Biomedical subjects

Bart W Koes

Publications and source records attributed to Bart W Koes.

At least 19 recordsLinked to original sources

PubMed2006

Incidence and risk factors of disability in the elderly: the Rotterdam Study.

BACKGROUND: This study analyzed the incidence of disability and its risk factors in multiple dimensions in community-dwelling women and men of older age, between 1990 and 1999, in Rotterdam, The Netherlands. METHODS: For this community-based prospective longitudinal study, data were obtained from the Rotterdam Study that comprised a cohort of 7983 elderly who are 55 and over. The study sample for incident disability consisted of 4258 subjects who were disability free at baseline and had complete outcome data at follow-up, 6 years later. Sociodemographic factors, lifestyle variables, health conditions and disability status were assessed at baseline and follow-up. Disability was defined as a Disability Index (DI) > or =0.50 according to the Health Assessment Questionnaire. RESULTS: Multivariate analyses, performed separately due to gender differences, revealed that age, self-rated health, overweight, depression, joint complaints, medication use were predictors of disability for both men and women. Stroke, falling and presence of comorbidities predicted disability in men only while having a partner, poor cognitive functioning, osteoarthritis and morning stiffness only predicted disability in women. CONCLUSION: Identified risk factors in this study are to some extent modifiable, enabling interventive strategies, reckoning with gender differences in risk profile, in order to prevent disability.

Age Factors↗

PubMed2006

Exercise proves effective in a systematic review of work-related complaints of the arm, neck, or shoulder.

OBJECTIVE: Interventions such as physiotherapy and ergonomic adjustments play a major role in the treatment of most work-related complaints of the arm, neck, and/or shoulder (CANS). We evaluated whether conservative interventions have a significant impact on outcomes for work-related CANS. STUDY DESIGN AND SETTING: A systematic review was conducted. Only (randomized) trials studying interventions for patients suffering from work-related CANS were included. Interventions may include exercises, relaxation, physical applications, and workplace adjustments. Two authors independently selected the trials, assessed methodological quality, and extracted data. RESULTS: We included 26 studies (in total 2,376 patients); 23 studies included patients with chronic nonspecific complaints. Over 30 interventions were evaluated and 7 main subgroups of interventions could be determined, of which the subgroup "exercises" was the largest one. Overall, the quality of the studies appeared to be poor. CONCLUSION: There is limited evidence for the effectiveness of exercises when compared to massage, adding breaks during computer work, massage as add-on treatment to manual therapy, manual therapy as add-on treatment to exercises, and some keyboards in people with carpal tunnel syndrome when compared to other keyboards or placebo. For other interventions no clear effectiveness could be demonstrated.

Arm↗

PubMed2006

Association between skin diseases and severe bacterial infections in children: case-control study.

BACKGROUND: Sepsis or bacteraemia, however rare, is a significant cause of high mortality and serious complications in children. In previous studies skin disease or skin infections were reported as risk factor. We hypothesize that children with sepsis or bacteraemia more often presented with skin diseases to the general practitioner (GP) than other children. If our hypothesis is true the GP could reduce the risk of sepsis or bacteraemia by managing skin diseases appropriately. METHODS: We performed a case-control study using data of children aged 0-17 years of the second Dutch national survey of general practice (2001) and the National Medical Registration of all hospital admissions in the Netherlands. Cases were defined as children who were hospitalized for sepsis or bacteraemia. We selected two control groups by matching each case with six controls. The first control group was randomly selected from the GP patient lists irrespective of hospital admission and GP consultation. The second control group was randomly sampled from those children who were hospitalized for other reasons than sepsis or bacteraemia. We calculated odds ratios and 95% confidence intervals (CI). A two-sided p-value less than 0.05 was considered significant in all tests. RESULTS: We found odds ratios for skin related GP consultations of 3.4 (95% CI: [1.1-10.8], p = 0.03) in cases versus GP controls and 1.4 (95% CI: [0.5-3.9], p = 0.44) in cases versus hospital controls. Children younger than three months had an odds ratio (cases/GP controls) of 9.2 (95% CI: [0.81-106.1], p = 0.07) and 4.0 (95% CI: [0.67-23.9], p = 0.12) among cases versus hospital controls. Although cases consulted the GP more often with skin diseases than their controls, the probability of a GP consultation for skin disease was only 5% among cases. CONCLUSION: There is evidence that children who were admitted due to sepsis or bacteraemia consulted the GP more often for skin diseases than other children, but the differences are not clinically relevant indicating that there is little opportunity for GPs to reduce the risk of sepsis and/or bacteraemia considerably by managing skin diseases appropriately.

