Pepijn Roelofs

Cost-effectiveness of lumbar supports for home care workers with recurrent low back pain: An economic evaluation alongside a randomized-controlled trial

Study Design. Economic evaluation from a societal perspective alongside a 12-months randomized-controlled trial. Objective. To determine the cost-effectiveness of wearing a lumbar support for home care workers with recurrent low back pain (LBP) (secondary prevention). Summary of Background Data. LBP is a large medical and economical burden. Evidence on the secondary preventive use of lumbar supports is sparse. Methods. A total of 360 home care workers with a self-reported history of LBP were randomly assigned to usual care or usual care plus wearing a lumbar support on working days with LBP, during a 1-year period. Primary clinical outcome measures were the average number of self-reported days with LBP, number of calendar days sick leave in general, and quality of life. Direct and indirect costs were measured by means of cost diaries. Differences in mean costs between groups, cost-effectiveness, and cost-utility ratios were evaluated, and cost-effectiveness planes and acceptability curves presented by applying nonparametric bootstrapping techniques. Results. During the intervention period, the home care workers using a lumbar support in addition to usual care reported on average 54 fewer days with LBP (95% confidence interval [CI], −85 to −29). The estimated mean difference in sick leave was not statistically significant (−5.0 days per year in favor of the lumbar support group; 95% CI, −21.1 to 6.8). There was no statistically significant difference in quality of life. Direct costs were &OV0556;235 (US

Employment-Related Concerns of HIV-Positive People in the Netherlands: Input for a Multidisciplinary Guideline

266) lower in the lumbar support group (95% CI, −386 to −79). Indirect costs were &OV0556;255 (US

Exploring effectiveness and effective components of self-management interventions for young people with chronic physical conditions: A systematic review

288) lower, but this was not statistically significant (95% CI, −879 to 299). Conclusion. Lumbar support seems to be a cost-effective addition to usual care for home care workers with recurrent LBP. For estimating the LBP-related indirect costs, it would be more precise when an objective measure for LBP-related sick leave would have been available. There is a need for more evidence to confirm these findings, also in other working populations.

NSAIDs for Chronic Low Back Pain.

Purpose Finding and keeping employment is difficult for people with HIV. To improve supportive care for people with HIV and employment-related problems, a multidisciplinary guideline was developed in the Netherlands in 2010/2011. To identify the employment-related concerns of people with HIV and to formulate the key questions for the guideline, we conducted a qualitative study. The results of this study are described in this article. Methods This study was performed in three HIV-treatment centers in the Netherlands. In total 18 participants participated in three focus-group interviews and nine participants were interviewed individually. The data were transcribed ad verbatim and were analyzed according to the principle of constant comparison. Results Our findings indicate that people with HIV in the Netherlands face many work-related concerns. The themes which emerged from this study were disclosure, stigma and discrimination, knowledge about HIV, physical and psychological factors, working conditions, absenteeism, reintegration, and dismissal and counselling. Conclusions This study provides insight into employment-related concerns for people with HIV living in a Western country. It formed the basis for the key questions which were addressed in a multidisciplinary, evidence-based guideline “HIV and work”. Finally, it gives leads for further scientific research and opportunities for improving the vocational guidance of people with HIV.

The development of a multidisciplinary, evidence-based guideline for “HIV and employment”

OBJECTIVE To systematically explore the effectiveness and effective components of self-management interventions. METHODS Study selection criteria were: Original articles in English published between 2003 and 2015; focusing on youth with chronic conditions; describing self-management interventions; with clear outcome measures; using RCT design. The random effects analysis was applied in which standardized mean differences per study were calculated. RESULTS 42 RCTs were included. Interventions focused on medical management, provided individually in clinical settings or at home by mono-disciplinary teams showed a trend in improving adherence. Interventions delivered individually at home by mono-disciplinary teams showed a trend in improving dealing with a chronic condition. CONCLUSIONS AND PRACTICAL IMPLICATIONS Adherence could be improved through interventions focused on medical management, provided individually in a clinical or home setting by a mono-disciplinary team. Interventions focused on dealing with a chronic condition might be provided individually, through telemedicine programs facilitating peer-support. These intervention elements seemed effective irrespective of diagnosis, and may therefore act as good starting points for further research into and for improvement of self-management support for youth with chronic conditions in pediatric care. Results underlined the need to systematically develop and evaluate self-management interventions, since this may provide more evidence for effectiveness and effective intervention components.

