Biomedical subjects

H C de Vet

Publications and source records attributed to H C de Vet.

At least 19 recordsLinked to original sources

PubMed2002

Rehabilitation after lumbar disc surgery.

BACKGROUND: Although several rehabilitation programs, physical fitness programs or protocols regarding instruction for patients to return to work after lumbar disc surgery have been suggested, little is known about the efficacy and effectiveness of these treatments. There are still persistent fears of causing re-injury, re-herniation, or instability. OBJECTIVES: The objective of this systematic review was to evaluate the effectiveness of active treatments that are used in the rehabilitation after first-time lumbar disc surgery. SEARCH STRATEGY: We searched the MEDLINE, EMBASE and Psyclit databases up to April 2000 and the Cochrane Controlled Trials Register 2001, Issue 3. SELECTION CRITERIA: Both randomized and non-randomized controlled trials on any type of active rehabilitation program after first-time disc surgery were included. DATA COLLECTION AND ANALYSIS: Two independent reviewers performed the inclusion of studies and two other reviewers independently performed the methodological quality assessment. A rating system that consists of four levels of scientific evidence summarizes the results. MAIN RESULTS: Thirteen studies were included, six of which were of high quality. There is no strong evidence for the effectiveness for any treatment starting immediately post-surgery, mainly because of lack of (good quality) studies. For treatments that start four to six weeks post-surgery there is strong evidence (level 1) that intensive exercise programs are more effective on functional status and faster return to work (short-term follow-up) as compared to mild exercise programs and there is strong evidence (level 1) that on long term follow up there is no difference between intensive exercise programs and mild exercise programs with regard to overall improvement. For all other primary outcome measures for the comparison between intensive and mild exercise programs there is conflicting evidence (level 3) with regard to long-term follow-up. Furthermore, there is no strong evidence for the effectiveness of supervised training as compared to home exercises. There was also no strong evidence for the effectiveness of multidisciplinary rehabilitation as compared to usual care. There is limited evidence (level 3) that treatments in working populations that aim at return to work are more effective than usual care with regard to return to work. Also, there is limited evidence (level 3) that low-tech and high-tech exercises, started more than 12 months post-surgery are more effective in improving low back functional status as compared to physical agents, joint manipulations or no treatment. Finally, there is no strong evidence for the effectiveness of any specific intervention when added to an exercise program, regardless of whether exercise programs start immediately post-surgery or later. None of the investigated treatments seem harmful with regard to re-herniation or re-operation. REVIEWER'S CONCLUSIONS: There is no evidence that patients need to have their activities restricted after first time lumbar disc surgery. There is strong evidence for intensive exercise programs (at least if started about 4-6 weeks post-operative) on short term for functional status and faster return to work and there is no evidence they increase the re-operation rate. It is unclear what the exact content of post-surgery rehabilitation should be. Moreover, there are no studies that investigated whether active rehabilitation programs should start immediately post-surgery or possibly four to six weeks later.

Exercise Therapy↗

PubMed2001

Splinting or surgery for carpal tunnel syndrome? Design of a randomized controlled trial [ISRCTN18853827].

BACKGROUND: Carpal tunnel syndrome is a common disorder, which can be treated with surgery or conservative options. However, there is insufficient evidence and no consensus among physicians with regard to the preferred treatment for carpal tunnel syndrome. Therefore, a randomized controlled trial is conducted to compare the short- and long-term efficacy of surgery and splinting in patients with carpal tunnel syndrome. An attempt is also made to avoid the (methodological) limitations encountered in earlier trials on the efficacy of various treatment options for carpal tunnel syndrome. METHODS: Patients of 18 years and older, with clinically and electrophysiologically confirmed idiopathic carpal tunnel syndrome, are recruited by neurologists in 13 hospitals. Patients included in the study are randomly allocated to either open carpal tunnel release or wrist splinting during the night for at least 6 weeks. The primary outcomes are general improvement, waking up at night and severity of symptoms (main complaint, night and daytime pain, paraesthesia and hypoesthesia). Outcomes are assessed up to 18 months after randomization.