Adolescent↗

PubMed2006

Treatment of arm, neck, and/or shoulder complaints in physical therapy practice.

STUDY DESIGN: This is a prospective cohort study with a follow-up period of 6 months. OBJECTIVE: To describe the interventions applied by physical therapists in treating patients with complaints of the arm, neck, and/or shoulder. SUMMARY OF BACKGROUND DATA: Complaints of the arm, neck, and/or shoulder occur frequently and are usually treated within primary care. Many patients with these complaints are treated with physical therapy. METHODS: During a 1-year period, the participating physiotherapists included new consulters with musculoskeletal complaints of the upper extremity. The patients completed a questionnaire at baseline, and the physical therapists completed a treatment record for up to 6 months. RESULTS: Of the 624 patients included in the cohort, physical therapists provided treatment data of 619 patients. The main treatment consisted of exercise therapy (93%) and massage (87%), or a combination of both. More patients with specific complaints received physical methods, and patients with nonspecific complaints were treated with manipulation techniques. CONCLUSIONS: The primary treatment of complaints the of arm, neck, and/or shoulder in physiotherapy practice consists of exercise therapy and massage therapy, mostly being a combination of both. Future studies should focus on the effectiveness of exercise therapies, combined or not combined with massage, for patients with complaints of the arm, neck, and/or shoulder.

Adult↗

PubMed2006

Magnetic resonance imaging abnormalities in symptomatic and contralateral knees: prevalence and associations with traumatic history in general practice.

BACKGROUND: After trauma, internal knee lesions are found in approximately two thirds of patients. However, magnetic resonance imaging abnormalities have also been described in asymptomatic volunteers. HYPOTHESIS: Not all visualized lesions in symptomatic posttraumatic knees are the result of recent trauma; there are subgroups of lesions that may be preexistent. STUDY DESIGN: Cross-sectional study (prevalence); Level of evidence, 2. METHODS: Patients visiting their general practitioners after knee trauma were invited for magnetic resonance imaging of both knees. Prevalence of knee abnormalities was compared between symptomatic and asymptomatic knees. Multivariable analysis was performed to investigate the association between lesions that were seen in symptomatic and asymptomatic knees (ie, effusion and meniscal tears) and recent trauma, history of old trauma, age, and osteoarthritis. RESULTS: In 134 participants, ligament lesions were found almost exclusively in symptomatic knees. Meniscal lesions and effusion were almost equally found in symptomatic and asymptomatic knees. Effusion was related to recent trauma (odds ratio, 14.0; 95% confidence interval, 5.0-39.6) and osteoarthritis (odds ratio, 4.7; 95% confidence interval, 1.4-15.5) but not to history of old trauma and age. Meniscal tears were more common in older patients (odds ratio, 1.09; 95% confidence interval, 1.05-1.12) but were not related to osteoarthritis. History of old trauma was more strongly related to the group of radial, longitudinal, and complex meniscal tears (odds ratio, 8.6; 95% confidence interval, 3.3-22.5) than to horizontal tears (odds ratio, 2.3; 95% confidence interval, 0.9-5.6). Recent trauma was not related to horizontal meniscal tears but was strongly related to other types of meniscal tears (odds ratio, 3.2; 95% confidence interval, 1.4-6.9). CONCLUSION: Ligament knee lesions are most probably the result of recent trauma. Radial, longitudinal, and complex meniscal tears are strongly related to trauma, whereas horizontal meniscal tears and effusion may be preexistent in many cases.

Adolescent↗

PubMed2006

Applicability and clinical relevance of results in randomized controlled trials: the Cochrane review on exercise therapy for low back pain as an example.

