Biomedical subjects

R A Oostendorp

Publications and source records attributed to R A Oostendorp.

At least 19 recordsLinked to original sources

PubMed2001

The efficacy of conservative treatment in patients with whiplash injury: a systematic review of clinical trials.

STUDY DESIGN: A systematic review of the literature. OBJECTIVES: To assess the efficacy of conservative treatment in patients with whiplash injuries. SUMMARY OF BACKGROUND DATA: Many treatments are available for patients with whiplash injury, but there continues to be no evidence for their accepted use. METHODS: A computerized literature search of Medline, Embase, Cinahl, Psychlit, and the Cochrane Controlled Trial Register was performed. Studies were selected if the design was a (randomized) clinical trial; if all patients had sustained a whiplash injury; if the type of intervention was a conservative one; if pain, global perceived effect, and participation in daily activities were used as one of the outcome measures, and if the publication was written in English, French, German, or Dutch. The methodologic quality was independently assessed by two reviewers by using the Maastricht-Amsterdam list. Three quality scores were calculated using this criteria list: the Overall Methodologic Quality Score, the Internal Validity Score, and the Delphi Quality Score. The conclusion of the review was based on articles that scored a quality score of at least 50% of the maximum available score on two of three quality scores. RESULTS: Eleven studies met the inclusion criteria. Only three studies satisfied at least 50% on two of three ways of calculating a quality score, indicating overall poor methodology. There was a high rank correlation among the three ways of calculating a quality score. No statistical pooling was performed because of the heterogeneity of the interventions. This review indicates that active treatments show a beneficial long-term effect on at least one of the primary outcome measures. CONCLUSION: Caution is needed when drawing a valid conclusion on the efficacy of conservative treatments in patients with whiplash injury. It appears that "rest makes rusty," whereas active interventions have a tendency to be more effective in patients with whiplash injury.

Bed Rest↗

PubMed2001

Conservative treatment for whiplash.

BACKGROUND: Many treatments are available for whiplash-patients, but to date, no evidence exists for their effectiveness. OBJECTIVES: The objective of this systematic review was to assess the efficacy of conservative treatment in patients with whiplash-injuries (rated as Whiplash-Associated Disorders [WAD] I or II). SEARCH STRATEGY: A computerized literature search of Medline, Embase, Cinahl, Psychlit and the Cochrane Controlled Trial Register through June 1998 was carried out. We also screened reference lists of publications of identified randomized trials and relevant systematic reviews. SELECTION CRITERIA: Studies were selected for inclusion if they fit the following criteria: design was a (randomized) clinical trial (RCT); all patients had suffered a whiplash-injury; the type of intervention was a conservative one; pain, global perceived effect, or participation in daily activities was used as one of the outcome measures; and the publication was written in English, French, German or Dutch. DATA COLLECTION AND ANALYSIS: The methodological quality of the studies was independently assessed by two reviewers using the Maastricht-Amsterdam list. Three quality scores were calculated using this criteria list: the Overall methodological Quality Score, the Internal Validity Score and the Delphi Quality Score. The conclusion of the review was based on articles that scored a quality score of at least 50 percent of the maximum available score on two out of three quality scores. MAIN RESULTS: Eleven studies met the inclusion criteria. A broad variety of conservative interventions were evaluated, and only one study was performed in chronic whiplash patients. Only three studies satisfied at least 50 percent on two out of three quality scores indicating poor overall methodological quality. A high rank correlation was observed among the three methods of quality. Because of the heterogeneity of patient selection, interventions and outcome measures, no statistical pooling was performed. This review indicates that active treatments show a beneficial effect on at least one of the primary outcome measures, preferably pain. REVIEWER'S CONCLUSIONS: It appears that "Rest makes rusty." In other words, rest and immobilization using collars are not recommended for the treatment of whiplash, while active interventions, such as advice to 'maintain usual activities' might be effective in whiplash-patients. Nevertheless, caution is needed when attempting to draw conclusions regarding the efficacy of conservative treatments in whiplash-patients, because of the paucity of high-quality studies. No conclusions can be drawn about the most effective therapy for chronic whiplash-patients because only one low quality trial was identified.

