineHip osteoarthritisJournal ArticleHumansphysical functioninglongitudinal studiesIn patientpainNon-U.S. Gov'tExercisePain Measurement030203 arthritis & rheumatologybusiness.industryResearch Support Non-U.S. Gov'tRehabilitationprognostic factorskipuGeneral MedicinePrognosismedicine.diseaseComorbidityrevalidatieosteoartritisfunctionerenMeta-analysiship osteoarthritisDisease ProgressionPhysical therapybusinessPsychosocial030217 neurology & neurosurgeryMeta-Analysis
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Quality of life and disability:can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisth…

2017

Purpose The aim of the study was to investigate the effectiveness of the postoperative 12-month exercise program compared to usual care on disability and health-related quality of life (HRQoL) in patients after lumbar spine fusion surgery (LSF). Methods Altogether, 98 patients with isthmic (31) or degenerative (67) spondylolisthesis were randomised to exercise therapy group (EG) (n = 48) or usual care group (UCG) (n = 50) 3 months after LSF. EG patients had home-based progressive strength and aerobic training program for 12 months. UCG patients received only oral and written instructions of exercises. Oswestry Disability Index (ODI) and HRQoL (RAND-36) were evaluated at the time of randomiz…

Malefusionmedicine.medical_specialtyRandomizationfysioterapialaw.inventionspine surgery03 medical and health sciencesvammaisuus0302 clinical medicineQuality of lifeRandomized controlled triallawmedicineAerobic exerciseHumansOrthopedics and Sports MedicineIn patientDisabled Persons030212 general & internal medicineAgedbusiness.industrylumbar spineMiddle Agedmedicine.diseaseSpondylolisthesisOswestry Disability IndexExercise Therapyhealth-related quality of lifeSpinal FusionPhysical therapyQuality of LifeSurgeryFemaleNeurosurgerySpondylolisthesisbusiness030217 neurology & neurosurgeryFollow-Up Studies
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Development of comorbidity-adapted exercise protocols for patients with knee osteoarthritis

2014

Mariëtte de Rooij,1 Marike van der Leeden,1,2 Ellis Avezaat,3 Arja Häkkinen,4 Rob Klaver,1 Tjieu Maas,5 Wilfred F Peter,1 Leo D Roorda,1 Willem F Lems,1,6 Joost Dekker1,71Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; 2VU University Medical Center Department of Rehabilitation Medicine, Amsterdam, the Netherlands; 3Sint Lucas Andreas Hospital, Department of Physical Therapy, Amsterdam, the Netherlands; 4Department of Health Sciences, University of Jyväskylä and Jyväskylä Central Hospital, Jyväskylä, Finland; 5HAN University, Institute of Health, GGM, Institute for Sports and Exercise Studies…

Malemedicine.medical_treatmentOsteoarthritislaw.inventionPulmonary Disease Chronic ObstructiveRandomized controlled triallawActivities of Daily LivingOrthopedics and Sports MedicineniveltulehdusHearing DisordersDepression (differential diagnoses)Original Researchkomorbiditeettiexercise therapyRehabilitationDepressionta3141General MedicineMiddle AgedOsteoarthritis KneeLow back paincomorbidityTreatment Outcomearthritiscoexisting diseaseHypertensionFemaleChronic Painmedicine.symptomliikuntahoitomedicine.medical_specialtyHeart DiseasesVision DisordersBiomedical Engineeringknee osteoarthritisrehabilitationRheumatologymental disordersmedicineHumansObesityAgedProtocol (science)business.industryRC952-954.6medicine.diseaseComorbidityDiabetes Mellitus Type 2GeriatricsHeart failureClinical Interventions in AgingQuality of LifePhysical therapykuntoutusGeriatrics and GerontologybusinessLow Back PainClinical Interventions in Aging
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Effectiveness of postoperative home-exercise compared with usual care on kinesiophobia and physical activity in spondylolisthesis:A randomized contro…

2017

Objective: To study the effectiveness of a 12-month exercise therapy on kinesiophobia and physical activity in patients with spondylolisthesis after lumbar spine fusion. Design: Randomized controlled trial. Subjects: Patients (n = 98) with spondylolisthesis who had undergone lumbar spine fusion. Methods: All patients (mean age 59 years) had received lumbar spine fusion surgery and identical postoperative instructions. Three months postoperatively, they were randomized into an exercise group (n = 48) or usual care group (n = 50). The exercise group received 12-month progressive home-based training with regular booster sessions, and the usual care group a single session of physiotherapy instr…

Male030506 rehabilitationmedicine.medical_specialtymedicine.medical_treatmentspondylolisteesiPhysical activityPhysical Therapy Sports Therapy and RehabilitationMetabolic equivalentfysioterapialaw.inventionspondylolyysi03 medical and health sciences0302 clinical medicinePhysical medicine and rehabilitationRandomized controlled triallawselkäsairaudetmedicineHumansPostoperative PeriodPhysical Therapy Modalitieslow back painphysical therapy modalitiesbusiness.industryRehabilitationGeneral MedicineMiddle Agedmedicine.diseaseLow back painSpondylolisthesis3. Good healthExercise TherapyQuartileSpinal fusionUsual carespinal fusionPhysical therapyFemalekuntoutusmedicine.symptomSpondylolisthesis0305 other medical sciencebusiness030217 neurology & neurosurgeryliikuntahoito
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OP0159 THE EFFECT OF HIGH-INTENSITY RESISTANCE TRAINING AND VITAMIN D SUPPLEMENTATION ON MUSCLE STRENGTH IN PATIENTS WITH KNEE OSTEOARTHRITIS: A RAND…