Carpal Tunnel Syndrome↗

PubMed2001

The art of quality assessment of RCTs included in systematic reviews.

The best evidence on the efficacy of medical interventions is provided by high-quality trials summarized in high-quality systematic reviews or meta-analyses. The methodological quality of studies included in a systematic review can have a substantial impact on the estimates of the treatment effect and therefore on the conclusions of such a review. But what is the empirical evidence to support quality assessment of randomized clinical trials (RCTs)? We elaborate on questions such as: what is the concept of quality of individual studies (RCTs), can quality be measured validly and reliably? Plans for future research on this issue are proposed.

Humans↗

PubMed2001

A method for research programming in the field of evidence-based medicine.

OBJECTIVE: This paper presents the method we used in programming research on the efficacy of therapeutic interventions for nine chronic benign pain disorders. METHODS: We started with an inventory to identify commonly applied interventions. For these interventions we searched the literature to identify gaps in evidence. First, we searched for recent reviews, of which we assessed the methodologic quality. If only reviews of poor or moderate quality were found, a new systematic review was recommended. When we found no recent reviews, we searched for randomized controlled trials (RCTs). If there was insufficient or inconsistent evidence, the performance of a new RCT was advised. This structured procedure resulted in a list with topics for which new systematic reviews were recommended and topics for which new RCTs were needed. These lists were the starting points for priority setting by four Centers for Pain Management and Research. All members of the centers were asked to state the priority of each topic. The resulting hierarchy of topics for their own center was discussed in a meeting in each center, giving participants the opportunity to elucidate their views and considerations. RESULTS: The final result was a robust priority list for the need of research (systematic reviews and RCTs) on chronic benign pain syndromes. DISCUSSION: The strength and weaknesses of this approach are discussed. This method of priority setting is by no means restricted to treatments for chronic pain; it is also a useful approach for programming research to enable evidence-based medicine in other fields of interest.

Decision Making, Organizational↗

PubMed2001

Systematic reviews of diagnostic research. Considerations about assessment and incorporation of methodological quality.

The aim of this paper is to provide a theoretical background for performing and reading systematic reviews of diagnostic studies. We first discuss items for assessment of methodological quality in diagnostic studies and then present methods on how to incorporate these quality measures in systematic reviews. The items of internal validity determine whether the presented results of the individual studies are unbiased and can be trusted. Items of external validity determine to what extent the results are applicable outside the population in which the study was performed. The issues concern the adequacy of the study population, the performance and interpretation of the diagnostic tests and the presentation of the results. Several methods exist for incorporation of issues of methodological quality into systematic reviews, such as subgroup analyses, meta-regression analysis, and methodological scores. Publications of diagnostic studies should provide sufficient information to enable assessment of the methodological quality. Furthermore, publication of results of subgroup analyses should be promoted. Methodological criteria lists might help to improve the quality of systematic reviews of diagnostic research. With the items of methodological quality in mind the general practitioner might be better equipped to critically read and interpret diagnostic reviews.

Epidemiologic Studies↗

PubMed2001

Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common disorder for which several surgical treatment options are available. However, there is no consensus on the most effective method of treatment. The object of this systematic review is to compare the efficacy of the various surgical techniques in relieving the symptoms of CTS and promoting return to work and/or activities of daily living. METHODS: Computer-aided searches of Medline, EMBASE and the Cochrane Controlled Trials Register were conducted, together with reference checking. A rating system, based on the number of studies and their methodological quality and findings, was used to determine the strength of the available evidence for the efficacy of the treatment. RESULTS: Fourteen studies were included in the review. None of the alternatives to standard open carpal tunnel release (OCTR) seems to offer better relief of symptoms. There is conflicting evidence about whether endoscopic carpal tunnel release results in earlier return to work and/or activities of daily living. CONCLUSION: Standard OCTR is still the preferred method of treatment for CTS. It is just as effective as the alternatives, but is technically less demanding, so incurs a lower risk of complications and of added costs.

