Biomedical subjects

Leendert Blankevoort

Publications and source records attributed to Leendert Blankevoort.

10 recordsLinked to original sources

PubMed2007

Perceptions and competence in evidence-based medicine: Are surgeons getting better? A questionnaire survey of members of the Dutch Orthopaedic Association.

BACKGROUND: The Journal of Bone and Joint Surgery, American Volume (The Journal) recently initiated a section called "Evidence-Based Orthopaedics." Furthermore, a level-of-evidence rating is now used in The Journal to help readers in clinical decision-making. Little is known about whether this recent emphasis has influenced surgeons' perceptions about and competence in evidence-based medicine. Therefore, we examined perceptions and competence in evidence-based medicine among Dutch orthopaedic surgeons. METHODS: Members of the Dutch Orthopaedic Association were surveyed to examine their attitudes toward evidence-based medicine and their competence in evidence-based medicine. We evaluated competences using a newly developed instrument tailored to surgical practice. RESULTS: Of the 611 members, 367 surgeons (60%) responded. Orthopaedic surgeons welcomed evidence-based medicine. Practical evidence-based medicine resources were perceived as the best method to move from opinion-based or experience-based to evidence-based practice. Four variables were significantly and positively associated with the competence instrument: (1) a younger age, particularly between thirty-six and forty-five years (p = 0.007), (2) experience of less than ten years (p = 0.032), (3) having a PhD degree (p < 0.001), and (4) working in an academic or teaching setting (p = 0.004). The majority of the respondents were aware of The Journal's evidence-based medicine section (84%) and level-of-evidence ratings (65%), and 20% used The Journal's evidence-based medicine abstracts in clinical decision-making. This increased awareness of evidence-based medicine was also reflected in the frequent use of Cochrane reviews in clinical decision-making (27% of the respondents). Surgeons who used and those who were aware of but did not use The Journal's evidence-based medicine abstracts or Cochrane reviews in clinical decision-making had significantly higher competence instrument scores than those who were unaware of these resources (p = 0.03 and p < 0.001, respectively). CONCLUSIONS: Evidence-based medicine is welcomed by Dutch orthopaedic surgeons. The recent emphasis on evidence-based medicine is reflected in an increased awareness about The Journal's evidence-based medicine section, levels of evidence, and the largest evidence-based medicine resource: the Cochrane reviews. Younger orthopaedic surgeons had better knowledge about evidence-based medicine. The development and use of evidence-based resources as well as preappraised summaries such as The Journal's evidence-based medicine abstracts and Cochrane reviews were perceived as the best way to move from opinion-based to evidence-based orthopaedic practice.

Adult↗

PubMed2006

Three-dimensional bone kinematics in an anterior laxity test of the ankle joint.

Questions addressed in this in-vitro study are (1) what are the actual three-dimensional kinematics of talus and calcaneus during an anterior drawer test as performed with the quasi-static anterior ankle tester (QAAT) (2) does laxity measurement with the QAAT represent the true anterior translation of talus relative to the tibia? Simultaneous measurements were made with the QAAT and a three-dimensional kinematics analysis system in five specimens. The three-dimensional translations and rotations on three axes were analysed at 25, 50 and 100 N of applied anterior load, with increased ligament damage. For four out of five remaining specimens, anterior translation values of talus and calcaneus and values as measured with the QAAT show a significant increase with growing ligament damage and with higher loads. Skeletal motions of talus and calcaneus show great similarity in three different motion axes, with increased ligament damage and at any given load. Skeletal translations and rotations of talus and calcaneus show great similarity during an anterior drawer movement of the ankle joint. Anterior skeletal translation of the talus and calcaneus show fair correlation with the anterior displacements measurements of the QAAT. These QAAT measurements show an overestimation of the laxity value by more than 200% irrespective of the load applied.

Aged↗

PubMed2006

Translation and validation of the Dutch version of the International Knee Documentation Committee Subjective Knee Form.

