Predictors of return to work and employment in cancer survivors: a systematic review.

The objective of this study was to provide an overview of the prognostic factors for return to work and employment of cancer survivors. Cohort studies were selected if the population consisted of cancer patients between 18 and 65 years of age, with return to work, employment or equivalent concepts as main outcome measure, studying at least one prognostic factor. The methodological quality of the included studies and level of evidence for each prognostic factor were assessed. Twenty-eight cohort studies met the inclusion criteria. Heavy work and chemotherapy were negatively associated with return to work. Less invasive surgery was positively associated with return to work. Breast cancer survivors had the greatest chance of return to work. Old age, low education and low income were negatively associated with employment. Moderate evidence was found for extensive disease being negatively associated with both return to work and employment, and for female gender being negatively associated with return to work. The review shows that in cancer survivors, a limited number of prognostic factors of return to work and employment can be identified. Physicians primarily engaged in the process of vocational rehabilitation of cancer survivors should be aware of the potential role these factors exert.

Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials.

OBJECTIVE: Assessment of the available evidence for the effectiveness of exercise therapy to improve arm function in patients who have suffered from a stroke. METHODS: A systematic search of bibliographical databases and reference checking were performed to identify publications on randomized controlled trials (RCTs) which evaluated the effect of exercise therapy on arm function in stroke patients. The methodological quality was assessed systematically by two raters, based on a standardized list of methodological criteria. Study characteristics, such as the chronicity and severity of impairment of the patient population, the amount and duration of interventions, and specific methodological criteria, were related to reported effects. RESULTS: Thirteen RCTs were identified, six of which reported positive results on an arm function test. In five of these six studies there was a contrast in amount or duration of exercise therapy between groups. Methodological scores ranged from 5 to 15 (maximum possible score: 19 points). CONCLUSION: Insufficient evidence made it impossible to draw definitive conclusions about the effectiveness of exercise therapy on arm function in stroke patients. The difference in results between studies with and without contrast in the amount or duration of exercise therapy between groups suggests that more exercise therapy may be beneficial.

Measuring subluxation of the hemiplegic shoulder: reliability of a method.

OBJECTIVE: Subluxation of the shoulder after stroke can be measured according to the method described by Van Langenberghe and Hogan. METHODS: To evaluate the reliability of this method, the shoulder radiographs of 25 patients were available for this study. Two independent raters each assessed these radiographs twice. RESULTS: The intrarater reliability was good: percentage of agreement was 88 and 84%, weighted kappa, 0.69 [95% confidence interval (CI), 0.38-1.0] and 0.78 (95% CI, 0.60-0.95) for raters 1 and 2, respectively. The interrater reliability was poor: percentage of agreement was 36 and 28%, kappa, 0.11 (95% CI, 0.0-0.31) and 0.09 (95% CI, 0.0-0.23) in sessions 1 and 2, respectively. Subsequently the original method was adjusted by combining two categories (no subluxation and beginning subluxation) into one ("no clinically important subluxation"). CONCLUSIONS: After this adjustment of the categories, the interrater reliability improved [percentage of agreement, 72%, and kappa, 0.49 (95% CI, 0.18-0.80)], but did not reach acceptable values.

Effect of triamcinolone acetonide injections on hemiplegic shoulder pain : A randomized clinical trial.