STUDY DESIGN: A critical appraisal of the literature. OBJECTIVES: To increase awareness of the importance of applicability and clinical relevance of the results of randomized controlled trials (RCTs) in the field of spinal disorders by formulating a list of items for assessment of applicability and clinical relevance of results of RCTs. SUMMARY OF BACKGROUND DATA: In systematic reviews of randomized controlled trials (RCTs), critical appraisal of methodologic quality is considered important. Less attention has been paid to the assessment of the applicability and the clinical relevance of the results. METHODS: RCTs in an update of the Cochrane review on exercise therapy for low back pain were used. Most of the trials did not score positively on the five Cochrane Back Review Group basic items describing patients: intervention and setting, outcome, effect size, and benefits related to adverse effects. Item 1 was met by 88% of the trials, but item 2 only by 51%, item 3 by 67%, item 4 by 35%, and item 5 by 0%. Subsequently, a more comprehensive list of items for the assessment of applicability and clinical relevance of results of RCTs was developed. These criteria were pilot tested on the RCTs. After pilot testing and a subsequent consensus meeting, the list of items was drafted and circulated among the members of the Editorial Board of the Cochrane Back Review Group. Changes were made in response to comments. RESULTS: The final list consists of 40 items. The items are ordered on two headings: Does the report enable the assessment of applicability? Are the study results clinically relevant? We present examples of informative and noninformative reporting of RCTs in order to illustrate how information on applicability and clinical relevance of results can be assessed. CONCLUSIONS: Authors of RCTs should adequately report on items that are essential to assess the applicability and clinical relevance of results. The presented list of items may help clinicians reading RCTs and authors of systematic reviews to draw more balanced conclusions on applicability and clinical relevance of results.

Humans↗

PubMed2006

Determinants for improvement in different back pain measures and their influence on the duration of sickness absence.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To identify the determinants for improvement in pain, functional limitations, and quality of life in low back pain (LBP) patients, and to evaluate whether return to work (RTW) can be predicted by these factors and associated improvement in health-related aspects. SUMMARY OF BACKGROUND DATA: It is unclear to what extent prognostic factors for the course of LBP and consequent functional limitations are similar to prognostic factors for RTW. METHODS: A total of 103 LBP patients on sickness absence for 3 to 12 weeks filled out three questionnaires: at inclusion, and after 3 and 6 months. Information on the duration of sickness absence was gathered from occupational health services. RESULTS: Different personal characteristics determined pain, functional limitations, and quality of life at baseline. These dimensions all improved over time, significantly during the first 3 months. Working at 3 months had a positive impact on all three dimensions. In the multivariate model, RTW was positively associated with male gender and recurrent LBP, whereas it was negatively associated with the level of functional limitations at baseline. CONCLUSION: Except for male gender, the primary determinants for improvement in pain, functional limitations, and quality of life were not associated with RTW. Although there is a large coherence in the improvement in the outcome measures, RTW seems primarily determined by the level of experienced functional limitations.

Absenteeism↗

PubMed2006

Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546].

BACKGROUND: Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation. METHODS/DESIGN: Patients (age 18-70 years) presenting with sciatica due to lumbar disc herniation lasting more than 6-8 weeks are included. Patients with disc herniation larger than 1/3 of the spinal canal diameter, or disc herniation less than 1/3 of the spinal canal diameter with concomitant lateral recess stenosis or sequestration, are eliglible for participation. Randomisation into microendoscopic discectomy or conventional unilateral transflaval discectomy will take place in the operating room after induction of anesthesia. The length of skin incision is equal in both groups. The primary outcome measure is the functional assessment of the patient, measured by the Roland Disability Questionnaire for Sciatica, at 8 weeks and 1 year after surgery. We will also evaluate several other outcome parameters, including perceived recovery, leg and back pain, incidence of re-operations, complications, serum creatine kinase, quality of life, medical consumption, absenteeism and costs. The study is a randomised prospective multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 2 years. DISCUSSION: Currently, open discectomy is the golden standard in the surgical treatment of lumbar disc herniation. Whether microendoscopic discectomy is more cost-effective than unilateral transflaval discectomy has to be determined by this trial.

Adult↗

PubMed2006

Reliability and responsiveness of the Dutch version of the Neck Disability Index in patients with acute neck pain in general practice.

A prospective cohort study with a 1 week follow-up. To examine the reliability and responsiveness of the Dutch version of the Neck Disability Index (NDI) in patients with acute neck pain in general practice. An increasing number of studies on treatment options is published in which the NDI is used. Reports of the ability of the NDI to detect change over time, often called responsiveness, however have not yet been published. At baseline 187 patients (119 women, 68 men) were included. They completed a questionnaire on demographic variables, self-reported cause of their complaints and the NDI. After 1 week, 86 patients were sent the NDI again together with the perceived recovery scale which was used as our external criterion. The scale ranged from 1 (complete recovery) to 7 (complaints are worse than ever). Response rate was 93%. Test-retest scores on reliability were good (ICC = 0.90). A Bland and Altman plot and a graph of total sum score differences showed no visible tendency towards unequal spreading of the data. For patients that reported on the perceived recovery scale that they were "stable" we found a responsiveness ratio of 1.82. The standard error of measurement (SEM) was 0.60 what resulted in a minimal detectable change (MDC) of 1.66. The NDI has shown to be a reliable and responsive instrument in patients with acute neck pain in general practice.