BACKGROUND: For knee-related surgery, there is a great demand for internationally useable subjective scoring systems. Before such measurements can be used, they should be translated and validated for the population they are used on. For the Dutch population, only the Western Ontario and McMaster Universities Osteoarthritis Index and Oxford 12 Questionnaire have been validated. However, these scores can only be used regarding osteoarthritis of the knee. In 2001, the International Knee Documentation Committee presented the Subjective Knee Form, which is a knee-specific rather than a disease-specific questionnaire. STUDY DESIGN: Cohort study (diagnosis/symptom prevalence); Level of evidence, 2. METHODS: The authors describe the translation procedure and validation of the Dutch Subjective Knee Form. After a forward-backward translation protocol, the reliability, validity, and content validity were tested. The responses of 145 consecutive knee patients on 2 questionnaires containing the Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford 12 Questionnaire score, a visual analog scale, and the Dutch International Knee Documentation Committee Subjective Knee Form were used. Reliability was tested by measuring the test-retest reliability and internal consistency. Validity was tested by correlating the questionnaire to the other outcome measurements, and content validity was tested by measuring the floor and ceiling effects. RESULTS: The reliability proved excellent with an intraclass coefficient of 0.96 for test-retest. Internal consistency was strong (Cronbach alpha, .92). The construct, convergent, and divergent validities were good. The content validity was good; no floor or ceiling effect occurred. CONCLUSION: The validation procedure shows that the Dutch International Knee Documentation Committee Subjective Knee Form is an excellent evaluation instrument for Dutch patients with knee-related injuries.

Adult↗

PubMed2005

Two ankle joint laxity testers: reliability and validity.

Two test devices were manufactured to objectively measure ankle joint laxity: the dynamic anterior ankle tester (DAAT) and the quasi-static anterior ankle tester (QAAT). The primary aim was to analyse the reliability of both testers; The secondary aim was to assess validity in correlation with TELOS stress test and manual anterior drawer test. Twenty-four normal subjects and 14 patients 1 year after acute lateral ankle ligament injury were included. Both ankles were tested with the DAAT and QAAT by two different observers; one experienced orthopaedic surgeon performed the manual test; the TELOS stress X-rays were evaluated by one observer. Intra observer reliability for the DAAT varied between 0.81 and 0.94; for the QAAT between 0.71 and 0.94. Inter observer reliability for the DAAT varied between 0.84 and 0.94; for the QAAT between 0.76 and 0.82. Concurrent validity showed fair correlation between DAAT and QAAT for the first couple observers (0.71); however, a poor correlation was observed for the second couple (0.42). No significant correlations were found between neither DAAT and the TELOS and the manual test, nor QAAT and the TELOS and the manual test. In conclusion, reliability of both testers is high. Validity of the testers needs further investigation.

Adult↗

PubMed2005

Co-contraction during static and dynamic knee extensions in ACL deficient subjects.

Co-contraction of the muscles is proposed in the literature as one of the strategies that anterior cruciate ligament deficient (ACLD) subjects can use to compensate the loss of ACL function. This study examined the response of ACLD and control subjects to different shear forces in isometric and slow-dynamic knee extensions. Twelve chronic ACLD and 10 control subjects performed submaximal positioning and slow-dynamic knee extensions (between 45 degrees and 5 degrees of knee flexion) with two external flexion moments both applied at two distances on the lower leg. The shear force was controlled by changing the moment arm without changing the moment. Electromyographic data were collected from knee flexor and extensor muscles. In the analysis of variance, no significant effect of subject group was found in positioning or slow-dynamic tasks across all muscles. The effect of knee angle was significantly different between the subject groups for biceps femoris in positioning and for rectus femoris in slow-dynamic tasks, but these effects were very small and will not have a great impact on the resulting shear forces. There was no interaction between moment arm and subject group. Therefore, the hypothesis that ACLD subjects increase co-contraction in situations with an increased shear load in positioning and slow-dynamic knee extensions could not be confirmed.

Adult↗

PubMed2005

Translation and validation of the Dutch version of the Oxford 12-item knee questionnaire for knee arthroplasty.

BACKGROUND: In 1998, the Oxford 12-item knee questionnnaire was developed by Dawson et al. as a self-administered disease- and site-specific questionnaire, specifically developed for knee arthroplasty patients. Since then,it has proven to be an effective outcome questionnaire, and is widely used. Despite the positive psychometric properties for the Total Knee Arthroplasty (TKA) population, the 12-item knee questionnaire has only been translated into a few languages. We thus translated and validated the Oxford 12-item knee questionnaire for the Dutch population. METHODS AND RESULTS: After translation according to a forward/backward protocol, 174 knee arthroplasty patients were asked to answer the questionnaire together with an SF-36, an AKSS and a VAS. The reliability, validity, content validity and the sensitivity to change were all tested. Our Dutch version of the Oxford 12-item knee questionnaire achieved excellent scores in all of these properties. INTERPRETATION: The Dutch Oxford 12-item knee questionnaire proved to be an excellent evaluation instrument for the Dutch orthopedic surgeon and can be used for all total knee arthroplasty patients.