Activities of Daily Living↗

PubMed2001

Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up.

OBJECTIVE: To determine whether the effects of an exercise programme in patients with osteoarthritis of hip or knee are sustained at six and nine months' follow up. METHODS: A randomised, single blind, clinical trial was conducted in a primary care setting. Patients with osteoarthritis of hip or knee (ACR criteria) were selected. Two intervention groups were compared. Both groups received treatment from their general practitioner, including patient education and drug treatment if necessary. The experimental group also received exercise treatment from a physiotherapist in primary care. The treatment period was 12 weeks, with an ensuing 24 week follow up. The main outcome measures were pain, drug use (non-steroidal anti-inflammatory drugs), and observed disability. RESULTS: 201 patients were randomly allocated to the exercise or control group, and 183 patients completed the trial. At 24 weeks exercise treatment was associated with a small to moderate effect on pain during the past week (difference in change between the two groups -11.5 (95% CI -19.7 to -3.3). At 36 weeks no differences were found between the groups. CONCLUSIONS: Beneficial effects of exercise decline over time and finally disappear.

Aged↗

PubMed2001

Muscle strength, pain and disability in patients with osteoarthritis.

OBJECTIVE: Reduced muscle strength is regarded as a risk factor for pain and disability in osteoarthritis (OA). Currently, various indices for muscle strength are used when assessing determinants of pain and disability. The goal of the present study was to evaluate these indices of muscle strength. DESIGN: Isometric muscle strength was measured for 16 muscle actions around the knees and hips in 52 patients with OA of the hip and 70 patients with OA of the knee. Various indices of muscle strength were derived from these measurements, applying five alternative approaches. These approaches ranged from a single overall index to a set of 16 separate indices. The internal consistency of these indices was determined (Cronbach's alpha), and it was determined to what extent they could reveal the association between reduced muscle strength on the one hand and pain and disability on the other hand. RESULTS: Internal consistency was satisfactory for all indices (Cronbach's alpha >0.74). As expected, reduced muscle strength was associated with increased disability, but no clear relationship could be established between muscle weakness and pain. The strength of these associations did not depend on the approach used to derive the indices for muscle strength. CONCLUSIONS: The indices did not show major differences with regard to internal consistency or the extent to which the association with pain and disability could be revealed. For reasons of parsimony, approaches resulting in few indices appear to be most useful. However, muscle strength was found to be significantly reduced around affected joints, compared with muscle strength around unaffected joints. Therefore, the most suitable approach for reducing muscle strength data into indices is one that results in as few indices as possible, but with separate indices for muscle strength around affected and unaffected joints.

Aged↗

PubMed2000

The Radboud skills questionnaire: construction and reliability in patients with reflex sympathetic dystrophy of one upper extremity.

PURPOSE: To construct a questionnaire to measure skills in which notably both hands are active, which is suitable for patients with a disease of one or both hands and to research its response stability and possible improvements. METHOD: Using the Dutch elaboration of the ICIDH and then experts in a Delphi round, the questionnaire was constructed. Thereafter, test-retest and inter-observer reliability was examined. Fifty-four patients with RSD in one upper extremity and a normal contralateral extremity participated in the study, the first twenty to evaluate the construction of the questionnaire and the others to test reliability. RESULTS: The constructed Radboud skills questionnaire was reliable in terms of response stability (median coefficients of variation 2.2% to 6.6%). Correlation's between categories of items were fair to good. CONCLUSIONS: A useful questionnaire was constructed to map alterations in the level of disability in patients with a disease of one hand or both hands.

Adult↗

PubMed2000

High-resolution tracking of cell division suggests similar cell cycle kinetics of hematopoietic stem cells stimulated in vitro and in vivo.