Acute Disease↗

PubMed2006

The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized controlled trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To compare high- and low-intensity back schools with usual care in occupational health care. SUMMARY OF BACKGROUND DATA: The content and intensity of back schools vary widely and the methodologic quality of randomized controlled trials is generally weak. Until now, no back school has proven to be superior for workers sick-listed because of subacute nonspecific low back pain. METHODS: Workers (n = 299) sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain were recruited by the occupational physician and randomly assigned to a high-intensity back school, a low-intensity back school, or care as usual. Outcome measures were days until return to work, total days of sick-leave, pain, functional status, kinesiophobia, and perceived recovery and were assessed at baseline and at 3 and 6 months of follow-up. Principal analyses were performed according to the intention-to-treat principle. RESULTS: We randomly allocated 299 workers. Workers in the low-intensity back school returned to work faster compared with usual care and the high-intensity back school, with hazard ratios of 1.4 (P = 0.06) and 1.3 (P = 0.09), respectively. The comparison between high-intensity back school and usual care resulted in a hazard ratio of 1.0 (P = 0.83). The median number of sick-leave days was 68, 75, and 85 in the low-intensity back school, usual care, and high-intensity back school, respectively. Beneficial effects on functional status and kinesiophobia were found at 3 months in favor of the low-intensity back school. No substantial differences on pain and perceived recovery were found between groups. CONCLUSIONS: The low-intensity back school was most effective in reducing work absence, functional disability, and kinesiophobia, and more workers in this group scored a higher perceived recovery during the 6-month follow-up.

Adult↗

PubMed2006

Daily spinal mechanical loading as a risk factor for acute non-specific low back pain: a case-control study using the 24-Hour Schedule.

A case-control study was conducted to assess the daily loading of the spine as a risk factor for acute non-specific low back pain (acute LBP). Acute LBP is a benign, self-limiting disease, with a recovery rate of 80-90% within 6 weeks irrespective of the treatment type. Unfortunately, recurrence rates are high. Therefore, prevention of acute LBP could be beneficial. The 24-Hour Schedule (24HS) is a questionnaire developed to quantify physical spinal loading, which is regarded as a potential and modifiable risk factor for acute and recurrent low back pain. A total of 100 cases with acute LBP and 100 controls from a primary care setting were included. Cases and controls completed questionnaires regarding acute LBP status and potential risk factors. Trained examiners blinded to subjects' disease status (acute LBP or not) assessed spinal loading using the 24HS. The mean difference of 24HS sum-scores between groups was statistically significant (P < 0.0001). After multivariate regression analysis, previous episode(s), the 24HS and the Nottingham Health Profile were associated with the presence of acute LBP. High 24HS scores, indicating longer and more intensive spinal loading in flexed position, are strongly associated with acute LBP.

Adolescent↗

PubMed2006

The effect of Tai Chi Chuan in reducing falls among elderly people: design of a randomized clinical trial in the Netherlands [ISRCTN98840266].

BACKGROUND: Falls are a significant public health problem. Thirty to fifty percent of the elderly of 65 years and older fall each year. Falls are the most common type of accident in this age group and can result in fractures and subsequent disabilities, increased fear of falling, social isolation, decreased mobility, and even an increased mortality. Several forms of exercise have been associated with a reduced risk of falling and with a wide range of physiological as well as psychosocial health benefits. Tai Chi Chuan seems to be the most promising form of exercise in the elderly, but the evidence is still controversial. In this article the design of a randomized clinical trial is presented. The trial evaluates the effect of Tai Chi Chuan on fall prevention and physical and psychological function in older adults. METHODS/DESIGN: 270 people of seventy years and older living at home will be identified in the files of the participating general practitioners. People will be asked to participate when meeting the following inclusion criteria: have experienced a fall in the preceding year or suffer from two of the following risk factors: disturbed balance, mobility problems, dizziness, or the use of benzodiazepines or diuretics. People will be randomly allocated to either the Tai Chi Chuan group (13 weeks, twice a week) or the no treatment control group. The primary outcome measure is the number of new falls, measured with a diary. The secondary outcome measures are balance, fear of falling, blood pressure, heart rate, lung function parameters, physical activity, functional status, quality of life, mental health, use of walking devices, medication, use of health care services, adjustments to the house, severity of fall incidents and subsequent injuries. Process parameters will be measured to evaluate the Tai Chi Chuan intervention. A cost-effectiveness analysis will be carried out alongside the evaluation of the clinical results. Follow-up measurements will be collected at 3, 6 and 12 months after randomization. DISCUSSION: As far as we know this is the first trial in Europe considering Tai Chi Chuan and fall prevention. This project will answer a pragmatic research question regarding the efficacy of Tai Chi Chuan regarding fall reduction.