2019

Background Exercise therapy is the cornerstone of knee osteoarthritis (OA) management. In particular muscle strengthening exercise, targeting the characteristic loss of muscle strength present in knee OA, is a key factor for the beneficial effects reported for exercise therapy. The optimal training intensity for resistance training in patients with knee OA, however, is not known to date. Besides resistance training, vitamin D supplementation in patients with vitamin deficiency may optimize muscle strength. Objectives To assess (i) whether high-intensity resistance training leads to greater improvements in muscle strength compared to moderate-intensity resistance training in patients with kn…

Vitaminmedicine.medical_specialtyWOMACStrength trainingbusiness.industrymedicine.diseasevitamin D deficiencychemistry.chemical_compoundKnee painchemistrymedicinePhysical therapyVitamin D and neurologymedicine.symptomLeg curlLeg pressbusinessOral Presentations
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Trunk Muscle Strength After Lumbar Spine Fusion: A 12-Month Follow-up.

2019

Objective: The aim of this study was to investigate changes in trunk muscle strength 12 months after lumbar spine fusion (LSF) compared to preoperative strength. Methods: A total of 194 patients (mean ± standard deviation [SD] age, 61 ± 21 years) who underwent LSF participated in this prospective longitudinal study. Physical measurements of the participants were made before surgery and 12 months postoperatively. Isometric trunk extension and flexion strength was measured using a strain-gauge dynamometer in the standing position. Strength changes were calculated. Regression analysis was performed to explore which factors predicted strength levels at 12 months postoperatively. Results: The pr…

Lumbar spine fusionmedicine.medical_treatmentIsometric exerciselcsh:RC346-429leikkaushoitospine surgerySpine surgerySpine surgeryselkärankamedicineisometric strengthSevere back painlcsh:Neurology. Diseases of the nervous systembusiness.industryMuscle strengthIsometric strengthTrunkSpineSpinal fusionspinal fusionSurgeryOriginal ArticleSpinal fusionseurantatutkimusNeurology (clinical)Trunk muscleNuclear medicinebusinesslihasvoimaMonth follow upNeurospine
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Defining the Field of Behavioral Medicine: A Collaborative Endeavor.

2017

Purpose: To respond to comments on our proposal for an update of the definition and scope of behavioral medicine. Methods: We identify common themes in the comments and provide a response. Results: We discuss the relationship of behavioral medicine to other disciplines and fields, the scope of behavioral medicine, and issues related to the application of behavioral medicine. Conclusion: Based on the comments of our esteemed colleagues and our reflection on those comments, we now offer the following refined definition and scope of behavioral medicine. ‘Behavioral medicine can be defined as the field characterized by the collaboration among multiple disciplines concerned with the development …

medicine.medical_specialty030505 public healthScope (project management)business.industryPublic healthAlternative medicineDiseaseHealth PromotionBehavioral Medicine03 medical and health sciencesHealth psychology0302 clinical medicineHealth promotionIntervention (counseling)Behavioral medicinemedicineHumansEngineering ethics030212 general & internal medicinePublic Health0305 other medical sciencebusinessApplied PsychologyClinical psychologyInternational journal of behavioral medicine
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Effects of a progressive aquatic resistance exercise program on the biomechanical composition and morphology of cartilage in women with mild knee ost…

2013

Background. Symptoms associated with osteoarthritis of the knee result in decreased function, loss of working capacity and extensive social and medical costs. There is a need to investigate and develop effective interventions to minimise the impact of and even prevent the progression of osteoarthritis. Aquatic exercise has been shown to be effective at reducing the impact of osteoarthritis. The purpose of this article is to describe the rationale, design and intervention of a study investigating the effect of an aquatic resistance exercise intervention on cartilage in postmenopausal women with mild knee osteoarthritis. Methods. A minimum of 80 volunteers who meet the inclusion criteria will…

dGEMRICAquatic exerciseOsteoarthritisluuQuantitative MRIT2 relaxation time
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Efficacy of tailored exercise therapy on physical functioning in patients with knee osteoarthritis and comorbidity : A randomized controlled trial

2017

Objective: To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities. Methods: In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ≥30 kg/m2), with severity score ≥2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities…

polvethoitomenetelmätkuntoutusnilverikkoharjoitushoitoknee osteoarthritisliikuntahoitokomorbiditeetti
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Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

2012

Abstract Background Lumbar spine fusion (LSF) effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes. Methods/design In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after su…

toimintakykysatunnaistettu kontrolloitu tutkimusselän jäykistysleikkauselämänlaatuterapeuttinen harjoittelu
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