The kinetics of proliferation of primitive murine bone marrow (BM) cells stimulated either in vitro with growth factors (fetal liver tyrosine kinase ligand 3 [FL], Steel factor [SF], and interleukin-11 [IL-11], or hyper-IL-6) or in vivo by factors active in myeloablated recipients were examined. Cells were first labeled with 5- and 6-carboxyfluorescein diacetate succinimidyl ester (CFSE) and then incubated overnight prior to isolating CFSE(+) cells. After 2 more days in culture, more than 90% of the in vivo lymphomyeloid repopulating activity was associated with the most fluorescent CFSE(+) cells (ie, cells that had not yet divided), although this accounted for only 25% of the repopulating stem cells measured in the CFSE(+) "start" population. After a total of 4 days in culture (1 day later), 15-fold more stem cells were detected (ie, 4-fold more than the day 1 input number), and these had become (and thereafter remained) exclusively associated with cells that had divided at least once in vitro. Flow cytometric analysis of CFSE(+) cells recovered from the BM of transplanted mice indicated that these cells proliferated slightly faster (up to 5 divisions completed within 2 days and up to 8 divisions completed within 3 days in vivo versus 5 and 7 divisions, respectively, in vitro). FL, SF, and ligands which activate gp130 are thus efficient stimulators of transplantable stem cell self-renewal divisions in vitro. The accompanying failure of these cells to accumulate rapidly indicates important changes in their engraftment potential independent of accompanying changes in their differentiation status.

Animals↗

PubMed2000

Kinetics of in vivo homing and recruitment into cycle of hematopoietic cells are organ-specific but CD44-independent.

In this study, we investigated the homing and initiation of division of fluorescently labelled adult mouse bone marrow cells after their intravenous injection into lethally irradiated congenic mice. After 2 h, only 3% of the transplanted cells remained in the blood, and approximately 35% could be retrieved from the marrow, liver and spleen in approximately equal numbers. Subsequently, the proportion of injected cells found in blood, liver and spleen decreased further, but increased slightly (to approximately 17%) in the marrow. Homing of progenitors followed a similar pattern. At 22 h post transplant, almost half of the injected cells in the blood, liver and spleen had completed a first mitosis; although these did not include progenitors with in vitro clonogenic ability. At the same time, >90% of the injected cells recovered from the marrow had not yet divided. Parallel studies with CD44-/- mice showed these to contain a numerically and functionally normal stem cell population whose homing and activation in either CD44+/+ or CD44-/- hosts appeared unaltered. These results indicate homing mechanisms that favor more stable retention of transplanted marrow cells in the marrow of the recipient, more rapid activation of some of those cells that home to other sites, and a lack of change in either of these responses when either the transplanted or the recipient cells do not express CD44.

Animals↗

PubMed2000

Range of joint motion and disability in patients with osteoarthritis of the knee or hip.

OBJECTIVE: To establish the relationships between the range of joint motion (ROM) and disability in patients with osteoarthritis (OA) of the knee or hip. Two related issues were addressed: (1) the inter-relationships between ROMs of joint actions, and (2) the relationship between ROM and disability. METHODS: Data on 198 patients with OA of the knee or hip were used. The ROM was assessed bilaterally for the hip and knee, using a goniometer. Disability was assessed using a self-reporting method (questionnaire) and an observational method. Correlation and factor analysis were used to establish the inter-relationships between the ROMs of joint actions. Correlation and multiple regression analyses were carried out to establish the relationships between ROM and disability. RESULTS: Close inter-relationships were found between the ROMs of the same joint action of the lateral and contralateral joints; inter-relationships between ROMs of different joint actions were substantially weaker. Low ROMs were associated with high levels of disability, both self-reported and observed. Some 25% of the variation in disability levels could be accounted for by differences in ROM. In both knee and hip OA patients, flexion of the knee and extension and external rotation of the hip were found to be most closely associated with disability. CONCLUSION: Restricted joint mobility, especially in flexion of the knee and extension and external rotation of the hip, appears to be an important determinant of disability in patients with OA.

Adult↗

PubMed2000

Evaluation of three methods to rate impairment in patients with complex regional pain syndrome I of one upper extremity.