Accidental Falls↗

PubMed2006

Increasing incidence of skin disorders in children? A comparison between 1987 and 2001.

BACKGROUND: The increasing proportion of skin diseases encountered in general practice represents a substantial part of morbidity in children. Only limited information is available about the frequency of specific skin diseases. We aimed to compare incidence rates of skin diseases in children in general practice between 1987 and 2001. METHODS: We used data on all children aged 0-17 years derived from two consecutive surveys performed in Dutch general practice in 1987 and 2001. Both surveys concerned a longitudinal registration of GP consultations over 12 months. Each disease episode was coded according to the International Classification of Primary Care. Incidence rates of separate skin diseases were calculated by dividing all new episodes for each distinct ICPC code by the average study population at risk. Data were stratified for socio-demographic characteristics. RESULTS: The incidence rate of all skin diseases combined in general practice decreased between 1987 and 2001. Among infants the incidence rate increased. Girls presented more skin diseases to the GP. In the southern part of the Netherlands children consulted their GP more often for skin diseases compared to the northern part. Children of non-Western immigrants presented relatively more skin diseases to the GP. In general practice incidence rates of specific skin diseases such as impetigo, dermatophytosis and atopic dermatitis increased in 2001, whereas warts, contact dermatitis and skin injuries decreased. CONCLUSION: The overall incidence rate of all skin diseases combined in general practice decreased whereas the incidence rates of bacterial, mycotic and atopic skin diseases increased.

Adolescent↗

PubMed2006

The PEX study - Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749].

BACKGROUND: Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome. Exercise therapy is also often prescribed although evidence on effectiveness is lacking. The objective of this article is to present the design of a randomized clinical trial that examines the outcome of exercise therapy supervised by a physical therapist versus a clinically accepted "wait and see" approach (information and advice about the complaints only). The research will address to both effectiveness and cost effectiveness of supervised exercise therapy in patients with patellofemoral pain syndrome (PFPS). METHODS/DESIGN: 136 patients (adolescents and young adults) with patellofemoral pain syndrome are recruited in general practices and sport medicine centers. They will be randomly allocated receiving either 3 months of exercise therapy (or usual care. The primary outcome measures are pain, knee function and perception of recovery after 3 months and 12 months of follow up and will be measured by self reporting. Measurements will take place at baseline, 6 weeks, and 3 monthly until 1 year after inclusion in the study. Secondary outcome measurements include an economic evaluation.A cost-utility analysis will be performed that expresses health improvements in Quality Adjusted Life Years (QALYs) and incorporates direct medical costs and productivity costs DISCUSSION: This study has been designed after reviewing the literature on exercise therapy for patellofemoral pain syndrome. It was concluded that to merit the effect of exercise therapy a trial based on correct methodological concept needed to be executed. The PEX study is a randomized clinical trial where exercise therapy is compared to usual care. This trial started in April 2005 and will finish in June 2007. The first results will be available around December 2007.

Adolescent↗

PubMed2006

Chronic non-specific abdominal complaints in general practice: a prospective study on management, patient health status and course of complaints.

BACKGROUND: While in general practice chronic non-specific abdominal complaints are common, there is insufficient data on the clinical course and the management of these complaints. Aim of this study was to present a primary care based profile of these chronic complaints including health care involvement, health status and clinical course. METHODS: Thirty general practitioners (GPs) and patients from their practices participated in a prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 6, 12 and 18 months of follow-up. The GPs provided information on diagnostic and therapeutic management and on referral concerning 619 patients with chronic non-specific abdominal complaints, while 291 patients provided information about health status and clinical course of the complaints. RESULTS: When asked after 18 months of follow-up, 51,7% of the patients reported an equal or worsened severity of complaints. General health perception was impaired and patients had high scores on SCL-anxiety and SCL-depression scales. Diagnostic tests other than physical examination and laboratory tests were not frequently used. Medication was the most frequent type of treatment. The persistence of chronic non-specific abdominal complaints was quite stable. CONCLUSION: Once non-specific chronic abdominal complaints have become labelled as chronic by the attending physician, little improvement can be expected. The impact on patients' physiological and psychological well-being is large. GPs use a variety of diagnostic and therapeutic strategies. Research into the evidence base of currently applied management strategies is recommended.

