Measuring subluxation of the hemiplegic shoulder: Reliability of a method

Objective: Subluxation of the shoulder after stroke can be measured according to the method described by Van Langenberghe and Hogan. Methods: To evaluate the reliability of this method, the shoulder radiographs of 25 patients were available for this study. Two independent raters each assessed these radiographs twice. Results: The intrarater reliability was good: percentage of agreement was 88 and 84%, weighted κ, 0.69 [95% confidence interval (CI), 0.38-1 0] and 0.78 (95% CI, 0.60-0.95) for raters 1 and 2, respectively. The interrater reliability was poor: percentage of agree ment was 36 and 28%, κ, 0.11 (95% CI, 0.0-0.31) and 0.09 (95% CI, 0.0-0.23) in sessions 1 and 2, respectively. Subsequently the original method was adjusted by com bining two categories (no subluxation and beginning subluxation) into one (“no clin ically important subluxation”). Conclusions: After this adjustment of the categories, the interrater reliability improved [percentage of agreement, 72%, and κ, 0.49 (95% CI, 0.18-0.80)], but did not reach acceptable values

Effectiveness of an Interactive Website Aimed at Empowerment of Disability Benefit Claimants: Results of a Pragmatic Randomized Controlled Trial

Introduction The aim of this study was to investigate the effectiveness of an interactive website aimed at empowerment of disability claimants, prior to the assessment of disability by an insurance physician. Methods A randomized controlled trial was conducted. Claimants applying for a work disability pension after being sick-listed for 104 weeks, were randomized into either an intervention group or control group. Participants who were randomized into the intervention group were able to logon to the website www.wiagesprek.nl, which mainly consisted of five interactive modules aimed at increasing knowledge, self-awareness, expectations, self-efficacy, and active participation. Participants from the control group were directed to a ‘sham’ website with commonly available information only. The primary outcome was empowerment. Secondary outcomes included coping, knowledge, claimant satisfaction, perceived justice, and physician satisfaction. Outcomes were assessed at baseline, 2 days before the disability assessment, as well as 1 day after, 6 weeks, and 4 months after the disability assessment. Results Claimants were randomly assigned to the intervention group (n = 123) or a control group (n = 119). The intervention had no significant short- and long-term effects on empowerment, but the intervention increased claimants’ knowledge significantly compared to the control group. Claimant satisfaction with the disability assessment interview and claimant perceived justice on the outcome of the assessment were lower in the intervention group (statistically not significant). Furthermore, the intervention had a significant negative effect on claimants perceived procedural justice. Conclusion Although knowledge increased significantly, the intervention www.wiagesprek.nl was not successful in reaching its primary target, that is, to increase levels of empowerment among disability claimants, prior to the assessment of disability

Process evaluation of a web-based intervention aimed at empowerment of disability benefit claimants

<p>Abstract</p> <p>Background</p> <p>The objective of this process evaluation study was to gain insight into the reach, compliance, appreciation, usage barriers, and users' perceived effectiveness of a web-based intervention <url>http://www.wiagesprek.nl</url>. This intervention was aimed at empowerment of disability claimants, prior to the assessment of disability by an insurance physician.</p> <p>Methods</p> <p>Reach was determined by registering claimants exposed to the study's invitation brochures, and by comparing trial participant characteristics with non-participants and nationwide claimant data. Compliance was registered by analyzing weblogs, which were automatically collected during the period of the trial. This made it possible to analyze individual use of the intervention. Appreciation, usage barriers, and users' perceived effectiveness were assessed using an online questionnaire that was sent to participants from the intervention group, 6 weeks after enrolment.</p> <p>Results</p> <p>Only 9% of the target population enrolled in the internet program. Because of selective enrolment, more females, higher educated claimants, and less ethnical minorities were reached. Compliance was ambiguous: out of the 123 participants randomized into the intervention group, a significant proportion (33%) did not use the intervention at all, while, at the same time, many participants (32%) used the intervention for more than two hours (i.e. in approximately two weeks). Overall satisfaction with the intervention was good. Claimants perceived the intervention most effective in increasing knowledge, while also a fair amount of users perceived the intervention effective in gaining right expectations or being able to communicate better with their physician.</p> <p>Conclusions</p> <p>The uptake of the intervention <url>http://www.wiagesprek.nl</url> was disappointing. Specifically, the poor reach and compliance of the intervention resulted in a small proportion of the target population using the intervention as intended. Improvements in the implementation process are desirable to increase the reach and compliance and, thereby possibly, the impact of the intervention.</p> <p>Trial registration</p> <p><a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1414">NTR-1414</a></p

Treating patients with hemiplegic shoulder pain

Studies on the efficacy of available methods of treatment for hemiplegic shoulder pain are reviewed in an attempt to identify the most effective treatment for this problem. Because of the poor quality of the 14 selected studies, no definite conclusion can be drawn about the most effective method of treatment. However, functional electrical stimulation and intra-articular triamcinolone acetonide injections seem to be the most promising treatment option