Arthroplasty, Replacement, Knee↗

PubMed2004

Stiffness of the healing medial collateral ligament of the mouse.

The knee joints of mice can serve as a model for studying knee ligament properties. The goal of our study was to measure the structural stiffness of the medial collateral ligament (MCL) of the murine knee. A tensile test was developed for this purpose. First 84 femur-MCL-tibia complexes of 11-week-old C57Black6 mice were tested. Of four groups (n = 14 per group) the right MCL was ruptured. The mice were sacrificed at 1.5, 3, 6, and 9 weeks after the operation. The other two groups served as controls at 0 and 9 weeks after the operation. Absolute values of the structural stiffness of the healed MCLs at 1.5 weeks were initially significantly lower than their unoperated controls, but were not different from normal values at three, six, and nine weeks of healing. The structural stiffness of the unoperated controls increased by 11% at 20 weeks compared to 11 weeks of age.

Animals↗

PubMed2003

Functional treatments for acute ruptures of the lateral ankle ligament: a systematic review.

Our aim with this systematic review was to assess the effectiveness of various functional treatments for acute ruptures of the lateral ankle ligament in adults. We performed an electronic database search using MEDLINE, EMBASE, COCHRANE CONTROLLED TRIAL REGISTER and CURRENT CONTENTS. We evaluated randomized clinical trials describing skeletally mature subjects with an acute rupture of the lateral ankle ligament and compared functional treatments for inclusion in this study. 9 trials met our inclusion criteria. Two reviewers independently assessed the quality of these trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (W)MD) for continuous outcome measures with 95% confidence intervals (95% CI). Heterogeneity between the trials was tested using a standard chi-square test. Persistent swelling at short-term follow-up was less with lace-up ankle support than with semi-rigid ankle support (RR 4.2 95% CI 1.3-14), an elastic bandage (RR 5.5; 95% CI 1.7-18) and tape (RR 4.1; 95% CI 1.2-14). A semi-rigid ankle support required a shorter period for return to work than an elastic bandage (WMD 4.2; 95% CI 2.4-6.1) (p = 0.7). One trial reported better results for subjective instability using the semi-rigid ankle support than the elastic bandage (RR 8.0; 95% CI 1.0-62). Treatment with tape resulted in more complications, mostly skin problems, than that with an elastic bandage (RR 0.1; 95% CI 0.0-0.8). We found no other statistically significant differences. We conclude that an elastic bandage is a less effective functional treatment. Lace-up supports seem better, but the data are insufficient as a basis for definite conclusions.

Bandages↗

PubMed2003

Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study.

BACKGROUND AND PURPOSE: Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises. SUBJECTS AND METHODS: Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests. RESULTS: Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2. DISCUSSION AND CONCLUSION: Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.

Adult↗

PubMed2002

Progressive surgical release of a posttraumatic stiff elbow. Technique and outcome after 2-18 years in 46 patients.

We treated 46 consecutive patients (47 elbows) suffering from posttraumatic contracture of the elbow joint with operative release. A lateral approach was used to perform a capsulectomy after release of the extensor muscles in 23 elbows. An additional medial approach was used to excise ulnar adhesions and perform a more extensive capsulectomy and an ulnar nerve neurolysis in 24 elbows. Postoperative rehabilitation consisted of immediate passive range-of-motion exercises. The results were assessed after average 10 (2-18) years. Before surgery, the mean active arc of motion was 45 (SD 36) degrees, which improved to 99 (SD 34) degrees after release. 7 patients had transient ulnar paresthesia, 4 recurrent stiffness, which did not become worse after surgery, 1 was reoperated on and 2 developed a postoperative infection, which responded to antibiotic treatment after a few months. No patient suffered from joint instability, or an increase in pain. 44 patients were satisfied with the result at the latest follow-up. We found similar improvement in both treatment groups.

Adolescent↗