Papers by Danielle Van Der Windt
The Journal of Pediatrics, Dec 1, 2000
Trials, Apr 11, 2023
Background Musculoskeletal disorders represented 149 million years lived with disability worldwid... more Background Musculoskeletal disorders represented 149 million years lived with disability worldwide in 2019 and are the main cause of years lived with disability worldwide. Current treatment recommendations are based on "one-size fits all" principle, which does not take into account the large degree of biopsychosocial heterogeneity in this group of patients. To compensate for this, we developed a stratified care computerized clinical decision support system for general practice based on patient biopsychosocial phenotypes; furthermore, we added personalized treatment recommendations based on specific patient factors to the system. In this study protocol, we describe the randomized controlled trial for evaluating the effectiveness of computerized clinical decision support system for stratified care for patients with common musculoskeletal pain complaints in general practice. The aim of this study is to test the effect of a computerized clinical decision support system for stratified care in general practice on subjective patient outcome variables compared to current care. Methods We will perform a cluster-randomized controlled trial with 44 general practitioners including 748 patients seeking their general practitioner due to pain in the neck, back, shoulder, hip, knee, or multisite. The intervention group will use the computerized clinical decision support system, while the control group will provide current care for their patients. The primary outcomes assessed at 3 months are global perceived effect and clinically important improvement in function measured by the Patient-Specific Function Scale (PSFS), while secondary outcomes include change in pain intensity measured by the Numeric Rating Scale (0-10), health-related quality of life (EQ-5D), general musculoskeletal health (MSK-HQ), number of treatments, use of painkillers, sick-leave grading and duration, referral to secondary care, and use of imaging. Discussion The use of biopsychosocial profile to stratify patients and implement it in a computerized clinical decision support system for general practitioners is a novel method of providing decision support for this patient group. The study aim to recruit patients from May 2022 to March 2023, and the first results from the study will be available late 2023.
Current treatment options in rheumatology, Aug 5, 2021
This article is part of the Topical Collection on Pain in Rheumatology Keywords Shoulder pain I C... more This article is part of the Topical Collection on Pain in Rheumatology Keywords Shoulder pain I Chronic shoulder pain I Imaging of the shoulder I Risk factors I Treatment of shoulder pain
http://isrctn.org/>, Jan 21, 2013
Oxford University Press eBooks, Sep 30, 2010
Rheumatology, 2016
Background: Treatments that are matched to patient risk subgroups (or stratified care) have the p... more Background: Treatments that are matched to patient risk subgroups (or stratified care) have the potential to improve the effectiveness of primary care for patients with musculoskeletal pain. However, musculoskeletal pain conditions are extensive and the knowledge base is large. To inform the development of matched treatment options, a rapid, yet detailed summary of evidence on the effectiveness of available treatment options was needed. The specific aims of this study were to develop an approach to synthesizing large evidence summaries, to rapidly synthesize and appraise current best evidence on treatment options for the five most common musculoskeletal pain presentations in primary care and to summarize the available evidence on treatments for patient risk subgroups using stakeholder groups. Methods: Evidence synthesis followed a pyramidal approach using national clinical guidelines, policy documents, clinical evidence pathways and summaries as a starting point. Recommendations about available treatment options for shoulder, neck, knee, back and multisite pain were extracted consecutively. Systematic searches of bibliographic databases were carried out to identify and retrieve more recently published trials that had not yet been summarized in reviews or guidelines or where evidence gaps existed. The quality of evidence was assessed based on modified Grading of Recommendations Assessment, Development and Evaluation quality ratings and strength of evidence. Evidence summaries were subsequently presented to stakeholders (including health service managers, clinicians and researchers) for interpretation and identification of appropriate treatment options that might be matched to patient risk subgroups. Results: Via a rapid, yet systematic and comprehensive approach, pragmatic summaries of the evidence base on treatment options for five musculoskeletal pain presentations were completed. Conclusion: Based on current best evidence, identification of matched treatment options according to patient risk subgroups appears feasible across musculoskeletal pain presentations.
Occupational and Environmental Medicine, 2000
The Journal of Pediatrics, 2000
Journal of Clinical Epidemiology, 2005
Shoulder pain is a common complaint in primary care, and the factors associated with persisting s... more Shoulder pain is a common complaint in primary care, and the factors associated with persisting shoulder pain are varied. We therefore explored prognostic factors associated with shoulder pain problems. Patients (n=109) were randomly allocated to 6 weeks of treatment with either corticosteroid injections (53 patients) or physiotherapy (56 patients). Patients were followed for 52 weeks. Severity of pain and shoulder disability was repeatedly scored at baseline and at 3, 7, 13, 26, and 52 weeks after randomization. Logistic regressions and mixed-effects models were used to explore prognostic factors. The data showed that during the 52 weeks of follow-up, 22% of the patients had persistent-recurrent symptoms (high risk of disability); the associated prognostic factors were gender (female) and age (>60 years). For the remaining patients, who had steady improvement in pain severity during the 52 weeks, there were still large between-patient variations in the rate of reaching recovery; this was influenced by treatment types: corticosteroid injections were associated with a faster relief of the pain. Age and gender might be the two important prognostic factors associated with persistent-recurrent problems. The effect of corticosteroid injections seems to be temporal.
