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Biomedical subjects

L Bouter

Publications and source records attributed to L Bouter.

7 recordsLinked to original sources
PubMed2001

Efficacy of spinal manipulation for chronic headache: a systematic review.

BACKGROUND: Chronic headache is a prevalent condition with substantial socioeconomic impact. Complementary or alternative therapies are increasingly being used by patients to treat headache pain, and spinal manipulative therapy (SMT) is among the most common of these. OBJECTIVE: To assess the efficacy/effectiveness of SMT for chronic headache through a systematic review of randomized clinical trials. STUDY SELECTION: Randomized clinical trials on chronic headache (tension, migraine and cervicogenic) were included in the review if they compared SMT with other interventions or placebo. The trials had to have at least 1 patient-rated outcome measure such as pain severity, frequency, duration, improvement, use of analgesics, disability, or quality of life. Studies were identified through a comprehensive search of MEDLINE (1966-1998) and EMBASE (1974-1998). Additionally, all available data from the Cumulative Index of Nursing and Allied Health Literature, the Chiropractic Research Archives Collection, and the Manual, Alternative, and Natural Therapies Information System were used, as well as material gathered through the citation tracking, and hand searching of non-indexed chiropractic, osteopathic, and manual medicine journals. DATA EXTRACTION: Information about outcome measures, interventions and effect sizes was used to evaluate treatment efficacy. Levels of evidence were determined by a classification system incorporating study validity and statistical significance of study results. Two authors independently extracted data and performed methodological scoring of selected trials. DATA SYNTHESIS: Nine trials involving 683 patients with chronic headache were included. The methodological quality (validity) scores ranged from 21 to 87 (100-point scale). The trials were too heterogeneous in terms of patient clinical characteristic, control groups, and outcome measures to warrant statistical pooling. Based on predefined criteria, there is moderate evidence that SMT has short-term efficacy similar to amitriptyline in the prophylactic treatment of chronic tension-type headache and migraine. SMT does not appear to improve outcomes when added to soft-tissue massage for episodic tension-type headache. There is moderate evidence that SMT is more efficacious than massage for cervicogenic headache. Sensitivity analyses showed that the results and the overall study conclusions remained the same even when substantial changes in the prespecified assumptions/rules regarding the evidence determination were applied. CONCLUSIONS: SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache. This conclusion rests upon a few trials of adequate methodological quality. Before any firm conclusions can be drawn, further testing should be done in rigorously designed, executed, and analyzed trials with follow-up periods of sufficient length.

Chiropractic↗
PubMed1999

Identification and priority setting for health technology assessment in The Netherlands: actors and activities.

This article describes the actual situation at the beginning of 1999 with regard to identification and priority setting for health technology assessment (HTA) on a national level in the Netherlands. For this purpose the literature on HTA published in 1980-1998, mainly national, was thoroughly reviewed. Many policy documents and other reports from the 'grey literature' of identification and priority setting for HTA in the Netherlands were also used. The results show that attempts to identify and set priorities for HTA is a new activity in the Netherlands. The three most important actors in the field are the Health Council, the Council for Health Research and the Health Insurance Council. Methodologies differ depending on the content and scope of each programme. In addition, the methods used are not always transparent and the activities are not co-ordinated. The lack of co-ordination is due to the fact that there is no single organisation that is authorized to identify and set priorities for HTA. Suggestions for improving co-ordination are proposed with the aim of developing a truly national effort in this field, which will enable a more balanced and efficient set of HTA activities.

Decision Making, Organizational↗
PubMed1999

The management of chronic neck pain in general practice. A retrospective study.

OBJECTIVE: To describe the management in patients with chronic non-specific neck pain in general practice. DESIGN: A descriptive, questionnaire-based retrospective study. SETTING: General practices in the Netherlands. PATIENTS: 517 patients with chronic non-specific neck pain. MAIN OUTCOME MEASURES: Nature and frequency of diagnostic procedures, therapeutic interventions and referrals by the general practitioner (GP). RESULTS: Forty-four per cent visited the GP for neck pain in the previous year. Of the patients who did visit the GP in the previous year, 32% did not receive a diagnostic modality, 31% did not receive therapy and 43% were not referred. The most frequently applied diagnostic and therapeutic modalities were physical examination (66%) and pain medication (58%), respectively. The GPs most frequently referred to a physiotherapist (51%). CONCLUSION: Once neck pain has become chronic, the minority (44%) of patients do seek help from their GP on a yearly base. In spite of the fact that the patients' conditions are non-specific and chronic, GPs still find indications for further diagnostics in two-thirds of patients. The GPs were rather consistent in their management, as the nature of the diagnostic/therapeutic modalities and referrals was similar in more than 50% of the patients.

Adolescent↗
PubMed1998

The use of societal criteria in priority setting for health technology assessment in The Netherlands. Initial experiences and future challenges.

Priority setting for the evaluation of health technologies in the Netherlands is exclusively based on the scientific merits of individual research proposals. This process has not resulted in satisfactory allocation of resources. Therefore, societal criteria for setting priorities for health technology assessment have been proposed as an adjunct to scientific criteria. These societal criteria include the burden of disease, uncertainty about the (cost-)effectiveness of the intervention at issue, the potential benefits of the research project, and its potential impact on health care. To realize the full potential of this model for priority setting, a number of methodological issues need to be addressed. Joint efforts of researchers and policy makers in this field are necessary for future progress.

Health Care Rationing↗
PubMed1990

Assessing the economic burden of injuries due to accidents: methodological problems illustrated with some examples from the literature.

This paper provides a survey of methodological problems encountered in an assessment of the economic consequences of accidents in The Netherlands. A sound epidemiological basis for such calculations appears to be lacking due to inadequate data-registration systems. We also discuss some studies of the economic costs of injuries due to accidents for other countries, which have used either a prevalence or an incidence-based approach. It is highlighted that they may be helpful in indicating the relative economic burden posed on society but that they cannot guide priority setting in health care resource allocation. Economic evaluation studies using incidence-based scenario comparisons may be more promising in that respect.

Accidents↗
PubMed1984

Active and passive coping under different degrees of stress; effects on urinary and plasma catecholamines and ECG T-wave.

Cardiac sympathetic, urinary and plasma catecholamine effects of active and passive coping were investigated during both low and high stress. Stress intensity was manipulated by varying the work load on a bicycle ergometer. As predicted, T-wave flattening of the ECG - an index of cardiac sympathetic activity - was significantly more pronounced during active coping than during passive coping. This effect did not depend upon the degree of stress. A significant increase in both adrenaline and noradrenaline levels depended upon the combined effects of active coping and high stress. Because high concentrations of circulating catecholamines are thought to be related to cardiovascular pathology, the results suggest that active coping during high stress might involve the highest cardiovascular risks.

Adult↗