UNLABELLED: Background and Purpose-Hemiplegic shoulder pain is not uncommon after stroke. Its origin is still unknown, and although many different methods of treatment are applied, none have yet been proved to be effective. We sought to study the efficacy of 3 injections of intra-articular triamcinolone acetonide on pain and arm function in stroke patients with hemiplegic shoulder pain. METHODS: -In a multicenter, randomized, placebo-controlled clinical trial, patients with hemiplegic shoulder pain received either 3 intra-articular injections of 40 mg triamcinolone acetonide or 1 mL physiological saline solution (placebo). Primary outcomes were pain measured according to 3 visual analogue scales (score range, 0 to 10), and arm function was measured by means of the Action Research Arm test and the Fugl-Meyer assessment scale; secondary outcomes were passive external rotation of the shoulder and general functioning measured according to Barthel Index and the Rehabilitation Activities Profile. RESULTS: -In the triamcinolone group (n=18), the median decrease in pain, 3 weeks after the last injection, was 2.3 (interquartile range, 0.3 to 4.3) versus 0.2 (interquartile range, -0.5 to 2.2) in the placebo group. This result was not statistically significant. The change in the other outcome measures did not differ significantly between the 2 treatment groups. Twenty-five patients reported side effects. CONCLUSIONS: -In the 37 participants included in this study, triamcinolone injections seemed to decrease hemiplegic shoulder pain and to accelerate recovery, but this effect was not statistically significant. Therefore, on the basis of the results of this study, these injections cannot be recommended for the treatment of patients with hemiplegic shoulder pain.

Treatment of hemiplegic shoulder pain in the Netherlands: results of a national survey.

OBJECTIVE: To describe the methods of treatment applied by physiotherapists, occupational therapists, rehabilitation physicians, nursing-home physicians and neurologists for hemiplegic shoulder pain, and to investigate their beliefs about the effectiveness of triamcinolone acetonide injections for this diagnosis. DESIGN: Postal questionnaire with structured and open-ended questions. If necessary, a written reminder was sent after 2-3 weeks. SUBJECTS: One hundred physiotherapists, 100 occupational therapists, 100 rehabilitation physicians, 100 nursing-home physicians and 100 neurologists in the Netherlands. These healthcare workers were all active in the rehabilitation of stroke patients. RESULTS: The response was 351 (70.2%), ranging from 58% (neurologists) to 83% (physiotherapists). Fifty-four different (combinations of) treatments were mentioned and were classified into eight treatment groups. The frequency of the first choice of treatment was: physiotherapy (32%), prevention/instruction/education (22%), oral medication (8%), local injection (7%), sling (4%), referral (3%), other therapies (4%), and different combinations (20%). In total, 86 respondents had applied local injections: 70 rehabilitation physicians, 10 nursing-home physicians and 6 neurologists. The injections used were: corticosteroids alone (51.2%), in combination with a local anaesthetic (37.2%) or a local anaesthetic only (9.3%). Belief in the effectiveness of triamcinolone injections, measured on a 0-100 point scale, was: physiotherapists median 62.5 (IQR 29.75-71.75), occupational therapists median 50.0 (IQR 43.0-63.0), rehabilitation physicians median 70.0 (IQR 56.5-80.0), nursing-home physicians median 35.0 (IQR 21.0-64.5), neurologists median 47.0 (IQR 20.0-63.0). CONCLUSIONS: As preventive measures and physiotherapy, or a combination of both, were found to be the favourite methods of treatment for hemiplegic shoulder pain in this survey, it seems that most physicians and therapists rely on a mechanical approach to hemiplegic shoulder pain. Rehabilitation physicians used additional local (anti-inflammatory) injections.

[Diabetes mellitus as cause of death]. / Diabetes mellitus als doodsoorzaak.

Certification and coding of diabetes mellitus as a cause of death were investigated by sending a random sample of 300 physicians a set of 6 case histories. Of these, 228 (76%) participated in the study by completing a death certificate for each of these cases. The certificates were subsequently coded by the Central Bureau of Statistics. The main finding was that doctors varied enormously in the way in which diabetes mellitus was mentioned on the death certificate: not at all, as a contributory cause of death, or as an underlying cause of death. Coding removes some of the inconsistencies, but induces additional variation: a higher age of the deceased is associated with a lower probability of having diabetes mellitus coded as the underlying cause of death, and a higher probability of not receiving a code of diabetes mellitus at all. It is concluded that the cause-of-death registration does not provide an accurate picture of the contribution of diabetes mellitus to the cause-of-death pattern of the Netherlands. This is due, amongst other things, to the conceptualization of causes of death on which the registration is based. On the other hand, changes in certification and coding practice within the current system may already lead to some improvement.