Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial

Background Lateral epicondylitis is generally treated with corticosteroid injections or physiotherapy. Dutch clinicalguidelines recommend a wait-and-see policy. We compared the efficacy of these approaches.Methods Patients with lateral epicondylitis of at least 6 weeks’ duration were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment with corticosteroid injections, physiotherapy, or a wait-and-see policy. Outcome measures included general improvement, severity of the main complaint, pain, elbow disability, and patient satisfaction. Severity of elbowcomplaints, grip strength, and pressure pain threshold were assessed by a research physiotherapist who was unaware oftreatment allocation. We assessed all outcomes at 3, 6, 12, 26, and 52 weeks. The principal analysis was done on anintention-to-treat basis. Findings We randomly assigned 185 patients. At 6 weeks, corticosteroid injections were significantly better than allother therapy options for all outcome measures. Success rates were 92% (57) compared with 47% (30) for physiotherapy and 32% (19) for wait-and-see policy. However, recurrence rate in the injection group was high. Long-term differences between injections and physiotherapy were significantly in favour of physiotherapy. Success rates at 52 weeks were 69% (43) for injections, 91% (58) forphysiotherapy, and 83% (49) for a wait-and-see policy. Physiotherapy had better results than a wait-and-see policy, but differences were not significant.Interpretation Patients should be properly informed about the advantages and disadvantages of the treatment options for lateral epicondylitis. The decision to treat with physiotherapy or to adopt a wait-and-see policy might depend on available resources, since the relative gain of physiotherapy is small

Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis:a randomised controlled trial

Background Lateral epicondylitis is generally treated with corticosteroid injections or physiotherapy. Dutch clinicalguidelines recommend a wait-and-see policy. We compared the efficacy of these approaches.Methods Patients with lateral epicondylitis of at least 6 weeks’ duration were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment with corticosteroid injections, physiotherapy, or a wait-and-see policy. Outcome measures included general improvement, severity of the main complaint, pain, elbow disability, and patient satisfaction. Severity of elbowcomplaints, grip strength, and pressure pain threshold were assessed by a research physiotherapist who was unaware oftreatment allocation. We assessed all outcomes at 3, 6, 12, 26, and 52 weeks. The principal analysis was done on anintention-to-treat basis. Findings We randomly assigned 185 patients. At 6 weeks, corticosteroid injections were significantly better than allother therapy options for all outcome measures. Success rates were 92% (57) compared with 47% (30) for physiotherapy and 32% (19) for wait-and-see policy. However, recurrence rate in the injection group was high. Long-term differences between injections and physiotherapy were significantly in favour of physiotherapy. Success rates at 52 weeks were 69% (43) for injections, 91% (58) forphysiotherapy, and 83% (49) for a wait-and-see policy. Physiotherapy had better results than a wait-and-see policy, but differences were not significant.Interpretation Patients should be properly informed about the advantages and disadvantages of the treatment options for lateral epicondylitis. The decision to treat with physiotherapy or to adopt a wait-and-see policy might depend on available resources, since the relative gain of physiotherapy is small

Cross-cultural validation of the motivation to change lifestyle and health behaviours for dementia risk reduction scale in the Dutch general population

Background: This study aimed to translate and validate the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale in the Dutch general population. Methods: A random sample of Dutch residents aged between 30 and 80 years old were invited to complete an online questionnaire including the translated MCLHB-DRR scale. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to assess construct validity. Cronbach's alpha was calculated to assess internal consistency. Results: Six hundred eighteen participants completed the questionnaire. EFA and Cronbach's alpha showed that four items were candidate for deletion. CFA confirmed that deleting these items led to an excellent fit (RMSEA = 0.043, CFI = 0.960, TLI = 0.951, χ2/df = 2.130). Cronbach's alpha ranged from 0.69 to 0.93, indicating good internal consistency. Conclusion: The current study demonstrated that the Dutch MCLHB-DRR scale is a valid scale for assessing health beliefs and attitudes towards dementia risk reduction among Dutch adults aged between 30 and 80 years old

Correction to:Cross-cultural validation of the motivation to change lifestyle and health behaviours for dementia risk reduction scale in the Dutch general population

An amendment to this paper has been published and can be accessed via the original article

The association between unemployment trajectories and alcohol consumption patterns. Evidence from a large prospective cohort in The Netherlands

Unemployment is expected to influence alcohol consumption, but studies show mixed results, partly because most studies concentrate on current employment status. However, unemployment could be particularly consequential if it is part of a trajectory of employment precariousness. Moreover, the association between unemployment and alcohol consumption may not be homogeneous across the population, but differ by subgroups (e.g. socioeconomic status). This study longitudinally analyses the association between different employment trajectories and alcohol consumption, and examines if the association is moderated by socioeconomic status (SES), partner status, age and gender. Four waves of data of the Lifelines Cohort study are used. Sample consists of individuals from 18-50 years old, active in the labor market (n = 104,766) from the northern provinces of the Netherlands. Employment trajectories are defined by employment status in each wave, duration of unemployment, and number of exposures to unemployment. Drinking patterns are divided into "abstainers", "moderate drinking" (1.5 drinks/day) and "binge drinking" (>5 drinks/occasion; 4 for women). The associations are estimated with multinomial logistic regression models. Results show that recent, long-term unemployment (> 6 months) is associated with higher rates of heavy drinking (RRR = 1.26 [95 % CI 1.03-1.54]), whereas short-term unemployment does not show any association with the outcome. Being continuously unemployed throughout the observation period shows a strong association with binge drinking (RRR = 1.43 [95 % CI 1.06-1.93]), as well as reporting 2 or more long unemployment spells (RRR = 1.49 [95 % CI 1.21-1.83]). The group of abstainers (77.95 % women) have significantly lower SES, and poorer health than their peers. For some individuals, recent unemployment increases the likelihood for abstinence (RRR = 1.23 [95 % CI 1.00-1.51]). Evidence suggests that length of unemployment is key in order to grasp its effects in terms of changing drinking patterns

Understanding socioeconomic differences in metabolic syndrome remission among adults:what is the mediating role of health behaviors?

BACKGROUND: Although the incidence of metabolic syndrome (MetS) strongly varies based on individuals' socioeconomic position (SEP), as yet no studies have examined the SEP-MetS remission relationship. Our aim is to longitudinally assess the associations between SEP measures education, income and occupational prestige, and MetS remission, and whether these associations are mediated by health behaviors, including physical activity, smoking, alcohol intake and diet quality. METHODS: A subsample (n = 16,818) of the adult Lifelines Cohort Study with MetS at baseline was used. MetS remission was measured upon second assessment (median follow-up time 3.8 years), defined according to NCEP-ATPIII criteria. To estimate direct associations between SEP, health behaviors and MetS remission multivariable logistic regression analyses were used. To estimate the mediating percentages of health behaviors that explain the SEP-MetS remission relationship the Karlson-Holm-Breen method was used. Analyses were adjusted for age, sex, the other SEP measures and follow-up time. RESULTS: At the second assessment, 42.7% of the participants experienced MetS remission. Education and income were positively associated with MetS remission, but occupational prestige was not. The association between education and MetS remission could partly (11.9%) be explained by health behaviors, but not the association between income and MetS remission. CONCLUSIONS: Individuals with higher education more often experienced remission from MetS, mainly because individuals with higher education were more likely to have healthier behaviors. However, individuals with higher income more often experienced MetS remissions, regardless of their health behaviors. The occupational prestige of individuals was not associated with MetS remission