Carpal Tunnel Syndrome↗

PubMed2001

The results of spinal cord stimulation in critical limb ischaemia: a review.

OBJECTIVES: to determine which patients with unreconstructible critical limb ischaemia (CLI) might benefit from spinal cord stimulation (SCS). METHODS: literature review. RESULTS: limb salvage in patients with an intermediate transcutaneous oxygen pressure (TcpO2) was not significantly higher with SCS (76%) than with conservative therapy (p=0.08). However, a limb salvage of 88% was achieved with SCS if the difference between the supine and sitting TcpO2 baseline values (DeltaTcpO2) was > or =15 mmHg. A rise in TcpO2 after trial stimulation of at least 15% resulted in a limb salvage of 77% at 18 months (p<0.01). CONCLUSION: randomised studies show no benefit of SCS over conservative therapy in patients with non-reconstructible CLI. However, data from experimental and non-randomised studies suggest this may be due to sub-optimal patient selection for SCS. Further trials are needed to identify subgroups who may benefit from SCS.

Algorithms↗

PubMed2001

Which patients with chronic reflex sympathetic dystrophy are most likely to benefit from physical therapy?

BACKGROUND: Chronic reflex sympathetic dystrophy (RSD) is a painful and disabling disorder for which no treatment with proven effects exists. Physical therapy (PT) has been demonstrated to be effective for recently diagnosed RSD, but its value in chronic RSD has not yet been studied. OBJECTIVE: To find predictors for successful use of PT in RSD with regard to (1) function, strength, and mobility and (2) patient satisfaction. SUBJECTS: Fifty-four patients with chronic RSD, age range 21 to 65 years. METHODS: All patients were treated in accordance with a standardized PT protocol for at least 6 months. The effects of treatment (functional status, strength, range of motion) and patient satisfaction measures (grade for result, would repeat, global effect) were evaluated at 12 months. Subgroup analyses were performed to find predictors for success of PT. RESULTS: The subgroup analyses revealed that patients with better baseline function (especially of the hands) obtained better results and greater satisfaction. Greater satisfaction was also associated with less baseline pain and higher baseline range of motion and strength (of leg) values. In general, PT did not show large improvements on effect measures, and the patients' mean grade for the result was 3.8 (on a 10-point scale). CONCLUSIONS: In overall terms, PT did not influence functional parameters or give satisfaction to patients with chronic RSD in this study. A randomized trial is required to prove or exclude the actual value of PT for these patients.

Adult↗

PubMed2001

Impact of spinal cord stimulation on sensory characteristics in complex regional pain syndrome type I: a randomized trial.

BACKGROUND: A randomized trial was performed to assess the effect of spinal cord stimulation (SCS) on detection and pain thresholds for pressure, warmth, and cold and on the extent of mechanical hyperalgesia in patients with chronic complex regional pain syndrome type I. METHODS: Fifty-four chronic complex regional pain syndrome type I patients were randomized to receive both SCS and physical therapy (SCS+PT; n = 36), or to receive only physical therapy (PT; n = 18). Twenty-four SCS+PT patients responded positively to trial stimulation and underwent SCS implantation. During a 12-month follow-up period, six quantitative sensory testing sessions were performed. The main analysis compared 24 SCS patients with 29 nonimplanted patients--one PT patient was excluded. RESULTS: SCS showed no effect on detection thresholds for warmth and cold or on pain thresholds for any sensation. The pressure detection threshold initially increased by SCS, but after 3 months, pressure detection thresholds returned to normal. Mechanical hyperalgesia, both dynamic and static, was reduced slightly with SCS. CONCLUSIONS: Although SCS has previously been shown to cause a significant pain reduction in complex regional pain syndrome type I, the treatment has no long-term effect on detection and pain thresholds for pressure, warmth, or cold. The treatment seems to have only minimal influence on mechanical hyperalgesia.

