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Biomedical subjects

L M Bouter

Publications and source records attributed to L M Bouter.

At least 253 records · Page 14Linked to original sources
PubMed1994

Clinical scores for acute asthma in pre-school children. A review of the literature.

The objective of this paper was to evaluate the applicability in research and clinical practice of clinical scores for acute asthma in pre-school children. All instruments were reviewed according to a standardized set of criteria: purpose of the score, suitability for use in children, inter-observer agreement, validity and responsiveness. A Medline literature research resulted in 16 different clinical asthma scores, which have been developed to assess the severity of acute asthma, to predict the outcome of an attack, or to evaluate the response to treatment. Most asthma scores could be easily obtained in children. Three scores have been modified to facilitate application in a younger age-category. Inter-observer agreement has received little attention, although all scores contained items that require subjective judgement. The predictive validity was insufficient to justify the application of clinical scores as a decision rule for the admission or discharge of children with acute asthma. Asthma scores seem to be useful for assessing the severity of an attack and evaluating the response to therapy, but as yet there is insufficient information on the performance of the scores to justify a preference. Wheezing and retractions appear to be important items of any useful score for acute asthma.

Acute Disease↗
PubMed1994

Development of a type 2 diabetes symptom checklist: a measure of symptom severity.

The aim of the present study was to develop a Type 2 diabetes symptom checklist for use in clinical and epidemiological research, which can measure differences in symptom severity between patients and detect changes over time within patients. Face and content validity of items and dimension structure were based on literature and experiences of diabetologists. Two Likert scales were used to measure symptom frequency and perceived burden. Reliability, responsiveness and validity were studied in 185 Type 2 diabetic patients. Factor-analysis confirmed the predesigned dimension structure with 34 items, distributed over 6 dimensions. The internal consistency with Cronbach alpha coefficients between 0.76 and 0.95 and test-retest reliability with Pearson product-moment correlation coefficients between 0.79 and 0.94 were satisfactory. The ability to detect change over time (responsiveness) was estimated in stable subjects, using sample size calculations. A minimal detectable mean change of 0.07-0.58 points in total score on the 10-point scale within a group of 100 subjects suggests an impressive responsiveness. Significant differences in symptom severity score were found between patients with different co-morbidity status and treatment modes, indicating satisfactory construct validity of the dimension structure. The Type 2 Diabetes Symptom Checklist was found to be a useful diabetes-specific symptom severity assessment method for clinical and epidemiological studies.

Aged↗
PubMed1993

Maternal characteristics and expected birth weight.

Fetal growth charts currently used aggregate birth weights of infants with various natural histories from 1931 until 1967. In order to modernize these charts, avoiding deviation from the natural history of fetal development, we report data from infants born after spontaneous onset of labour in 'normal' pregnancy from a gestational age of 267 to 295 days between 1972 and 1982 (n = 14,113). The relationship between birth weight and gestational age in days was studied by multiple regression analysis, containing dummy variables for parity and gender. The estimated proportion of the variance in the model, attributed to these characteristics, was 15%. This could be improved to 22% by supplementing the model with maternal characteristics such as age, height, mid-pregnancy weight and ethnic origin. According to this extended model, in the Dutch section of the population 511 (4.6%) babies had a birth weight below the 5th percentile, whereas 412 (3.7%) babies would be labeled as such according to the conventional birth weight tables. Moreover, 93 babies would be wrongly considered too small, corresponding with a sensitivity of 62.4%, and 192 babies would be wrongly considered normal, corresponding with a specificity of 99.3%. Integration of the four currently used tables into one, and adjustment for easily available maternal characteristics, could substantially improve classification methods.

Birth Weight↗
PubMed1993

A randomized clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures.

