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van Tilburg ML, Kloek CJJ, Pisters MF, Staal JB, van Dongen JM, de Weerd M, Ostelo RWJG, Foster NE, Veenhof C. Stratified care integrated with eHealth versus usual primary care physiotherapy in patients with neck and/or shoulder complaints: protocol for a cluster randomized controlled trial. BMC Musculoskelet Disord 2021; 22:143. [PMID: 33546656 PMCID: PMC7862842 DOI: 10.1186/s12891-021-03989-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient's risk of persistent disabling pain. Mode of care delivery can be matched to the patient's suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. METHODS This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient's risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient's suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. DISCUSSION The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints. TRIAL REGISTRATION Netherlands Trial Register: NL8249 . Officially registered since 27 December 2019. Date of first enrollment: 30 September 2020. Study status: ongoing, data collection.
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Affiliation(s)
- Mark L van Tilburg
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
| | - Corelien J J Kloek
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
| | - Martijn F Pisters
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
| | - Marjolein de Weerd
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- STARS Education and Research Alliance, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Cindy Veenhof
- Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Heerkens YF, de Weerd M, Huber M, de Brouwer CPM, van der Veen S, Perenboom RJM, van Gool CH, Ten Napel H, van Bon-Martens M, Stallinga HA, van Meeteren NLU. Reconsideration of the scheme of the international classification of functioning, disability and health: incentives from the Netherlands for a global debate. Disabil Rehabil 2017; 40:603-611. [PMID: 28129712 DOI: 10.1080/09638288.2016.1277404] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe 'functioning' and 'disability'), including the ICF scheme (visualization of functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes. METHOD Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes. RESULTS The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of 'health condition' at the top and role of 'contextual factors'). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme. CONCLUSIONS There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health. Implications for Rehabilitation We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm. We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health. We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases). We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.
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Affiliation(s)
- Yvonne F Heerkens
- a Dutch Institute of Allied Health Care , Amersfoort , The Netherlands.,b Research Group Occupation & Health , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | | | - Machteld Huber
- d Institute for Positive Health , Amersfoort , The Netherlands
| | - Carin P M de Brouwer
- e Department of Epidemiology, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Sabina van der Veen
- f Innovation Health Care Professions & Education , Dutch Health Care Institute , Diemen , The Netherlands
| | | | - Coen H van Gool
- g WHO Collaborating Centre for the Family of International Classifications in The Netherlands, National Institute for Public Health and the Environment , Bilthoven , The Netherlands
| | - Huib Ten Napel
- g WHO Collaborating Centre for the Family of International Classifications in The Netherlands, National Institute for Public Health and the Environment , Bilthoven , The Netherlands
| | - Marja van Bon-Martens
- h The Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht , The Netherlands
| | - Hillegonda A Stallinga
- i School of Nursing & Health, University Medical Center, University of Groningen , Groningen , The Netherlands
| | - Nico L U van Meeteren
- j Topsector Life Sciences and Health (Health ∼ Holland) , The Hague , The Netherlands.,k CAPHRI, Maastricht University , Maastricht , The Netherlands
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de Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, O'Leary DH, Rosvall M, Sitzer M, de Borst GJ, Buskens E, Bots ML. Prediction of asymptomatic carotid artery stenosis in the general population: identification of high-risk groups. Stroke 2014; 45:2366-71. [PMID: 24994719 DOI: 10.1161/strokeaha.114.005145] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Because of a low prevalence of severe carotid stenosis in the general population, screening for presence of asymptomatic carotid artery stenosis (ACAS) is not warranted. Possibly, for certain subgroups, screening is worthwhile. The present study aims to develop prediction rules for the presence of ACAS (>50% and >70%). METHODS Individual participant data from 4 population-based cohort studies (Malmö Diet and Cancer Study, Tromsø Study, Carotid Atherosclerosis Progression Study, and Cardiovascular Health Study; totaling 23 706 participants) were pooled. Multivariable logistic regression was performed to determine which variables predict presence of ACAS (>50% and >70%). Calibration and discrimination of the models were assessed, and bootstrapping was used to correct for overfitting. RESULTS Age, sex, history of vascular disease, systolic and diastolic blood pressure, total cholesterol/high-density lipoprotein ratio, diabetes mellitus, and current smoking were predictors of stenosis (>50% and >70%). The calibration of the model was good confirmed by a nonsignificant Hosmer and Lemeshow test for moderate (P=0.59) and severe stenosis (P=0.07). The models discriminated well between participants with and without stenosis, with an area under the receiver operating characteristic curve corrected for over optimism of 0.82 (95% confidence interval, 0.80-0.84) for moderate stenosis and of 0.87 (95% confidence interval, 0.85-0.90) for severe stenosis. The regression coefficients of the predictors were converted into a score chart to facilitate practical application. CONCLUSIONS A clinical prediction rule was developed that allows identification of subgroups with high prevalence of moderate (>50%) and severe (>70%) ACAS. When confirmed in comparable cohorts, application of the prediction rule may lead to a reduction in the number needed to screen for ACAS.
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Affiliation(s)
- Marjolein de Weerd
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Jacoba P Greving
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.).
| | - Bo Hedblad
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Matthias W Lorenz
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Ellisiv B Mathiesen
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Daniel H O'Leary
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Maria Rosvall
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Matthias Sitzer
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Gert Jan de Borst
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Erik Buskens
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
| | - Michiel L Bots
- From the Julius Center for Health Sciences and Primary Care (M.d.W., J.P.G., M.L.B.) and Department of Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Sciences, Cardiovascular Epidemiology (B.H.) and Department of Clinical Sciences, Social Epidemiology (M.R.), Lund University, Malmö University Hospital, Malmö, Sweden; Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany (M.W.L., M.S.); Department of Clinical Medicine, University of Tromsø, Tromsø, Norway (E.B.M.); Tufts University School of Medicine, Boston, MA (D.H.O'L.); and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (E.B.)
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