Biomedical subjects

L M Bouter

Publications and source records attributed to L M Bouter.

267 records · Page 15Linked to original sources

PubMed1991

Incidence of medically treated burns in The Netherlands.

During the period January 1988 to December 1989, medically treated burn injuries in The Netherlands were recorded prospectively by three registration systems. These systems cover patients treated in burn units, in general and university hospitals, and by general practitioners. Incidence rates and 95 per cent confidence intervals were calculated, and basic epidemiological data about severity and localization of the burns and about accident circumstances were collected. The overall incidence rate of medically treated burns over all levels of medical care is estimated to be about 280 per 100,000 persons per year. This overall incidence figure appeared to be about three times as high for 0-4-year-old children: 775 per 100,000 per year. At all levels of medical care, scalds are the most frequent type of burn, resulting in an overall incidence rate among 0-4-year-old children of 430 per 100,000 per year. Incidence rates are lowest among the elderly (55 years and over), but this age group suffers a higher mortality from burns. Furthermore, it appeared that males are more prone to serious burns than females, whereas female are more often treated for less severe burns. Most of the accident circumstances for serious burns were related to professions, whereas most of the circumstances for less severe burns were related to household activities.

Adolescent↗

PubMed1991

Determinants of behavioural risk factors for burn injuries.

Systematically developed health education should be based on a thorough knowledge of the determinants of the behavioural risk factors. Compared to other health-related behaviours, safety behaviour has some specific characteristics, which complicate studying its determinants. First, there is a multitude of circumstances leading to injuries, which means that it is not possible to pinpoint one desired behaviour to be linked with the prevention of injuries. Secondly, people are often not familiar with (the advantages and disadvantages of) all the possible preventive measures. Thirdly, the usefulness of preventive measures may depend on housing situations. So far, no elegant way of coping with these problems in examining the determinants of safety behaviour seems to have been suggested in the literature. In this article an approach to the study of determinants of safety behaviour is presented. The general description of this approach is illustrated by a study on the determinants of the behavioural risk factors for burn injuries in young children, which was conducted among Dutch and Turkish parents of children aged 0-4 years. The results indicate, for instance, that parents who implemented the safety behaviour reported that safety behaviour had become habitual to them.

Accidents, Home↗

PubMed1991

Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British Randomized Clinical Trial.

This article discusses the methodology of a recently published British randomized clinical trial comparing chiropractic and physiotherapy as treatments for low back pain. The authors base their main conclusions on a difference shown by the Oswestry pain questionnaire 2 yr after randomization, when data of only 26% of the patients were available. This might have led to an overestimation, because it appears that the difference in Oswestry scores is much larger for patients included early in the study. It may also be doubted whether the magnitude of the effect reported really indicates a clinically significant difference between the interventions. In addition to allocated intervention, the groups also differ in duration of treatment, number of sessions, level of experience of the therapist, and health care setting. The results are difficult to extrapolate, because only a small portion of the eligible patients participated, and chiropractic seems to be clearly superior only in the subgroup originally presenting to a chiropractic clinic. We conclude that it is premature to draw conclusions about the long-term effectiveness of chiropractic based on the results of this study alone.

Adult↗

PubMed1990

Importance of planned health education for burn injury prevention.

The planning of health education in the prevention of burn injuries is typically incomplete and not stated explicitly, while the evaluation is executed only partially or is altogether non-existent. This article presents a theoretical framework for planning and evaluating health education for those at risk for burns. Systematic planning consists of an assessment of the magnitude and severity of the problem, an analysis of the behavioural risk factors, a study of the determinants of the most risky modes of behaviour, the design of an optimal intervention, and the implementation of this intervention. The evaluation phase deals with the effects on these five levels (implementation, intervention, determinants, behaviour and injury risk). Some common pitfalls are mentioned and special attention is given to the study of determinants of behaviour and to the design of the intervention. Furthermore, the importance of pretesting health education material is underlined. There appears to be a strong need for further research on the aetiology of burn injury and the relevant determinants of behaviour, before effective prevention can be realized.

Age Factors↗

PubMed1989

The aetiology of burns in developed countries: review of the literature.