OBJECTIVE: To study the efficacy of manual therapy and physiotherapy in subgroups of patients with persistent back and neck complaints. The second objective was to determine the correlation between three important outcome measures used in this trial. DESIGN: Randomized clinical trial (subgroup analysis). SETTING: Primary health care in the Netherlands. PATIENTS: Two hundred fifty-six patients with nonspecific back and neck complaints of at least 6 wk duration who had not received physiotherapy or manual therapy in the past 2 yr. INTERVENTIONS: At the discretion of the manual therapists, physiotherapists and general practitioners. Physiotherapy consisted of exercises, massage and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manual therapy consisted of manipulation and mobilization of the spine. Treatment by the general practitioner consisted of drugs (e.g., analgesics), advice about posture, home exercises and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 min) and detuned ultrasound (10 min). MAIN OUTCOME MEASURES: Changes in severity of the main complaint and limitation of physical functioning measured on 10-point scales by a blinded research assistant and global perceived effect measured on a 6-point scale by the patients. RESULTS: Improvement in the main complaint was larger with manual therapy (4.3) than with physiotherapy (2.5) for patients with chronic conditions (duration complaint of 1 yr or longer). Also, improvement in the main complaint was larger with manual therapy (5.5) than with physiotherapy (4.0) for patients younger than 40 yr (both were measured after 12-mo follow-up). Labeling of patients by the treating manual therapists as "suitable" or "not suitable" for treatment with manual therapy did not predict differences in outcomes. Generally, there was a moderate to strong correlation between the three outcome measures, although a considerable number of patients gave a relatively low score for perceived benefit, while the research assistant gave a high improvement score for the main complaint and physical functioning. CONCLUSIONS: The subgroup analysis suggests better results of manual therapy compared to physiotherapy in chronic patients (duration of present complaints of 1 yr or longer) and in patients younger than 40 yr old). Differences for other subgroups were less clear. The explorative findings of these subgroup analyses have to be investigated in future research.

Adult↗
PubMed1993

Efficacy of physiotherapy for musculoskeletal disorders: what can we learn from research?

In order to summarize the available clinical evidence for the efficacy of physiotherapy, 400 randomized clinical trials were identified from the literature. Studies were found by using bibliographic databases, citation tracking, and correspondence with researchers in the field. Focusing on disorders of the musculoskeletal system, a number of criterion based meta-analyses were performed on 180 trials in order to summarize the available evidence. For each randomized clinical trial in each meta-analysis a methodological score was calculated using a set of explicit criteria and weighting factors applied by two or three independent reviewers who were blinded as to the outcomes, the journal and the authors of the publication. In each meta-analysis the randomized clinical trials were ordered hierarchically depending on their score for methodological quality. Meta-analyses were performed for spinal manipulation, exercise therapy, traction, ultrasound, and laser therapy, and for disorders of the back, neck, shoulder and knee. In general, the methodological quality of the studies appeared to be low, and the efficacy of physiotherapy was shown to be convincing for only a few indications and treatments. On the other hand, because of the prevalence of serious methodological flaws, it cannot be concluded that physiotherapy has no effect.

Humans↗
PubMed1992

Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.

OBJECTIVE: To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN: Randomised clinical trial. SETTING: Primary health care in the Netherlands. PATIENTS: 256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years. INTERVENTIONS: At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes). MAIN OUTCOME MEASURES: Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients. RESULTS: Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments. CONCLUSIONS: Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.

Adult↗
PubMed1992

[Future numbers of patients with a cerebrovascular accident in The Netherlands].

Based on future population size estimates, and sex and age specific CVA incidence rates, the yearly number of new cases of CVA in the Netherlands is projected up to 2020. Compared with 1991 the number of patients with a first CVA will increase by at least 4 and at most 6 per cent in 1995, to 41-62 per cent in 2020. Because the prevalence and the number of handicapped patients will probably be much lower, future attention should primarily be directed at support of early phase care facilities.

Aged↗
PubMed1992

The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials.

