The feasibility and efficacy of a multidisciplinary intervention with aftercare meetings for fibromyalgia

The objective of this study is to examine the feasibility and long-term results of a 12-week multidisciplinary part-time daycare intervention with five aftercare meetings in fibromyalgia (FM) patients. One hundred and five patients diagnosed with FM started with a multidisciplinary intervention and were assessed for feasibility, functional status (Fibromyalgia Impact Questionnaire [FIQ]), and quality of life (EuroQol-5D [EQ-5D]) until 9 months after completion. The program consisted of sociotherapy, physiotherapy, psychotherapy, and creative arts therapy. Drop-out rate was 4.8%. The attendance rate of 100 patients who completed the 12-week program and five aftercare meetings was high (97.4%), just like patient and therapist satisfaction (8.2 on a 10 points scale). After the 12-week program, statistically significant improvement was seen in both FIQ and EQ-5D. This improvement was maintained after 9 months of follow-up. On average, moderate improvements were observed. Our 12-week multidisciplinary part-time daycare intervention with five aftercare meetings for FM patients is feasible and it is indicated that it can lead to sustained improvement in functional status and quality of life

Design of a trial-based economic evaluation on the cost-effectiveness of employability interventions among work disabled employees or employees at risk of work disability: The CASE-study

<p>Abstract</p> <p>Background</p> <p>In the Netherlands, absenteeism and reduced productivity due to work disability lead to high yearly costs reaching almost 5% of the gross national product. To reduce the economic burden of sick leave and reduced productivity, different employability interventions for work-disabled employees or employees at risk of work disability have been developed. Within this study, called 'CASE-study' (Cost-effectiveness Analysis of Sustainable Employability), five different employability interventions directed at work disabled employees with divergent health complaints will be analysed on their effectiveness and cost-effectiveness. This paper describes a consistent and transparent methodological design to do so.</p> <p>Methods/design</p> <p>Per employability intervention 142 participants are needed whereof approximately 66 participants receiving the intervention will be compared with 66 participants receiving usual care. Based on the intervention-specific characteristics, a randomized control trial or a quasi-experiment with match-criteria will be conducted. Notwithstanding the study design, eligible participants will be employees aged 18 to 63, working at least 12 h per week, and at risk of work disability, or already work-disabled due to medical restrictions. The primary outcome will be the duration of sick leave. Secondary outcomes are health status and quality of life. Outcomes will be assessed at baseline and then 6, 12 and 18 months later. Economic costs will consist of healthcare costs and cost of lost production due to work disability, and will be evaluated from a societal perspective.</p> <p>Discussion</p> <p>The CASE-study is the first to conduct economic evaluations of multiple different employability interventions based on a similar methodological framework. The cost-effectiveness results for every employability intervention will be published in 2014, but the methods, strengths and weaknesses of the study protocol are discussed in this paper. To contribute to treatment options in occupational health practice and enable the development of guidelines on how to conduct economic evaluation better suited to this field; this paper provides an important first step.</p> <p>Trial registration</p> <p>Four trials involved in the CASE-study are registered with the Netherlands Trial Registry: Care for Work (<a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2040">NTR2886</a>), Health and Motion (<a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2040">NTR3111</a>), Guidance to Excel in Return to Work (<a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2040">NTR3151</a>), Care for Companies/Second Care (<a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2040">NTR3136</a>).</p

Development and measurement of guidelines-based quality indicators of caesarean section care in the Netherlands: A RAND-modified delphi procedure and retrospective medical chart review

Background There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. Method Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. Results The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adh