Nonsteroidal Anti-inflammatory Drugs for Sciatica : An Updated Cochrane Review

Clinical Question Are nonsteroidal anti-inflammatory drugs (NSAIDs) associated with greater pain relief than placebo, other drugs, and nondrug treatments for patients with chronic low back pain? Bottom Line Compared with placebo, NSAIDs are associated with a small but significant improvement in pain and disability in patients with chronic low back pain, although this difference became nonsignificant when studies with high risk for bias were excluded. The associated benefits were smaller than the minimal clinically important difference.

Are people living with HIV less productive at work

The objective of this study was to develop a multidisciplinary guideline that supports the care and vocational rehabilitation of HIV-infected people with employment-related problems. The guideline was developed according to the “evidence-based guideline development” method developed by the Dutch Institute for Health Care Improvement. This method consists of the following steps: forming a multidisciplinary core group and an expert panel, formulating key questions, searching and appraising the available literature, formulating considerations and recommendations, peer reviewing the draft guideline, and authorizing the final guideline. All relevant professional associations were represented in the core group that was assembled to develop the guideline, i.e., HIV doctors, HIV nurses, general practitioners, occupational health physicians, psychologists, social workers, occupational health nurses, vocational experts, and insurance physicians. Five key questions for the guideline were formulated with the following themes: determinants of employment, disclosure and stigma, self-management, interventions, and the organization of care. In the literature review on these topics, 45 studies met the inclusion criteria. The methodological quality of the included articles was poor. Factors such as patient preferences and medical/ethical issues were considered. The recommendations in the guideline are a weighting of the scientific evidence and the considerations of the core group. The guideline, as well as its summary for daily practice, clarifies the most important barriers and facilitators to people with HIV either staying at work or returning to work, and it constitutes a clinical, easy-to-use guideline for health-care providers and how they can support people with HIV who want to work.

Work-related stigma and disclosure: A daily challenge for people living with HIV

STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To determine the efficacy of Nonsteroidal anti-inflammatory drugs (NSAIDs) on pain reduction, overall improvement, and reported adverse effects in people with sciatica. SUMMARY OF BACKGROUND DATA NSAIDs are one of the most frequently prescribed drugs for sciatica. METHODS We updated a 2008 Cochrane Review through June 2015. Randomized controlled trials that compared NSAIDs to placebo, to other NSAIDs, or to other medication were included. Outcomes included pain using mean difference (MD, 95% confidence intervals 95%CI). For global improvement and adverse effects risk ratios (RR,95% CI) were used. We assessed level of evidence using the GRADE approach. RESULTS Ten trials were included (N = 1651). Nine out of ten trials were assessed at high risk of bias. For pain reduction (Visual Analogue Scale, 0 to 100) NSAIDs were no more effective than placebo (MD -4.56, 95% CI -11.11 to 1.99, quality of evidence: very low). For global improvement NSAIDs were more effective than placebo (RR 1.14 (95%CI 1.03 to 1.27, low quality of evidence). One trial reported the effect of NSAIDs on disability with very low quality evidence that NSAIDs are no more effective than placebo. There was low-quality evidence that the risk for adverse effects is higher for NSAID than placebo (RR 1.40, 95%CI 1.02 to 1.93). CONCLUSION Our findings show very low quality evidence that the efficacy of NSAIDs for pain reduction is comparable to that of placebo, low quality evidence that NSAIDs is better than placebo for global improvement and low quality evidence for higher risk of adverse effects using NSAIDs compared to placebo. The findings must be interpreted with caution, due to small study samples, inconsistent results and a high risk of bias in the included trials.Study Design. Systematic review and meta-analysis. Objective. To determine the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) on pain reduction, overall improvement, and reported adverse effects in people with sciatica. Summary of Background Data. NSAIDs are one of the most frequently prescribed drugs for sciatica. Methods. We updated a 2008 Cochrane Review through June 2015. Randomized controlled trials that compared NSAIDs with placebo, with other NSAIDs, or with other medication were included. Outcomes included pain using mean difference (MD, 95% confidence intervals [95% CI]). For global improvement and adverse effects risk ratios (RR, 95% CI) were used. We assessed level of evidence using the Grades of Recommendation, Assessment, Development and Evaluation approach. Results. Ten trials were included (N = 1651). Nine out of 10 trials were assessed at high risk of bias. For pain reduction (visual analog scale, 0 to 100) NSAIDs were no more effective than placebo (MD −4.56, 95% CI −11.11 to 1.99, quality of evidence: very low). For global improvement NSAIDs were more effective than placebo (RR 1.14 [95% CI 1.03 to 1.27], low quality of evidence). One trial reported the effect of NSAIDs on disability with very low-quality evidence that NSAIDs are no more effective than placebo. There was low-quality evidence that the risk for adverse effects is higher for NSAID than placebo (RR 1.40, 95% CI 1.02 to 1.93). Conclusion. Our findings show very low-quality evidence that the efficacy of NSAIDs for pain reduction is comparable with that of placebo, low-quality evidence that NSAIDs is better than placebo for global improvement and low-quality evidence for higher risk of adverse effects using NSAIDs compared with placebo. The findings must be interpreted with caution, due to small study samples, inconsistent results, and a high risk of bias in the included trials. Level of Evidence: 1

