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Biomedical subjects

Lex Bouter

Publications and source records attributed to Lex Bouter.

9 recordsLinked to original sources
PubMed2006

Review conclusions by Ernst and Canter regarding spinal manipulation refuted.

In the April 2006 issue of the Journal of Royal Society of Medicine, Ernst and Canter authored a review of the most recent systematic reviews on the effectiveness of spinal manipulation for any condition. The authors concluded that, except for back pain, spinal manipulation is not an effective intervention for any condition and, because of potential side effects, cannot be recommended for use at all in clinical practice. Based on a critical appraisal of their review, the authors of this commentary seriously challenge the conclusions by Ernst and Canter, who did not adhere to standard systematic review methodology, thus threatening the validity of their conclusions. There was no systematic assessment of the literature pertaining to the hazards of manipulation, including comparison to other therapies. Hence, their claim that the risks of manipulation outweigh the benefits, and thus spinal manipulation cannot be recommended as treatment for any condition, was not supported by the data analyzed. Their conclusions are misleading and not based on evidence that allow discrediting of a large body of professionals using spinal manipulation.

Editorial↗
PubMed2006

Cost-effectiveness of a disease management program for major depression in elderly primary care patients.

BACKGROUND: Major depression is common in older adults and is associated with increased health care costs. Depression often remains unrecognized in older adults, especially in primary care. OBJECTIVE: To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care. DESIGN: Economic evaluation alongside a cluster randomized-controlled trial. PARTICIPANTS: Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis. INTERVENTIONS: General practitioners in the intervention group received training on how to implement the disease management program consisting of screening, patient education, drug therapy with paroxetine, and supportive contacts. General practitioners in the usual care group were blind to the screening results. Treatment in this group was not restricted in any way. MEASUREMENTS: Severity of depression, recovery from depression, and quality of life. Resource use measured over a 12-month period using interviews and valued using standard costs. RESULTS: Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant. Total costs were 2,123 dollars in the intervention and 2,259 dollars in the usual care group (mean difference -136 dollars, 95% confidence interval: -1,194 dollars; 1,110 dollars). Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups. CONCLUSIONS: This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes, costs, and cost-effectiveness. Therefore, based on these results, continuing usual care is recommended.

Aged↗
PubMed2005

The effect of a balance training programme on centre of pressure excursion in one-leg stance.

BACKGROUND: Balance training is widely used in the rehabilitation after an ankle sprain and is thought to have a decreasing effect on postural sway. The present study investigated whether a 5.5-week balance training programme leads to a decreased postural sway showing in a reduced range of centre of pressure excursion. METHODS: Thirty university students participated in this study. Twenty-two untrained subjects were randomly assigned to either an intervention group (n=11) or a control group (n=11). The remaining eight subjects were participants in an organized volleyball competition and were assigned to an additional volleyball group (n=8). All subjects of the intervention group and the volleyball group received a 5.5-week balance training programme, while subjects of the control group received no training. Centre of pressure of the ground reaction force was measured as a proxy measure of postural sway, using a force platform. Measurements took place before and after the 5.5-week training programme for standing on one leg (both for right and for left leg) of single leg stance, both for the eyes-open and eyes-closed situation. From these measurements centre of pressure excursion in the anterior-posterior and the medial-lateral direction was calculated. A linear regression analysis was performed to check for differences in centre of pressure excursion between any of the groups over the training period. FINDINGS: No differences in changes of centre of pressure excursion were found between any of the groups over the 5.5-week training period. INTERPRETATION: Balance training does not lead to a reduction in centre of pressure excursion in a general population consisting of non-injured and previously injured subjects.

Adaptation, Physiological↗
PubMed2005

Parents' perceptions, attitudes and behaviours towards child safety: a study in 14 European countries.

Injury is the leading cause of death for children 0- 19 years of age in Europe, accounting for 3.1 deaths per 10 000 children per year. The youngest children of the ages 0-4 years require the most protection in this age group, with 2.5 injury-related deaths per 10 000 children in Europe annually. As parents are the primary caregivers of children, it is necessary to learn more about parents' perceptions, attitudes and behaviours towards child safety. This study presents the findings of a 14-country study in Europe on this theme. A quantitative survey of parents of children aged 5 years or under was performed in 14 EU member states in order to enable better targeting of prevention efforts aimed at educating parents. The total sample size was 2088. The results show that 95% of parents reported that they personally take measures to avoid accidental injury to their children. Their top concern with regard to safety of their children was children being hit by a car. The most common response, when asked why some parents find it difficult to protect their children from accidental injury, was not being able to watch their children constantly. Lack of awareness or knowledge about the causes of accidents was the second response. Two-thirds of parents would like to see more help from the government to prevent childhood injuries. Three-quarters of parents agreed that child injuries can be avoided. It was concluded that parents want to be better informed about the causes of child accidents and about actions they and society can take to reduce injury-related risks to children.

Accident Prevention↗
PubMed2004

The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial.