The efficacy of laser therapy for musculoskeletal and skin disorders has been assessed on the basis of the results of 36 randomized clinical trials (RCTs) involving 1,704 patients. For this purpose, a criteria-based meta-analysis that took into account the methodological quality of the individual trials was used. The studies with a positive outcome were generally of a better quality than the studies with a negative outcome. No clear relationship could be demonstrated between the laser dosage applied and the efficacy of laser therapy, or between the dosage and the methodological score. In general, the methodological quality of these studies appeared to be rather low. Consequently, no definite conclusions can be drawn about the efficacy of laser therapy for skin disorders. The efficacy of laser therapy for musculoskeletal disorders seems, on average, to be larger than the efficacy of a placebo treatment. More specifically, for rheumatoid arthritis, posttraumatic joint disorders, and myofascial pain, laser therapy seems to have a substantial specific therapeutic effect. Further RCTs, avoiding the most prevalent methodological errors, are needed in order to enable the benefits of laser therapy to be more precisely and validly evaluated.

Dose-Response Relationship, Radiation↗
PubMed1992

The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial.

In a randomized trial, the effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for patients (n = 256) with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner. Differences in effectiveness between physiotherapy and manual therapy could not be shown. A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects.

Adult↗
PubMed1992

Aetiology of handball injuries: a case--control study.

This article presents the results of a case--control study regarding the background to handball injuries among players of 12 years and older. Data were collected by means of a written questionnaire on the nature, location and direct causes of the injuries as well as information on risk factors. Injured players (n = 130) are compared with non-injured players (n = 512). The response for the cases was 67% and for the controls 75%. These injuries are frequently located at the lower extremities (54% of injuries), especially the ankle, and the majority involve distortions (35%) and strains (26%). Players greater than 20 years have a significantly greater risk of injury than players less than 20 years (odds ratio 1.9). Several factors seem to increase the injury risk, although not significantly: having greater than 5 years experience, not doing stretching exercises and not wearing tape or bandages. Another factor, not wearing elbow protectors, appears to decrease the injury risk significantly. It is advisable to interpret the results of this study with some caution, as selection and information bias might have influenced the validity to some extent. Furthermore, the reliability of the data is limited due to the relatively small number of injured players in the study. Some guidelines for future studies are formulated.

Adolescent↗
PubMed1992

The efficacy of chiropractic manipulation for back pain: blinded review of relevant randomized clinical trials.

OBJECTIVE: To assess the efficacy of chiropractic for patients with back pain. DATA SOURCES: Randomized clinical trials (RCTs) on spinal manipulation were identified with a Medline search (1966-1990), by citration tracking, and by manual examination of the relevant chiropractic reference systems [Chiropractic Research Archives Collection and Index to Chiropractic Literature]. [Indexing terms, Medline; backache, musculoskeletal diseases, manipulation, osteopathy or chiropractic in combination with evaluation studies, outcome and process assessment, prospective studies, comparative studies, clinical trials or double blind method. Indexing terms, Chiropractic Research Archives Collection: backache therapy-chiropractic clinical trials, cost benefit analysis, evaluation studies--chiropractic, manipulation--spinal, prospective studies, sciatica-therapy. Indexing terms, Index to Chiropractic Literature, backache therapy, clinical trials, cost benefit analysis, intervertebral disc displacement-therapy.] STUDY SELECTION: All RCTs involving chiropractors as therapists. To find additional evidence from nonchiropractic RCTs, chiropractic standards similar to the type of treatment used in nonchiropractic trials were determined by a panel of blinded chiropractors. DATA EXTRACTION: Review by two blinded reviewers independently, using a list of methodological criteria, each of which was attached to a weight. The maximum was set at 100 points. DATA SYNTHESIS: We identified five chiropractic RCTs. No similarity to chiropractic standards could be detected in any of the nonchiropractic RCTs. No chiropractic RCT had a methodological score of more than 50 points. The authors of four of the trials report favorable results for chiropractic, while one refrains from drawing conclusions. The results of the chiropractic RCTs differed on the timing of maximal effect as well as on the subgroups showing the best treatment results. CONCLUSIONS: Although the small number of chiropractic RCTs and the poor general methodological quality precludes the drawing of strong conclusions, chiropractic seems to be an effective treatment of back pain. However, more studies with a better research methodology are clearly still needed.

Back Pain↗
PubMed1992

A blinded randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures.