Adolescent↗

PubMed2001

Psychosocial work characteristics and psychological strain in relation to low-back pain.

OBJECTIVES: This study investigated the relationship between psychosocial work characteristics and low-back pain and the potential intermediate role of psychological strain variables in this relationship. METHODS: The research was part of a prospective cohort study of risk factors for musculoskeletal symptoms. The study population consisted of 861 workers from 34 companies in The Netherlands who had no low-back pain at baseline and for whom data on the occurrence of low-back pain were obtained with annual questionnaires during a 3-year follow-up period. Information on psychosocial work characteristics and psychological strain variables was collected using a questionnaire at baseline. Cases of low-back pain were defined as workers who reported, in at least one of the annual follow-up questionnaires, that they had had regular or prolonged low-back pain in the previous 12 months. RESULTS: After adjustment for individual factors and quantified physical load at work, nonsignificant relative risks ranging from 1.3 to 1.6 were observed for high quantitative job demands, high conflicting demands, low supervisory support, and low co-worker support. Decision authority and skill discretion showed no relationship with low-back pain. In general, the estimated relative risks for the psychosocial work characteristics were scarcely influenced by additional adjustment for job satisfaction, emotional exhaustion, and sleeping difficulties. CONCLUSIONS: It can be concluded that low social support, from either supervisors or co-workers, appears to be a risk factor for low-back pain. Some indications of a relationship between high quantitative job demands and high conflicting demands and low-back pain were also found. Little evidence was found for an intermediate role for the psychological strain variables under study.

Cohort Studies↗

PubMed2001

Conservative treatment for repetitive strain injury.

Various conservative treatment options for repetitive strain injury are widely used, despite questionable evidence of their effectiveness. This systematic review evaluates the effectiveness of these treatment options for relieving symptoms of repetitive strain injury and improving activities of daily living. Searches in Medline and Embase, with additional reference checking resulted in 15 eligible trials for this review. Methodological quality was assessed, and data-extraction was performed. With the use of a "best-evidence synthesis", no strong evidence was found for the effectiveness of any of the treatment options. There is limited evidence that multidisciplinary rehabilitation, ergonomic intervention measures, exercises, and spinal manipulation combined with soft tissue therapy are effective in providing symptom relief or improving activities of daily living. There is conflicting evidence for the effectiveness of behavioral therapy. In conclusion, little is known about the effectiveness of conservative treatment options for repetitive strain injury. To establish strong evidence, more high-quality trials are needed.

Behavior Therapy↗

PubMed2001

Reproducibility and responsiveness of evaluative outcome measures. Theoretical considerations illustrated by an empirical example.

OBJECTIVE: This article outlines basic methods for quantifying reproducibility and responsiveness of evaluative outcome measures. METHODS: The background noise in stable patients provides the desired information to quantify the reproducibility. From this, the smallest real difference (SRD) for longitudinal differences can be derived. We propose to use the SRD to define responsiveness: from all patients who change according to an external criterion, we take the percentage that changes at least SRD on the outcome measure. A more complete picture of the responsiveness of the outcome measure arises when the receiver operating characteristic (ROC) is constructed, corresponding to all possible cut-off change scores. The proposed methods are illustrated with an empirical example. RESULTS: In the illustration the methods appeared to be very useful and complemented each other. We could evaluate whether the observed change score was larger than that expected due to chance. With the methods it was possible to evaluate both the ability of an instrument to detect change if there is a real change in health status (sensitivity to change) and the ability to detect absence of change if there is no real change (specificity to change). CONCLUSION: We presented the use of SRDs and ROC curves for quantifying reproducibility and responsiveness. We started with the basic notions and arrived at methods that are both understandable and useful.