OBJECTIVE: To gain insight into the best way of obtaining an impairment rating in complex regional pain syndrome I (CRPS I) of the upper extremity. This syndrome can potentially result in permanent impairment. DESIGN: Comparison of three evaluation methods to obtain impairment scores. Each patient was seen by one tester; two testers in total participated in the research. SETTING: Outpatient clinic of a university hospital. SUBJECTS: Seventy-four patients (27 men, 47 women, mean age 52 years) with CRPS I of one upper extremity. MAIN OUTCOME MEASURES: Methods I and II were conducted according to the American Medical Association's Guides to the evaluation of permanent impairment method I according to the general guidelines, and method II according to the methodology specificially described for CRPS I. Method III was developed by the Dutch Association of Neurologists. For comparison, differences between methods were plotted against their mean ratings, with the limits of agreement. Also the paired t-statistics were calculated (alpha = 0.05/3). RESULTS: The mean difference between methods I and II was -0.7% whole body impairment, between methods II and III 8.1% and between methods I and III 7.3%. Outcomes obtained with method III differed significantly from the other outcomes. CONCLUSIONS: Method I most accurately and objectively reflected the permanent impairment level resulting from CRPS I.

Adult↗

PubMed2000

Adjuvant physical therapy versus occupational therapy in patients with reflex sympathetic dystrophy/complex regional pain syndrome type I.

OBJECTIVE: To investigate the effectiveness and cost of physical therapy (PT) or occupational therapy (OT) in patients with reflex sympathetic dystrophy (RSD). DESIGN: Prospective randomized controlled trial, with 1 year follow-up. SETTING: Two university hospitals. PATIENTS: One hundred thirty-five patients who had been suffering from RSD of one upper extremity for less than 1 year. INTERVENTIONS: Patients were assigned to PT, OT, or a control group (social work). MAIN OUTCOME MEASURES: Improvement in impairment level sumscore (ISS) over 1 year (Student's t test). A difference of 5 ISS points between the groups was defined as being clinically relevant. Furthermore, severity of disability and handicap was measured and tested exploratively (Wilcoxon; alpha = .05), and cost-effectiveness of the groups was calculated. RESULTS: PT and, to a lesser extent, OT resulted in a significant and also more rapid improvement in the ISS as compared with controls (6 and 4 ISS points, respectively). On a disability level, a positive trend was found in favor of OT. On a handicap level, no differences were found between the groups. PT had an advantage over OT regarding the cost-effectiveness ratio. CONCLUSION: In different ways PT and OT each contribute to the recovery from RSD of the upper extremity.

Female↗

PubMed1999

Internal consistency and validity of an observational method for assessing disability in mobility in patients with osteoarthritis.

OBJECTIVE: To establish the internal consistency and validity of an observational method for assessing disability in mobility in patients with osteoarthritis (OA). METHODS: Data were obtained from 198 patients with OA of the hip or knee. Results of the observational method were compared with results of self-report methods (questionnaires) on disability in mobility. RESULTS: Both Cronbach's alpha and Mokken Scale Analysis indicate that the method is internally consistent. Using factor analysis, observed and self-reported disability in mobility were found to be closely associated and could not be differentiated. CONCLUSIONS: The observational method is internally consistent and indeed measures disability in mobility (high convergent validity), but observations and self-report seem to yield largely equivalent information (low divergent validity). This raises questions regarding the simultaneous use of both observational and self-report methods in the assessment of disability in mobility in OA patients.

Activities of Daily Living↗

PubMed1999

Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials.

OBJECTIVE: To review the effectiveness of exercise therapy in patients with osteoarthritis (OA) of the hip or knee. METHODS: A computerized literature search of Medline, Embase, and Cinahl was carried out. Randomized clinical trials on exercise therapy for OA of the hip or knee were selected if treatment had been randomly allocated and if pain, self-reported disability, observed disability, or patient's global assessment of effect had been used as outcome measures. The validity of trials was systematically assessed by independent reviewers. Effect sizes and power estimates were calculated. A best evidence synthesis was conducted, weighting the studies with respect to their validity and power. RESULTS: Six of the 11 assessed trials satisfied at least 50% of the validity criteria. Two trials had sufficient power to detect medium-sized effects. Effect sizes indicated small-to-moderate beneficial effects of exercise therapy on pain, small beneficial effects on both disability outcome measures, and moderate-to-great beneficial effects according to patient's global assessment of effect. CONCLUSION: There is evidence of beneficial effects of exercise therapy in patients with OA of the hip or knee. However, the small number of good studies restricts drawing firm conclusions.