In a blinded randomized clinical trial, we compared the effectiveness of manual therapy, physiotherapy, (continued) treatment by the general practitioner (GP), and a placebo therapy (detuned ultrasound and detuned short wave diathermy) for patients (n = 256) with chronic nonspecific back and neck complaints. The physical outcome measures (spinal mobility and physical functioning) are presented for 3, 6 and 12 wk follow-up. Manual therapy showed a faster and larger improvement in physical functioning compared to the other three therapies. The changes in spinal mobility among the four study groups appear to be small and show no consistent pattern.

Adult↗
PubMed1991

Spinal manipulation and mobilisation for back and neck pain: a blinded review.

OBJECTIVE: To assess the efficacy of spinal manipulation for patients with back or neck pain. DESIGN: Computer aided search for published papers and blinded assessment of the methods of the studies. SUBJECTS: 35 randomised clinical trials comparing spinal manipulation with other treatments. MAIN OUTCOME MEASURES: Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis) and main conclusion of author(s) with regard to spinal manipulation. RESULTS: No trial scored 60 or more points (maximum score 100) suggesting that most were of poor quality. Eighteen studies (51%) showed favourable results for manipulation. In addition, five studies (14%) reported positive results in one or more subgroups. Of the four studies with 50-60 points, one reported that manipulation was better, two reported that manipulation was better in only a subgroup, and one reported that manipulation was no better or worse than reference treatment. Eight trials attempted to compare manipulation with some placebo, with inconsistent results. CONCLUSIONS: Although some results are promising, the efficacy of manipulation has not been convincingly shown. Further trials are needed, but much more attention should be paid to the methods of study.

Acute Disease↗
PubMed1991

Physiotherapy exercises and back pain: a blinded review.

OBJECTIVE: To determine the quality of randomised controlled trials of exercise therapy for back pain. DESIGN: Computer aided search of published papers and blinded assessment of the methods of studies. SUBJECTS: 23 randomised controlled trials, of which 16 studied exercise therapy given by physiotherapists to individual patients with back pain. Other conservative treatments could be included. MAIN OUTCOME MEASURES: Score for quality of methods (based on four main categories: study population, interventions, measurement of effect, and data presentation and analysis) and main conclusion of author(s) with regard to exercise therapy. RESULTS: Only four studies scored more than 50 points (maximum 100), indicating that most were of poor quality. Six studies found that exercise was better than reference treatments and 10 reported it to be no better or worse than the reference treatment. Those reporting positive results tended to have higher methods scores (4/6 positive v 4/10 negative scored greater than or equal to 42). CONCLUSIONS: No conclusion can be drawn about whether exercise therapy is better than other conservative treatments for back pain or whether a specific type of exercise is more effective. Further trials are needed in which greater attention is paid to methods of study.

Back Pain↗
PubMed1991

Aetiology of burn injuries among children aged 0-4 years: results of a case-control study.

During the year 1987/1988 a case-control study was conducted, by means of a postal questionnaire, among parents of children aged 0-4 years. Cases (n = 122) were 0-4-year-old Dutch children who visited emergency departments with burn injuries. Controls (n = 213) were a sample of the Dutch population of 0-4-year-old children without burn injuries. Odds ratios based on logistic regression (OR-LR) and 90 per cent confidence intervals (CI (90 per cent) were calculated for a number of putative risk factors. The risk of burns was higher for children with other than Dutch (e.g. Turkish) ethnicity (OR-LR = 5.6; CI (90 per cent) = 2.6-11.9). Children who lived in relatively small houses turned out to have a higher risk of burns (OR-LR = 2.5; CI(90 per cent) = 1.3-4.7). To our surprise, children belonging to lower socioeconomic classes were found to have a decreased risk of burns (OR-LR = 0.3; CI (90 per cent) = 0.1-0.6). Furthermore, among several manipulatable risk factors, the use of an oven window which gets hot while in use appeared to have an increased risk of burns (OR-LR = 2.1; CI(90 per cent) 1.3-3.5). The same holds for the storage of hot drinks in their original pots instead of in vacuum flasks (OR-LR = 2.0; CI (90 per cent) 1.2-3.1). Cooking on a gas stove was found to be another risk factor (OR-LR = 2.5; CI(90 per cent) 1.1-10.0).

Burns↗