This article reviews the literature on the incidence and aetiology of burn injuries. Burn injuries are among the most serious injuries man can incur. Although prevention of burn injuries has been given a good deal of attention in the past, it has never been subjected to a systematic approach which could result in a thorough knowledge of the incidence and the major risk factors and risk groups. The methodological limitations of the studies carried out in this field are striking. For instance, none of the studies of risk factors has used a control population for comparison. No figures are available on the total number of burn injury patients in the Netherlands. Estimates are derived from the situation in other countries, which yields an incidence of four per 1000 per year. Scalds are relatively common in the 0-4-year category. This is usually assumed to be caused by the stage of development of motor and cognitive skills, coupled with incorrect assumptions about these skills by parents. Men are found to be more often the victims of burns than women. Coffee and tea are assumed to be risk factors. The supposed risk factors and risk groups need to be investigated in a controlled epidemiological study, in order to allow establishment of preventive measures.

Accidents, Home↗

PubMed1989

How to study the aetiology of burn injury: the epidemiological approach.

Effective prevention of burn injury should be based on sound aetiological knowledge. This article deals with epidemiological methods to study the incidence of burn injury as a function of its risk factors. Central methodological issues are comparability of baseline prognosis, comparability of measurements (of effects in cohort studies and of risk factors in case-control studies), and comparability of external circumstances. These principles are clarified with a number of fictitious examples of risk factors for burn injury. It is explained that in preventive trials comparability may be achieved by randomization, blinding and placebo intervention. The main tools in non-experimental studies are deliberate selection and multivariate analysis. Special attention is given to the definition of the source population and to reducing measurement incomparability in case-control studies. Some well-designed case-control studies following these principles might bring effective prevention of burn injury some steps nearer.

Burns↗

PubMed1989

Personal and environmental factors in relation to injury risk in downhill skiing.

A case-control study was conducted among Dutch downhill skiers. This article presents data on the circumstances of the accident leading to injury and on personal and environmental risk factors for both cases (n = 572) and controls (n = 576). Most accidents (84%) happened on the pistes and ski lifts were involved in about 6% of them. Bad condition of the ski run (30%) and lost balance (24%) were the direct causes most frequently mentioned. Risk seemed to be constant for particular days and moments of the day. Injury risk for the individual appeared to rise with increasing duration of exposure, although very small durations had an elevated risk as well. A relatively low risk was observed for skiers who reported to be only moderately rested (OR = 0.4) and for those who admitted a certain fear of having a ski accident (OR = 0.6). A relatively high risk was observed for the presence of icy spots (OR = 1.4), while poor visibility (OR = 0.4), the presence of clouds (OR = 0.5), and perceived coldness (OR = 0.5) were associated with a relatively low injury risk. No recommendations for prevention can be based on these results. Most factors mentioned are not open to manipulation and further quantification should involve prospective study designs and independent measurements of these factors.

Accidents↗

PubMedDate not supplied

Binding function in relation to injury risk in downhill skiing.

Time-trend studies suggest that in the recent past, the use of modern equipment and adequately functioning ski bindings have had a preventive effect on injuries. The question of whether a further decrease of injury figures can still be expected from better binding adjustment is investigated in a case-control study (N = 1,148) conducted among Dutch skiers. Nonrelease of both bindings directly before injury was associated with a higher risk (odds ratio = 3.3) for lower extremity (LE) injury. Binding release before LE injury was highest (31%) among those for whom adjustment was performed and then confirmed with a test device. The proportion of nonrelease is highest for knee injuries. No effect on injury risk could be found for the time of adjustment, the method of adjustment, or the person performing the adjustment. Direct measurement of binding function seems indispensable. The use of rented or borrowed skis was associated with a higher risk (odds ratio = 1.9) for LE injury. The same holds for ignorance concerning the type of ski and the age of the skis and bindings. We concluded that binding adjustment still seems to be a risk factor open to manipulation. The efficacy of intervention aimed at better adjustment should be studied experimentally.

Adolescent↗

PubMedDate not supplied

On the importance of planned health education. Prevention of ski injury as an example.

The planning of health education aimed at preventing sports injuries is often incomplete and not stated explicitly. In most instances, the evaluation is incomplete or nonexistent. We present a theoretical framework for planning and evaluating health education, illustrating the main points by using as an example the health education for downhill skiers. Systematic planning consists of analyzing the magnitude of the problem and the behavioral risk factors, studying behavior determinants, designing an optimal intervention, and implementing the intervention. The evaluation phase deals with the effects on these five levels (implementation, intervention, determinants, behavior, and incidence of injury). Some common pitfalls are mentioned and special attention is given to the study of determinants of behavior and to the design of the intervention. The importance of pretesting health education material and the community approach in educating sports participants is underlined. Health education, together with regulations and facilities, constitutes the health promotion strategy in the prevention of sports injuries. For most sports, there seems to be a strong need for further research on the etiology and determinants of behavior before effective prevention can be realized.

