It was hypothesized that, for people with severe traumatic injuries, no association between long ... more It was hypothesized that, for people with severe traumatic injuries, no association between long term health status and receiving financial compensation would be detected. Two prospective cohort studies. A group of people with severe traumatic brain injury (n = 132) and a group of people with traumatic spinal cord injury (n = 58). Health status and functioning were measured at baseline and at 5 years follow-up for both injury groups. Results per group were compared between those who received compensation and those who were non-compensable. In the brain injury cohort those receiving financial compensation showed a significantly worse Disability Rating Scale score after 5 years compared to the non-receiving group (p = 0.01). Financial compensation was a modest predictor for being disabled (scores ≥ 4) after 5 years (Exp (B) = 2.47, 95% confidence interval 1.03 to 5.93). In the spinal cord injury cohort those receiving financial compensation scored significantly lower with the Short-Form 36 General Health Survey/Physical Component Summarise scores after 5 years than those who did not (p = 0.04). Again, receiving financial compensation had a modest predictive value for the Short-Form 36/Physical Component Summarise scores after 5 years (B = -4.72, SE = 2.16, 95% confidence interval -9.05 to -0.38). Financial compensation may have a small negative association with recovery, even for people with severe traumatic injury.
Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrial... more Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training se...
Best Practice & Research Clinical Rheumatology, 2015
ABSTRACT Despite all the efforts in studying work-related risk factors for low back pain (LBP), i... more ABSTRACT Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.
Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 2008
... Er is op systematische wijze infor-matie gezocht, beoordeeld en in een direct bruik-bare vorm... more ... Er is op systematische wijze infor-matie gezocht, beoordeeld en in een direct bruik-bare vorm gegoten. Het is bekend uit de litera-tuur dat professionals aan dit soort bronnen het meeste hebben voor hun praktijkvoering. ... 2005 Jun;13(2):59-61. | Friedman DS et al. ...
Workers without a permanent employment contract represent a vulnerable group within the working p... more Workers without a permanent employment contract represent a vulnerable group within the working population. Mental disorders are a major cause of sickness absence within this group. Common mental disorders are stress-related, depressive and anxiety disorders. To date, little attention has been paid to effective return to work interventions for this type of sick-listed workers. Therefore, a participatory supportive return to work program has been developed. It combines elements of a participatory return to work program, integrated care and direct placement in a competitive job.The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual. The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months.The program strongly involves the sick-listed worker in the identification of obstacles...
ABSTRACT Evidence-based patiëntenbespreking is een nieuwe vorm van intercollegiaal overleg voor b... more ABSTRACT Evidence-based patiëntenbespreking is een nieuwe vorm van intercollegiaal overleg voor bedrijfsartsen. intercollegiale toetsing,-evidence-based medicine,-bedrijfsartsen
Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 2007
Samenvatting Bij het begeleiden van zieke werknemers kan het voorkomen dat u vragen heeft in het... more Samenvatting Bij het begeleiden van zieke werknemers kan het voorkomen dat u vragen heeft in het proces van diagnostiek, etiologie, re-integratie.1 Er zijn tegenwoordig veel hulpmiddelen ook online beschikbaar die u mogelijk hierbij kunnen helpen. Bijgaande casus illustreert dit.
Physical conditioning as part of a return to work strategy aims to improve work status for worker... more Physical conditioning as part of a return to work strategy aims to improve work status for workers on sick leave due to back pain. This is the second update of a Cochrane Review (originally titled 'Work conditioning, work hardening and functional restoration for workers with back and neck pain') first published in 2003, updated in 2010, and updated again in 2013. To assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain. Further, to assess which aspects of physical conditioning are related to a faster return to work for workers with back pain. We searched the following databases to March 2012: CENTRAL, MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1982), PsycINFO (from 1967), and PEDro. Randomized controlled trials (RCTs) and cluster RCTs that studied workers with work disability related to back pain and who were included in physical conditioning programmes. Two review authors independently extracted data and assessed risk of bias. We used standard methodological procedures expected by The Cochrane Collaboration. We included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies.Three studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.In 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment.For acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers).For subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18).For chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD -4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03).Physical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning. The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research.
... Tijdens deze cursus leerden de deelne-mers de basisstappen van EBM en het zoeken van litera-t... more ... Tijdens deze cursus leerden de deelne-mers de basisstappen van EBM en het zoeken van litera-tuur in PubMed. ... BMJ 2004; 329: 1029–1032. Nordin-Johansson A, Asplund K. Randomized controlled trials and consensus as a basis for interventions in internal medicine. ...
