Development of a standard set of outcome measures for non-specific low back pain in Dutch primary care physiotherapy practices: a Delphi study

Item does not contain fulltextPURPOSE: To develop a clinical standard set of outcome measures that are accepted for relevance and feasibility by stakeholders and useful for (a) interaction between patient and the professional, e.g. shared decision-making in goal-setting, monitoring and feedback based on outcomes, (b) internal quality improvement, and (c) external transparency in patients with non-specific low back pain (NSLBP) in primary care physical therapy. METHODS: We used a consensus-driven modified RAND-UCLA Delphi method in seven steps with panellists (patients, representatives of patient and physiotherapy associations, researchers, policy makers, health insurers): (1) literature search, (2) first online survey, (3) patient interviews, (4) an experts meeting, (5) a consensus meeting, (6) second online survey, and (7) final approval of an advisory board. Steps 1-4 resulted in potential outcome measures. In the consensus meeting after discussion panellists voted for inclusion per measure. In the second online survey the final standard set was rated on relevance and feasibility on a 9-point Likert scale; when the median score was >/= 7, the standard set was accepted and finally approved. RESULTS: Thirteen draft outcome measures were rated and discussed, and finally, six outcome measures were accepted. The standard set includes the Quebec Back Pain Disability Scale, Oswestry Disability Index, Patient-Specific Functional Scale, Numeric Pain Rating Scale, Global Perceived Effect (GPE-DV), and the STarT Back Screening Tool (SBT). CONCLUSION: This study presents a standard set of outcome measures for patients with NSLBP in primary care physiotherapy accepted for relevance and feasibility by stakeholders. The standard set is currently used in daily practice and tested on validity and reliability in a pilot study. These slides can be retrieved under Electronic Supplementary Material

The diagnostic accuracy of headache measurement instruments: A systematic review and meta-analysis focusing on headaches associated with musculoskeletal symptoms

Contains fulltext : 208202.pdf (publisher's version ) (Open Access)AIM: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms. DESIGN: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966-2018), Cochrane (1898-2018) and Cinahl (1988-2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible, a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument. RESULTS: From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85-0.89) and specificity of 0.75 (95% CI: 0.72-0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire - Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55-0.80) and specificity of 0.90 (95% CI 0.77-0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21-0.54) and specificity of 0.86 (95% CI 0.74-0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72-0.94) and specificity of 0.82 (95% CI 0.73-0.91). DISCUSSION: The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple headaches

Dying to be born again: Mortality, immortality and the fashion model

The primary focus of this thesis is limited to the relationship between sartorial fashion and the fashion model within the world of representation. This includes the forms of fashion display and dissemination that existed prior to the establishment of the modern fashion system—fashion dolls, fashion plates and illustration and the mannequin de monde—as well as the fields where the fashion model as a modern phenomenon came into being—fashion photography and the fashion parade. While the portrait of feminine beauty and ideals in the fashion image betrays the imprint of the representation of the female body in art, pornography and the entertainment industries, this thesis argues for a reading of the fashion image and the fashion model specifically through the prism of fashion which, as a quasi-autonomous system, operates according to its own rules and has its own mode of being. Since its inception, fashion has frustrated its critics and delighted its proponents with a nonchalant rejection of the creations it had hitherto enthroned as essential. This dedication to perpetual change and the ephemeral—the ‘death-wish’ that ensures the continuation of fashion as a structure even as individual fashions are discarded—has fascinated both those who have seriously contemplated fashion and those who document the vicissitudes of fashion’s creations. For its critics, the sin fashion commits in refusing to manifest itself in a permanent form of beauty is compounded by its perceived attacks upon the body, cloaking it in a layer of artifice that distorts it into ‘unnatural’ forms. This imposition by fashion on the body made from flesh and blood is never fully realised. Rather it is only on the body in representation that fashion can begin to escape the limitations imposed upon it by the human form and give full reign to its creative impulse. In the fashion image the fundamental principles of fashion—change and artifice—are metaphorically expressed by the interplay of mortality and immortality on the body of the model which, ultimately, serves as the blank canvas where fashion is free to invent its imaginary self

Current status and future prospects for shared decision making before and after total knee replacement surgery—a scoping review

Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients’ decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients’ decisional needs and preferences. From these, we identified four domains that affected the patients’ decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery

Quid movet?

Contains fulltext : 83289.pdf (publisher's version ) (Open Access)Rede uitgesproken bij de aanvaarding van het ambt van hoogleraar Paramedische Wetenschappen aan het UMC St Radboud/de Radboud Universiteit Nijmegen op 24 september 2009, 24 september 200

Movere et moveri

Contains fulltext : 200952.pdf (publisher's version ) (Open Access)Rede uitgesproken bij het afscheid als hoogleraar Paramedische Wetenschappen van de Radboud Universiteit/het Radboudumc, 1 februari 201

Studies of movement performance problems in Turner syndrome: what have we learned?. English special World Congress for Physical Therapy. June 2-6, 2007, Vancouver, Canada.

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