Athletic Injuries↗

PubMedDate not supplied

Which are the best instruments for measuring disabilities in gait and gait-related activities in patients with rheumatic disorders.

OBJECTIVES: Our first objective was to make an inventory of available instruments for the assessment of disabilities in gait and related activities in patients with rheumatic disorders. Our second aim was to investigate which of these instruments have acceptable methodological quality with regard to reliability and validity. Our third aim was to investigate the assumption that the evaluation of convergent construct validity results in stronger correlations when validated against a more similar construct. MATERIALS: A computer-aided literature search (1982-2001) of several databases was performed to identify studies focusing on the clinimetric properties of instruments to assess impairments in function in patients with rheumatic disorders. Data on intra-rater reliability, inter-rater reliability and convergent construct validity were extracted in a standardized manner and compared to a priori defined criteria. RESULTS: In total 78 instruments were eligible. Intra-observer reliability was investigated for 28 instruments and only 7 demonstrated good reliability as well as good validity. Surprisingly, the convergent construct validation against a similar construct resulted often in lower correlations than validation against a less similar construct. CONCLUSION: Based on the available information, the Rheumatoid Arthritis Quality of Life Scale and the Health Assessment Questionnaire seem to be the best instruments for assessing disabilities in gait and related activities in patients with rheumatic disorders.

Databases, Factual↗

PubMedDate not supplied

Reliability, validity and responsiveness of instruments to assess disabilities in personal care in patients with rheumatic disorders. A systematic review.

OBJECTIVES: The first aim was to make an inventory of available instruments and questionnaires for the assessment of disabilities in personal care in patients with rheumatic disorders. The second aim was to investigate which of these instruments have acceptable, methodological quality with regard to reliability, validity and responsiveness. The third aim was to investigate the assumption that convergent validity results in stronger correlations when validated against a more similar construct. METHODS: A computer-aided literature search (1982-2001) in several databases was performed to identify studies focusing on the clinimetric properties of instruments to assess impairments in function in patients with rheumatic disorders. Data were extracted in a standardised way and compared to a priori defined criteria. RESULTS: In total, 19 measurement instruments were included. Five out of these 19 were found to have acceptable reliability, while 12 had acceptable validity. Only three questionnaires met both criteria. Results concerning the responsiveness of these three questionnaires were conflicting. No difference was found in the strength of correlation between validation against the most similar construct versus validation against the least similar construct. CONCLUSION: It is concluded that the Arthritis Impact Measurement Scale (AIMS) is the most suitable instrument for the assessment of disabilities in personal care.

Activities of Daily Living↗

PubMedDate not supplied

Construct validity of instruments measuring impairments in body structures and function in rheumatic disorders: which constructs are selected for validation? A systematic review.

PURPOSE: This paper focuses on the construct validity of instruments measuring impairments in body structures and function in rheumatic disorders. The objective is: 1) to make an inventory of constructs, based on the domains of the International Classification of Functioning, Disabilities and Health problems (ICF), against which instruments measuring impairments in body structures and function were validated; 2) to analyse whether validation against a similar construct resulted in higher correlation coefficients than validation against a dissimilar construct. METHODS: In a systematic review papers were identified in which instruments measuring impairments in body structures and function for patients with rheumatic disorders were validated. The instruments identified were assessed on their methodological properties and the constructs against which they were validated. Subsequently, pooled (interclass) correlations of similar constructs and dissimilar constructs against which was validated were compared. An instrument was decided to have good construct validity, if the correlation coefficient was 0.50 or higher, and the measurement instrument in question is validated against similar constructs. RESULTS: In total 216 papers were identified analysing the validity of 42 different instruments. Only 16% of these instruments were validated against instruments that represent the most similar construct. In general, estimates of construct validity were lower when validated against dissimilar constructs, except for instruments measuring impairments in mental functions. CONCLUSION: There is a trend that validation against a similar construct yields higher correlation coefficients than validation against a dissimilar construct. If an instrument measuring impairments is validated against the most similar construct, and a criterion of r > 0.50 is applied, only 10 out of the 42 identified instruments turned out to be valid.