Exercise Therapy↗

PubMed1999

Cost-effectiveness analysis of adjuvant physical or occupational therapy for patients with reflex sympathetic dystrophy.

OBJECTIVE: To study from a societal viewpoint the cost-effectiveness of adjuvant treatment for patients with reflex sympathetic dystrophy (RSD) of one upper extremity. DESIGN: A two-center randomized clinical trial comparing pairwise physical therapy (PT), occupational therapy (OT), and control treatment (CT). PATIENTS: One hundred thirty-five patients with RSD for less than 1 year participated. INTERVENTIONS: PT and OT were given according to protocols. For CT, services by social workers were offered. MAIN OUTCOME MEASURES: The Impairment-level Sum Score (ISS), the modified Greentest, and the Sickness Impact Profile (SIP) were used to determine effectiveness. Real medical costs, nonmedical costs, and productivity costs were distinguished and incremental cost-effectiveness ratios were calculated. Sensitivity analyses were performed on cost estimates. RESULTS: The ISS, but not the Greentest and SIP, showed a significant difference between PT versus OT and CT. The mean adjuvant treatment costs were significantly higher for PT (Netherlands Guilders [NLG] 1,726) and OT (NLG 2,089) compared with CT (NLG 903). The mean total medical costs were not significantly different for the groups (PT, NLG 8,692; OT, NLG 13,023; and CT, NLG 7,888) (intention-to-treat analysis). The sensitivity analyses showed a moderate influence of the cost estimates. CONCLUSIONS: PT results in clinically relevant improvement in RSD. Costs associated with adjuvant treatment are moderate compared to other medical costs. The incremental cost-effectiveness ratios of PT versus OT and CT were moderate or even dominant, thus PT was both more effective and less costly than its comparators.

Adult↗

PubMed1999

Measuring small linear displacements with a three-dimensional video motion analysis system: determining its accuracy and precision.

OBJECTIVES: To determine accuracy, precision, and smallest detectable difference for a three-dimensional (3D) video motion analysis system specifically configured for measuring small and slow displacements within a small measurement volume (0.7 x 0.5 x 0.3 m). DESIGN: Repeated measurements with random sequence of conditions. SETTING: Rehabilitation research laboratory. INTERVENTION: A reference sliding device was used to control cyclic displacements of two reflective markers over 5 calibrated ranges (1, 3, 10, 30, and 60 mm). Nine cycles were performed for each of 9 conditions (3 directions x 3 zones). Four cameras recorded all trials on tapes, which were digitized with a Kinemetrix system. MAIN OUTCOME MEASURES: Change in distance of the moving markers relative to a third static marker was averaged over 50 frames per trial. Mean error, mean absolute error, and intertrial and intratrial standard deviations (SDs) were calculated for each zone and direction. RESULTS: For 810 trials, mean error and absolute error were, respectively, .034 mm and .094 mm. The mean intertrial and intratrial SDs and 99% confidence interval were .047 mm (CI = +/- .121 mm) and .030 mm (CI = +/- .077 mm). The corresponding smallest detectable differences were .171 mm and .109 mm. CONCLUSION: Motion analysis configured for registration within small volumes allows measurement of minuscule displacements with great accuracy and may therefore be suitable for many applications in rehabilitation research other than gait analysis.

Equipment Design↗

PubMed1999

Pain and reduced mobility in complex regional pain syndrome I: outcome of a prospective randomised controlled clinical trial of adjuvant physical therapy versus occupational therapy.