It was hypothesized that, for people with severe traumatic injuries, no association between long ... more It was hypothesized that, for people with severe traumatic injuries, no association between long term health status and receiving financial compensation would be detected. Two prospective cohort studies. A group of people with severe traumatic brain injury (n = 132) and a group of people with traumatic spinal cord injury (n = 58). Health status and functioning were measured at baseline and at 5 years follow-up for both injury groups. Results per group were compared between those who received compensation and those who were non-compensable. In the brain injury cohort those receiving financial compensation showed a significantly worse Disability Rating Scale score after 5 years compared to the non-receiving group (p = 0.01). Financial compensation was a modest predictor for being disabled (scores ≥ 4) after 5 years (Exp (B) = 2.47, 95% confidence interval 1.03 to 5.93). In the spinal cord injury cohort those receiving financial compensation scored significantly lower with the Short-Form 36 General Health Survey/Physical Component Summarise scores after 5 years than those who did not (p = 0.04). Again, receiving financial compensation had a modest predictive value for the Short-Form 36/Physical Component Summarise scores after 5 years (B = -4.72, SE = 2.16, 95% confidence interval -9.05 to -0.38). Financial compensation may have a small negative association with recovery, even for people with severe traumatic injury.
Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrial... more Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training se...
Best Practice & Research Clinical Rheumatology, 2015
ABSTRACT Despite all the efforts in studying work-related risk factors for low back pain (LBP), i... more ABSTRACT Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.
Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 2008
... Er is op systematische wijze infor-matie gezocht, beoordeeld en in een direct bruik-bare vorm... more ... Er is op systematische wijze infor-matie gezocht, beoordeeld en in een direct bruik-bare vorm gegoten. Het is bekend uit de litera-tuur dat professionals aan dit soort bronnen het meeste hebben voor hun praktijkvoering. ... 2005 Jun;13(2):59-61. | Friedman DS et al. ...
Workers without a permanent employment contract represent a vulnerable group within the working p... more Workers without a permanent employment contract represent a vulnerable group within the working population. Mental disorders are a major cause of sickness absence within this group. Common mental disorders are stress-related, depressive and anxiety disorders. To date, little attention has been paid to effective return to work interventions for this type of sick-listed workers. Therefore, a participatory supportive return to work program has been developed. It combines elements of a participatory return to work program, integrated care and direct placement in a competitive job.The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual. The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months.The program strongly involves the sick-listed worker in the identification of obstacles...
ABSTRACT Evidence-based patiëntenbespreking is een nieuwe vorm van intercollegiaal overleg voor b... more ABSTRACT Evidence-based patiëntenbespreking is een nieuwe vorm van intercollegiaal overleg voor bedrijfsartsen. intercollegiale toetsing,-evidence-based medicine,-bedrijfsartsen
Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde, 2007
Samenvatting Bij het begeleiden van zieke werknemers kan het voorkomen dat u vragen heeft in het... more Samenvatting Bij het begeleiden van zieke werknemers kan het voorkomen dat u vragen heeft in het proces van diagnostiek, etiologie, re-integratie.1 Er zijn tegenwoordig veel hulpmiddelen ook online beschikbaar die u mogelijk hierbij kunnen helpen. Bijgaande casus illustreert dit.
Physical conditioning as part of a return to work strategy aims to improve work status for worker... more Physical conditioning as part of a return to work strategy aims to improve work status for workers on sick leave due to back pain. This is the second update of a Cochrane Review (originally titled 'Work conditioning, work hardening and functional restoration for workers with back and neck pain') first published in 2003, updated in 2010, and updated again in 2013. To assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain. Further, to assess which aspects of physical conditioning are related to a faster return to work for workers with back pain. We searched the following databases to March 2012: CENTRAL, MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1982), PsycINFO (from 1967), and PEDro. Randomized controlled trials (RCTs) and cluster RCTs that studied workers with work disability related to back pain and who were included in physical conditioning programmes. Two review authors independently extracted data and assessed risk of bias. We used standard methodological procedures expected by The Cochrane Collaboration. We included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies.Three studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.In 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment.For acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers).For subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18).For chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD -4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03).Physical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning. The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research.
... Tijdens deze cursus leerden de deelne-mers de basisstappen van EBM en het zoeken van litera-t... more ... Tijdens deze cursus leerden de deelne-mers de basisstappen van EBM en het zoeken van litera-tuur in PubMed. ... BMJ 2004; 329: 1029–1032. Nordin-Johansson A, Asplund K. Randomized controlled trials and consensus as a basis for interventions in internal medicine. ...
Uploads
Papers