Health Status Indicators↗

PubMed2000

Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: results of a prospective cohort study.

STUDY DESIGN: A 3-year prospective cohort study among workers of 34 companies in the Netherlands. OBJECTIVES: To investigate the relation between flexion and rotation of the trunk and lifting at work and the occurrence of low back pain. SUMMARY OF BACKGROUND DATA: Previous studies on work-related physical risk factors for low back pain either lacked quantification of the physical load or did not take confounding by individual and psychosocial factors into account. METHODS: The study population consisted of 861 workers with no low back pain at baseline and complete data on the occurrence of low back pain during the 3-year follow-up period. Physical load at work was assessed by means of analyses of video-recordings. Information on other risk factors and the occurrence of low back pain was obtained by means of self-administered questionnaires. RESULTS: An increased risk of low back pain was observed for workers who worked with the trunk in a minimum of 60 degrees of flexion for more than 5% of the working time (RR 1.5, 95% CI 1.0-2.1), for workers who worked with the trunk in a minimum of 30 degrees of rotation for more than 10% of the working time (RR 1.3, 95% CI 0.9-1. 9), and for workers who lifted a load of at least 25 kg more than 15 times per working day (RR 1.6, 95% CI 1.1-2.3). CONCLUSIONS: Flexion and rotation of the trunk and lifting at work are moderate risk factors for low back pain, especially at greater levels of exposure.

Adult↗

PubMed2000

Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy.

BACKGROUND: Chronic reflex sympathetic dystrophy (also called the complex regional pain syndrome) is a painful, disabling disorder for which there is no proven treatment. In observational studies, spinal cord stimulation has reduced the pain associated with the disorder. METHODS: We performed a randomized trial involving patients who had had reflex sympathetic dystrophy for at least six months. Thirty-six patients were assigned to receive treatment with spinal cord stimulation plus physical therapy, and 18 were assigned to receive physical therapy alone. The spinal cord stimulator was implanted only if a test stimulation was successful. We assessed the intensity of pain (on a visual-analogue scale from 0 cm [no pain] to 10 cm [very severe pain]), the global perceived effect (on a scale from 1 [worst ever] to 7 [best ever]), functional status, and the health-related quality of life. RESULTS: The test stimulation of the spinal cord was successful in 24 patients; the other 12 patients did not receive implanted stimulators. In an intention-to-treat analysis, the group assigned to receive spinal cord stimulation plus physical therapy had a mean reduction of 2.4 cm in the intensity of pain at six months, as compared with an increase of 0.2 cm in the group assigned to receive physical therapy alone (P<0.001 for the comparison between the two groups). In addition, the proportion of patients with a score of 6 ("much improved") for the global perceived effect was much higher in the spinal cord stimulation group than in the control group (39 percent vs. 6 percent, P=0.01). There was no clinically important improvement in functional status. The health-related quality of life improved only in the 24 patients who actually underwent implantation of a spinal cord stimulator. Six of the 24 patients had complications that required additional procedures, including removal of the device in 1 patient. CONCLUSIONS: In carefully selected patients with chronic reflex sympathetic dystrophy, electrical stimulation of the spinal cord can reduce pain and improve the health-related quality of life.

Adult↗

PubMed2000

Increased D-dimer levels correlate with binding of activated protein C, but not tissue factor expression, on peripheral blood monocytes in cancer patients.