Humans↗

PubMedDate not supplied

The effectiveness of manual therapy, physiotherapy and continued treatment by the general practitioner for chronic nonspecific back and neck complaints: design of a randomized clinical trial.

There are strong arguments for publishing research protocols before the results are available. First, it permits a critical judgment of the design unbiased by knowledge of the results, and second it may prevent publication bias. We present the design of a randomized trial on the effectiveness of manual therapy, physiotherapy, (continued) treatment by the general practitioner and a placebo treatment for patients (n = 300) with chronic (more than 6 wk) nonspecific back and neck complaints. In designing this trial in close cooperation with manual therapists and physiotherapists, special attention has been given to inclusion and exclusion criteria, (blinded) outcome measurements and control (placebo) treatment(s). Outcome measures include severity of complaints rated by a blinded research assistant, global perceived effect assessed by the patient, pain severity, functional status, range of motion (ROM) of the spine and recurrence. Measurements are carried out at baseline and after 3 wk, 6 wk, 3 months, 6 months and 1 yr.

Back Pain↗

PubMedDate not supplied

Chiropractic in The Netherlands: a survey of Dutch chiropractors.

BACKGROUND: In the Netherlands, there is increasing public and political interest in chiropractic treatment. There is, however, very little descriptive information available in the Netherlands on the chiropractic profession. Therefore, a survey was conducted among all Dutch chiropractors. METHODS: A questionnaire was sent to all members of the Netherlands' Chiropractors Association (n = 59). It contained questions on (postgraduate) education, practice management, diagnostics (including radiology use), treatment, interprofessional cooperation and referral. RESULTS: The response was 88%. Chiropractic is growing rapidly: the number of chiropractors has doubled in five years. Chiropractors primarily treat back and neck pain, with an average of 8 treatments. Conventional orthopedic and neurological examination along with motion palpation are the cornerstones of physical examination. The respondents stressed the importance of direct access to radiography and specialized (hospital) diagnostics. Fifty-eight percent of the chiropractors have their own X-ray equipment. The most frequent reason for taking new X-rays was the absence of cooperation with radiology departments. Self-referral is the largest source of patients. The referral rate to other health care professionals is low. CONCLUSIONS: The number of chiropractors is growing rapidly. They have an exceptional position in the Dutch health care system. Access to X-ray and more specialized diagnostics are presently the most important political issues.

Chiropractic↗

PubMedDate not supplied

Does the goose really lay golden eggs? A methodological review of Workmen's Compensation studies.

OBJECTIVE: To assess the value of workmen's compensation (WC) studies to determine the effectiveness of chiropractic. Therefore, the results of the available WC studies are summarized and the methodological quality of WC studies is discussed. DATA SOURCES: All studies were eligible without time restriction. Studies were identified by a Medline search from 1966 to 1990 (key words: chiropractic, and manipulation-orthopedic in combination with comparative studies, follow-up studies, evaluation studies) by manual examination of the most important chiropractic reference systems (CRAC and Index to Chiropractic Literature), by tracking the reference lists of identified (reviews of) WC studies and by correspondence with researchers. STUDY SELECTION: Studies were regarded as WC studies if by means of databases of WC boards, a comparison was made between claimants treated by chiropractors and those treated by other health care professionals. At least one of the following outcomes should be reported: compensated days, compensation paid or treatment costs. DATA EXTRACTION: Relevant data (authors, year, state, study population, number of patients, days compensated, compensation paid, number of treatments, consultation costs, additional treatment costs and total cost per case) were extracted by one nonblinded observer. The methodological value was reviewed narratively. DATA SYNTHESIS: The retrospective character of WC studies and the use of large WC databases harbor severe methodological problems like incomparability of study groups, absence of information on prognostic indicators, insufficient outcome measures and missing data. The results of older WC studies (before 1980) and the more recent WC studies, which were of better methodological quality, are presented separately. The older studies are in favor of chiropractic. Two of the six more recent WC studies challenge chiropractic effectiveness. CONCLUSIONS: WC studies in general report positive results for chiropractic. Recent results are more ambiguous. Because of the methodological drawbacks identified, WC studies are insufficient to enable a valid study made of chiropractic effectiveness. Therefore, chiropractic (cost-) effectiveness is not yet convincingly proven. More effort should be directed at establishing randomized clinical trials including the question of (cost-) effectiveness.

Accidents, Occupational↗