Homeopathy, 2010
Individualised homeopathy involves a large number of possible medicines. For clinical research pu... more Individualised homeopathy involves a large number of possible medicines. For clinical research purposes it is desirable to limit this number, create more consistency between prescribers and optimising the accuracy of prescription. Using a semi-standardised treatment protocol, we aimed to improve homeopathic management of targeted subgroups of women with premenstrual syndrome/symptoms (PMS/S). To design a semi-standardised protocol for individualised prescribing in PMS/S with a limited number of homeopathic medicines, and to explore the feasibility of working with it in daily homeopathic practice. With help of an expert panel, homeopathic medicines were selected, as well as predictive symptoms and characteristics (keynotes) for each medicine. With those, we designed a patient questionnaire and a diagnostic algorithm. The patient questionnaire contained 123 questions, representing potential predictive symptoms for 11 homeopathic medicines for PMS/S. The medicines selected (in rank order) were Sep, Nat-m, Lach, Cimic, Lac-c, Puls, Calc, Lil-t, Mag-p, Mag-c, Phos. In a feasibility study 20 homeopathic doctors used the protocol in daily practice. The diagnosis was confirmed by daily rating of pre-defined symptoms during two consecutive menstrual cycles. The acceptability and feasibility of the protocol were evaluated after 3 months follow-up, at which time we also measured changes in premenstrual symptom scores and patient-reported changes in symptoms and general health. The doctors mostly complied with the protocol and valued the computerised diagnostic algorithm as a useful tool for homeopathic medicine selection. 33 patients completed 3 months follow-up. By then, 19 patients still taking the first medicine on the basis of the algorithm. We received valid symptom records of 30 patients. Premenstrual symptom scores dropped by 50% or more in 12 patients and by 30-50% in 6 patients; scores dropped by less than 30% or increased in 12 patients. Recruitment of patients (n=38 in 9 months) proved difficult. Adherence to the diaries and the questionnaire was satisfactory. It is feasible to use a semi-standardised protocol for individualised homeopathic prescribing in PMS, in daily practice. Its predictive value and the percentage of women with PMS/S helped by the selected medicines remain to be evaluated in further research. In future research, active promotion will be needed to recruit patients.
European Neuropsychopharmacology, 2006
The authors concluded that there is insufficient evidence to confirm or refute the effectiveness ... more The authors concluded that there is insufficient evidence to confirm or refute the effectiveness of naltrexone for treating opioid dependence, but there is evidence for its effectiveness in managing alcohol dependence. The effect of combining naltrexone with psychosocial interventions is unclear. Despite methodological limitations and inadequate reporting in the review, the data presented appear to support these conclusions. Searching The following databases were searched in March 2004, from inception: PubMed, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials. Search terms were reported. The reference lists of studies and reviews retrieved were checked. Only studies published in English were included.
British Journal of General Practice, 2014
Background The publication of clinical prediction rules (CPRs) studies has risen significantly. I... more Background The publication of clinical prediction rules (CPRs) studies has risen significantly. It is unclear if this reflects increasing usage of these tools in clinical practice or how this may vary across clinical areas. Aim To review clinical guidelines in selected areas and survey GPs in order to explore CPR usefulness in the opinion of experts and use at the point of care. Design and setting A review of clinical guidelines and survey of UK GPs. Conclusion GPs use CPRs to guide management but also to comply with local policy requirements. Future research could focus on which clinical areas clinicians would most benefit from CPRs and promoting the use of robust, externally validated CPRs.
Annals of the Rheumatic Diseases, 2004
Evidence-Based Medicine, 2011
Background Clinical management of musculoskeletal shoulder pain can be challenging due to diagnos... more Background Clinical management of musculoskeletal shoulder pain can be challenging due to diagnostic uncertainty, variable prognosis and limited evidence for long-term treatment benefits. The UK-based PANDA-S programme (Prognostic And Diagnostic Assessment of the Shoulder) is investigating short and long-term shoulder pain outcomes. This paper reports linked qualitative research exploring patients’ and clinicians’ views towards primary care consultations for shoulder pain. Methods Semi-structured interviews were conducted with 24 patients and 15 primary care clinicians. Twenty-two interviews (11 patients, 11 clinicians) were conducted as matched patient-clinician ‘dyads’. Data were analysed thematically. Results Clinicians reported attempts to involve patients in management decisions; however, there was variation in whether patients preferred treatment choice, or for decisions to be clinician-led. Some patients felt uncertain about the decisions made, due to a lack of discussion abo...
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Papers by Danielle Van Der Windt