Psychological constructs are of minor predictive value in the course of low back pain in primary care: Call for correction of Foster et al.

ABSTRACT Health problems may cause decreased productivity among working people. It is unclear if this also applies for people living with HIV (PLWH). This cross-sectional study compares data of PLWH of one of the main HIV treatment centres in the Netherlands (n = 298) to data of the general working population from a previously conducted study (n = 986). We investigate whether productivity at work differs between these groups. The questionnaires used in these studies contained a core of identical questions regarding productivity losses, in the form of absenteeism and presenteeism, over a four-week period and a variety of baseline characteristics, including health status measured with EQ-5D. For PLWH additional clinical data were collected from patient records. From the data, descriptive statistics were computed to characterize the samples. Pearson correlations were used to explore significant associations of productivity with baseline characteristics. A two-part model was used to evaluate both the occurrence and of size of productivity losses in working PLWH and an aggregated sample of PLWH and the general population. It was observed that, on average, total productivity losses do not differ significantly between working PWLH and the general working population, but that the occurrence and size of absenteeism and presenteeism were different. Furthermore, more health problems were associated with higher productivity losses. HIV status was not significantly associated with productivity losses. We conclude that among working people, health status was related to productivity losses but HIV status was not. However, further research is needed into the relation between HIV status and unemployment.

Occupational style, the prodigal son: The revival of a construct.

BACKGROUND Stigma and disclosure are important work-related issues for people living with HIV (PLWH). To gain better understanding and improve the position of PLWH in the labor market, further insight in these issues is needed. OBJECTIVE This study reviews the scientific evidence related to work-related stigma and disclosure. METHODS A sensitive literature search was performed in the databases of Medline, Embase, Cochrane Library, Cinahl and Psychinfo for articles published between 1996 and 2016. All studies on PLWH in western countries and investigating disclosure or stigma in relation to work were included. RESULTS Of the 866 identified studies, 19 met the inclusion criteria: 4 addressed both disclosure and stigma (2 quantitative), 9 addressed only disclosure (4 quantitative) and 7 studies addressed only stigma (4 quantitative). CONCLUSION This review provides a unique overview of the research on work-related disclosure and stigma, which will enable health care providers to support PWLH to make well-considered decisions. However, the available literature was heterogeneous and in most studies the topics of our interest were secondary outcomes and provided only basic insight.