BACKGROUND: Ankle sprains are the most common injuries in a variety of sports. HYPOTHESIS: A proprioceptive balance board program is effective for prevention of ankle sprains in volleyball players. STUDY DESIGN: Prospective controlled study. METHODS: There were 116 male and female volleyball teams followed prospectively during the 2001-2002 season. Teams were randomized by 4 geographical regions to an intervention group (66 teams, 641 players) and control group (50 teams, 486 players). Intervention teams followed a prescribed balance board training program; control teams followed their normal training routine. The coaches recorded exposure on a weekly basis for each player. Injuries were registered by the players within 1 week after onset. RESULTS: Significantly fewer ankle sprains in the intervention group were found compared to the control group (risk difference = 0.4/1000 playing hours; 95% confidence interval, 0.1-0.7). A significant reduction in ankle sprain risk was found only for players with a history of ankle sprains. The incidence of overuse knee injuries for players with history of knee injury was increased in the intervention group. History of knee injury may be a contraindication for proprioceptive balance board training. CONCLUSIONS: Use of proprioceptive balance board program is effective for prevention of ankle sprain recurrences.

Adult↗
PubMed2004

Economic evaluations and randomized trials in spinal disorders: principles and methods.

STUDY DESIGN: Descriptive methodologic recommendations. OBJECTIVE: To help researchers designing, conducting, and reporting economic evaluations in the field of back and neck pain. SUMMARY OF BACKGROUND DATA: Economic evaluations of both existing and new therapeutic interventions are becoming increasingly important. There is a need to improve the methods of economic evaluations in the field of spinal disorders. MATERIALS AND METHODS: To improve the methods of economic evaluations in the field of spinal disorders, this article describes the various steps in an economic evaluation, using as example a study on the cost-effectiveness of manual therapy, physiotherapy, and usual care provided by the general practitioner for patients with neck pain. RESULTS: An economic evaluation is a study in which two or more interventions are systematically compared with regard to both costs and effects. There are four types of economic evaluations, based on analysis of: (1) cost-effectiveness, (2) cost-utility, (3) cost-minimization, and (4) cost-benefit. The cost-utility analysis is a special case of cost-effectiveness analysis. The first step in all these economic evaluations is to identify the perspective of the study. The choice of the perspective will have consequences for the identification of costs and effects. Secondly, the alternatives that will be compared should be identified. Thirdly, the relevant costs and effects should be identified. Economic evaluations are usually performed from a societal perspective and include consequently direct health care costs, direct nonhealth care costs, and indirect costs. Fourthly, effect data are collected by means of questionnaires or interviews, and relevant cost data with regard to effect measures and health care utilization, work absenteeism, travel expenses, use of over-the-counter medication, and help from family and friends, are collected by means of cost diaries, questionnaires, or (telephone) interviews. Fifthly, real costs are calculated, or the costs are estimated on the basis of real costs, guideline prices, or tariffs. Finally, in the statistical analysis the mean direct, indirect, and total costs of the alternatives are compared, using bootstrapping techniques. Incremental cost-effectiveness ratios are graphically presented on a cost-effectiveness plane and acceptability curves are calculated. CONCLUSION: Economic evaluations require specific methods. These recommendations may be helpful in improving the quality of economic evaluations of new and existing therapeutic interventions in the field of spinal disorders.

Back Pain↗
PubMed2003

Updated method guidelines for systematic reviews in the cochrane collaboration back review group.

STUDY DESIGN: Descriptive method guidelines. OBJECTIVES: To help reviewers design, conduct, and report reviews of trials in the field of back and neck pain. SUMMARY OF BACKGROUND DATA: In 1997, the Cochrane Collaboration Back Review Group published method guidelines for systematic reviews. Since its publication, new methodologic evidence emerged and more experience was acquired in conducting reviews. METHODS: All reviews and protocols of the Back Review Group were assessed for compliance with the 1997 method guidelines. Also, the most recent version of the Cochrane Handbook (4.1) was checked for new recommendations. In addition, some important topics that were not addressed in the 1997 method guidelines were included (e.g., methods for qualitative analysis, reporting of conclusions, and discussion of clinical relevance of the results). In May 2002, preliminary results were presented and discussed in a workshop. In two rounds, a list of all possible recommendations and the final draft were circulated for comments among the editors of the Back Review Group. RESULTS: The recommendations are divided in five categories: literature search, inclusion criteria, methodologic quality assessment, data extraction, and data analysis. Each recommendation is classified in minimum criteria and further guidance. Additional recommendations are included regarding assessment of clinical relevance, and reporting of results and conclusions. CONCLUSIONS: Systematic reviews need to be conducted as carefully as the trials they report and, to achieve full impact, systematic reviews need to meet high methodologic standards.

Back Pain↗
PubMed2002

Epidemiological data and ranking home and leisure accidents for priority-setting.

OBJECTIVE: To determine how to use the multitude of available epidemiological data to rank accidents for prioritisation of prevention. METHODS: A stepwise method to rank accidents for priority-setting at any time is proposed. The first step is to determine the overall objectives of injury prevention. Based on these objectives, the relevant epidemiological criteria are determined. These criteria need to be weighed by experts in such a way that these weights can be used for every new cycle of priority-setting. Thus, every time the method is applied: first, the relevant types of accidents are identified; second, the epidemiological criteria are determined per type of accident; and third, the types of accidents are ranked by means of standardised weights per criterion. The proposed indirect method is illustrated by an empirical example. The results were compared with a direct method, i.e. ranking by an expert panel. RESULTS: In the pilot, we ranked four age groups of victims of a home and leisure accident: 0-4, 4-19 and 20-54 years of age, and victims aged 55 years or older. The resulting rankings differ largely per application; number one are victims older than 55 years or those of 20-54 years. CONCLUSIONS: The proposed method enables a structured, transparent way to set priorities for home and leisure accidents. It is a promising method, although further development is clearly necessary, based on the actual application of the model.

Accident Prevention↗