Monocyte tissue factor expression is supposed to play an important role in the hypercoagulability of blood in cancer patients. The relation between coagulation parameters and the expression of monocyte membrane proteins involved in hemostasis or monocyte activation was studied in 21 patients with a disseminated malignancy and 21 age- and sex-matched healthy controls. In the cancer patient group no increase of monocyte tissue factor expression was found (8. 4% vs. 7.8%; P = 0.83), but a significant increase of monocyte-bound activated protein C (APC) (28.8% vs. 13.4%; P = 0.009) and monocyte CD16 expression (34.5% vs. 27.0%; P = 0.007) was observed. There was also a significant increase of D-dimers (2.0 vs. 0.2 microg/ml; P = 0.001), a decrease of antithrombin (83.5% vs. 102.0%; P = 0.004), but no increase of TAT complexes (1.7 vs. 1.5 microg/l; P = 0.38) or factor VII(a) (68.5% vs. 75.0%; P = 0.52). The increase of D-dimers was significantly correlated with the monocyte APC (R = 0.60; P = 0. 005), but not with monocyte tissue factor levels (R = -0.22; P = 0. 35) or TAT complexes (R = 0.12; P = 0.60). These results reflect a local rather than systemic thrombin and fibrin formation. It is suggested that the APC formed locally enters the circulation and binds to peripheral blood monocytes. APC bound on monocytes is known to inhibit monocyte cytokine production and might therefore be involved in regulatory responses of monocytes in cancer patients.

Adolescent↗

PubMed2000

Balneotherapy for rheumatoid arthritis and osteoarthritis.

BACKGROUND: Balneotherapy (hydrotherapy or spa therapy) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain and as a consequence to relieve patients' suffering and make them feel well. OBJECTIVES: To perform a systematic review to assess the effects of balneotherapy for rheumatoid arthritis and osteoarthritis. SEARCH STRATEGY: Using the Cochrane search strategy, studies were found by screening: 1) The Medline CD-ROM database from 1966 to June 1999 and 2) the database from the Cochrane Field 'Rehabilitation and Related Therapies', which contains also studies published in journals not covered by Medline. Also, 3) reference checking and 4) personal communications with authors was carried out to retrieve eligible studies. To perform an adequate assessment of the methodological quality the languages of the publications had to be: Dutch, English, French or German. Date of the most recent literature search: June, 1999 SELECTION CRITERIA: Studies were eligible if they were randomized controlled trials (RCT) comparing balneotherapy with any intervention or with no intervention. Patients included had rheumatoid arthritis (RA), osteoarthritis (OA) or some other form of arthritis. Trials incorporating patients with definite or classical rheumatoid arthritis (RA) as defined by the American Rheumatism Association Criteria (ARA) (Ropes 1958) (these criteria have changed over time) or by the criteria of Steinbrocker (1949) were regarded as a separate group. At least one of the WHO/ILAR core set of endpoints for RA clinical trials had to be the main outcome measures. DATA COLLECTION AND ANALYSIS: A criteria list used to assess the methodological quality was the one developed at the Department of Epidemiology at the Maastricht University, called "the Maastricht list". The quality scores and data abstraction of the studies were carried out independently by two reviewers (HdV, RdB). Disagreements were solved by consensus. MAIN RESULTS: Ten trials with 607 patients were included in this review. Most trials reported positive findings, but were methodologically flawed to some extent. A 'quality of life' outcome was reported by two trials. Just one of the randomized trials mentioned an intention-to-treat analysis and only three performed a comparison of effects between groups. Pooling of the data was not performed, because of heterogeneity of the studies, multiple outcome measurements, and, apart from two studies, the overall data presentation was too scarce to enable pooling of the data. REVIEWER'S CONCLUSIONS: One cannot ignore the positive findings reported in most trials. However the scientific evidence is weak because of the poor methodological quality, the absence of an adequate statistical analysis, and the absence, for the patient, of most essential outcome measures (pain, quality of life), Therefore, the noted "positive findings" should be viewed with caution. Because of the methodological flaws an answer about the efficacy of balneotherapy cannot be provided at this time. Flaws found in the reviewed studies could be avoided in future trials.

Arthritis, Rheumatoid↗

PubMed2000

Injection therapy for subacute and chronic benign low back pain.