Abdominal Pain↗

PubMed2006

Follow-up of occult bone lesions detected at MR imaging: systematic review.

PURPOSE: To perform a systematic review of the literature regarding the natural course of posttraumatic occult bone lesions (often referred to as bone bruises) detected at magnetic resonance (MR) imaging. MATERIALS AND METHODS: A systematic review of the literature was performed by searching the MEDLINE database (from January 1966 to February 2003) with the keywords bone bruise, trauma, follow-up, and MRI. Keywords were linked by using the Boolean operator AND. Studies were included if all of the following criteria were fulfilled: patients sustained trauma, MR imaging was used as a diagnostic method, results of clinical or MR imaging follow-up were available, and study was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and kappa statistics were estimated to rate the level of agreement between the two reviewers. Results were compared with regard to study design and quality scores. RESULTS: The MEDLINE search identified 266 articles, 13 of which met the inclusion criteria. The quality of the included studies was moderate. The two reviewers initially agreed on 179 quality items (kappa = 0.84). The study population was generally small, and follow-up periods ranged from 1 to 73 months. Four different classification systems were used, and in two studies bone bruise was not specified. Study results suggest a generally good clinical prognosis of bone bruises. Normalization of MR imaging appearance is possible and is most often encountered after the occurrence of reticular lesions. Cartilage loss at follow-up is often found in cases of initial cartilage damage (impaction or osteochondral fracture). CONCLUSION: In general, a healing response was often encountered after sustained posttraumatic occult bone lesions. The initial MR imaging appearance appears to have prognostic value.

Ankle Injuries↗

PubMed2006

Follow-up of posttraumatic ligamentous and meniscal knee lesions detected at MR imaging: systematic review.

PURPOSE: To perform a systematic review of the literature regarding the natural course of ligamentous and meniscal knee lesions detected at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The MEDLINE database was searched from January 1966 to February 2003. Studies were included if all of the following criteria were met: patients had collateral ligament, cruciate ligament, or meniscal lesions; MR imaging was performed in all patients; study included a group and/or subgroup of patients who underwent conservative treatment during follow-up; patients returned to the clinic for follow-up and clinical data or MR imaging outcomes were noted; and article was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and kappa statistics were used to grade the level of agreement between the two reviewers. Studies with quality scores of 8 or more were designated as high quality. Results were compared with regard to study design and quality scores. RESULTS: The literature search identified 649 articles, and 11 studies (five on posterior cruciate ligament [PCL] injuries, five on anterior cruciate ligament [ACL] injuries, and one on meniscal injuries) met the inclusion criteria. No studies on the follow-up of collateral ligament injuries were identified. Four studies were of high quality, and the kappa value for quality items was 0.80. Between 77% and 93% of the partial or complete PCL ruptures regained continuity. In cases of partial or total ACL rupture, repair of continuity was also possible. A possible association between MR imaging continuity and clinical stability was identified. CONCLUSION: The ACL and PCL can regain continuity after partial or complete rupture. On the basis of this review, no conclusions can be drawn about the natural course of meniscal or collateral ligament injury seen at MR imaging.

Anterior Cruciate Ligament Injuries↗

PubMed2006

Incidence and prevalence of upper-extremity musculoskeletal disorders. A systematic appraisal of the literature.

BACKGROUND: A systematic appraisal of the worldwide incidence and prevalence rates of UEDs available in scientific literature was executed to gauge the range of these estimates in various countries and to determine whether the rates are increasing in time. METHODS: Studies that recruited at least 500 people, collected data by using questionnaires, interviews and/or physical examinations, and reported incidence or prevalence rates of the whole upper-extremity including neck, were included. RESULTS: No studies were found with regard to the incidence of UEDs and 13 studies that reported prevalence rates of UEDs were included. The point prevalence ranged from 1.6-53%; the 12-months prevalence ranged from 2.3-41%. One study reported on the lifetime prevalence (29%). We did not find evidence of a clear increasing or decreasing pattern over time. The case definitions for UEDs used in the studies, differed enormously. Therefore, it was not possible to pool the data. CONCLUSION: There are substantial differences in reported prevalence rates on UEDs. Main reason for this is the absence of a universally accepted way of labelling or defining UEDs. If we want to make progress in this field, the first requirement is to agree on unambiguous terminology and classification of EUDs.

Arm↗