There are no adequate comparative studies on physical therapy (PT) versus occupational therapy (OT) in patients with complex regional pain syndrome I (CRPS I). Therefore, we conducted a prospective randomised clinical trial to assess their effectiveness. The outcomes regarding reducing pain and normalising active range of motion (AROM) are discussed. Included in the study were 135 patients who had been suffering from CRPS I of one upper extremity for less than one year. They were randomly assigned to one of three groups: PT, OT, or control (social work, CT). Measurements were taken at base-line (t0), after 6 weeks, and after 3, 6 and 12 months (t1 to t4). Pain was measured on four visual analogue scales (VAS) and the McGill Pain Questionnaire, Dutch Language Version (MPQ-DLV). The AROM was recorded relative to the contralateral side. Explorative statistical evaluations were performed (Wilcoxon; alpha=0.05). PT and to a lesser extent OT, resulted in more rapid improvement in the VAS scores than CT, especially for the VAS during or after effort (P<0.05 at t1 to t3). PT was superior to CT and OT according to the MPQ-DLV particularly at t4. Improvement on the MPQ-DLV over the year was significantly greater for PT than for OT and CT (P<0.05). PT -and to a lesser degree OT- led to better results than CT for the AROM of the wrist, fingers and thumb at t1 to t3 (most-times P<0.05 for PT), but the improvements over the year were not significantly different. Our results indicated that PT, and to a lesser extent OT, were helpful for reducing pain and improving active mobility in patients with CRPS I of less than one year duration, localised in one upper extremity.

Arm↗

PubMed1999

Cell division tracking and expansion of hematopoietic long-term repopulating cells.

The combined use of rigorous assays for quantitating transplantable stem cell numbers and precise cell labeling and tracking procedures have provided definitive evidence that stem cell self-renewal divisions can occur in vitro in the absence of stromal feeder layers. These findings set the stage for defining conditions that may alter the ability of these cells to maintain their primitive status when mitogenically activated.

Animals↗

PubMed1999

Pain threshold in patients with rheumatoid arthritis and effect of manual oscillations.

Using a pressure algometer pain threshold (PT) measurements were carried out in the paraspinal area as well as at the knee and ankle joints in 30 adults with active rheumatoid arthritis (RA) and in 30 healthy adults. The group of RA patients was then randomly divided in two. In 15 RA patients a manual oscillation technique was applied at T12 and L4 for 12 minutes. The 15 other patients were resting. Immediately after the experimental procedure the PT was measured again at the same points in all patients. The RA patients showed a significantly (p < 0.05) lower PT than the healthy adults at all investigated points, which suggests that in RA certain changes arise in the peripheral and central nociceptive processing system, as mentioned in the literature. In the second measurement session for the RA patients the PT was significantly higher (p<0.05) after manual oscillations than after rest, at the paraspinal area of T6, L1 and L3. Further research into the long-term effect of repeated manual oscillation sessions is warranted.

Adult↗

PubMed1999

Signs and symptoms in complex regional pain syndrome type I/reflex sympathetic dystrophy: judgment of the physician versus objective measurement.

OBJECTIVE: To assess the relation between the subjectively assessed and objectively measured diagnostic signs and symptoms in complex regional pain syndrome type I (CRPS I) and to quantify their severity. DESIGN: Diagnostic signs and symptoms were recorded in patients suffering from CRPS I of one upper extremity for less than 1 year. Independent assessors measured (a) pain by using four visual analog scales (VAS) and the McGill Questionnaire list of adjectives (MPQ), (b) edema with a hand volumeter, (c) skin temperature with an infrared thermometer, and (d) active range of motion (AROM) with goniometers. SETTING: Two university hospitals. PATIENTS: Ninety-five women and 40 men with CRPS I of one upper extremity. RESULTS: Four signs and symptoms were diagnosed in 50 patients, and five in the remaining 85 patients. The mean score for present pain intensity was 31.5 mm and that for pain resulting from exertion of the affected extremity was 71.9 mm. A median of 11.5 words was chosen from the MPQ, with the highest number from its evaluative part. The difference in volume between both hands was 30.4 ml. The mean difference in temperature between the two hands was 0.78 degrees C dorsally and 0.66 degrees C palmarly. The largest decrease in mobility was seen in the wrist and fingers; the thumb was relatively less affected and the little finger relatively more affected than the other fingers. CONCLUSIONS: Bedside evaluation of CRPS I with Veldman's criteria was in good accord with psychometric or laboratory testing of these criteria.

Adult↗