BACKGROUND: Injection with anaesthetics and/or steroids is one of the treatment modalities used in patients with chronic low back pain which needs evaluation with respect to the effectiveness on short and long term pain relief. OBJECTIVES: To evaluate the effectiveness of injection therapy in patients with low back pain lasting longer than one month. We distinguished between three injection sites: facet joint, epidural or local injections. SEARCH STRATEGY: We searched the Medline and Embase databases up to 1996 and other search methods as advocated by the Back Review Group search strategy. Abstracts and unpublished studies were not included. SELECTION CRITERIA: Randomized controlled trials of injection therapy for pain relief (although additional treatments were allowed) in patients with benign low back pain lasting longer than one month and not originating from cancer. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the trials for methodological quality. Subgroup analyses were made between trials with different control groups (placebo and active injections), with different injection site (facet joint, epidural and local injection), and timing of outcome measurement (short and long term). Within the resulting 12 subcategories of studies (2*3*2), the overall relative risks and corresponding 95% confidence intervals were estimated, using a random effects model (DerSimonian and Laird). In the case of trials in which control groups were active injections, we refrained from pooling the results. MAIN RESULTS: Twenty-one randomized trials were included in this review. All studies involved patients with low back pain lasting longer than one month. Only 11 studies compared injection therapy with placebo injections (explanatory trials). The methodologic quality of many studies was low: only 8 studies had a methodologic score of 50 or more points. There were only three well designed explanatory clinical trials: one on injections into the facet joints with a short-term RR of 0.89 (95% CI: 0.65-1.21) and a long-term RR of 0.90 (95% CI: 0.69-1.17); one on epidural injections with a short-term RR of 0.94 (95% CI: 0.76-1.15) and a long-term RR of 1.00 (95% CI: 0.71-1.41); and one on local injections with a long-term RR of 0.79 (95% CI: 0.65-0.96). Within the 6 subcategories of explanatory studies the pooled RRs with 95% confidence intervals were: facet joint, short-term: RR=0.89 (0.65-1.21); facet joint, long-term: RR=0.90 (0.69-1.17); epidural, short-term: RR=0.93 (0. 79-1.09); epidural, long-term: RR=0.92 (0.76-1.11); local, short-term: RR=0.80 (0.40-1.59); local, long-term: RR=0.79 (0.65-0. 96). REVIEWER'S CONCLUSIONS: Convincing evidence is lacking on the effects of injection therapies for low back pain. There is a need for more, well designed explanatory trials in this field.

Acute Disease↗

PubMed2000

Health-related quality of life in chronic refractory reflex sympathetic dystrophy (complex regional pain syndrome type I).

The aim of this study was to find out which aspects of health-related quality of life (HRQL), measured with generic instruments, are important to patients with reflex sympathetic dystrophy (RSD) affecting the arm or leg. The Sickness Impact Profile 68 (SIP68), the Nottingham Health Profile (NHP), and the EuroQol-5D (EQ-5D) were completed by 54 patients suffering from RSD (33 arm, 21 leg). The scores of the three questionnaires for patients with an affected arm or leg are presented. Aspects relevant to patients with RSD of the arm include the NHP1 dimensions of pain (mean score: 63%), sleep (58%), and energy (45%), and the EQ-5D dimensions of pain (67% extreme), usual activities (76% some problems), and self care (76% some problems). Aspects relevant to patients with RSD of the leg include the SIP68 dimensions of social behavior (51%) and mobility control (46%), the NHP 1 dimensions of pain (mean score: 86%), mobility (54%), energy (53%), and sleep (52%), and the EQ-5D dimensions of mobility (81% some problems), pain (71% extreme), and usual activities (71% some problems). The study showed that applying generic HRQL instruments and measuring treatment effect with the dimensions scoring high provides a responsive instrument which at the same time gains information concerning dimensions not maximally responsive to a specific disease. Some dimensions which, on the basis of their label, might be expected to be important were found not to be so. After using this approach, clinicians can more directly focus treatment on specific areas that have been shown to affect a patient's HRQL.

Adolescent↗