Cognitive outcome in congenital central hypothyroidism: a systematic review with meta-analysis of individual patient data.

Objective: To provide an overview of cognitive and motor outcome, and quality of life (QoL) in patients with congenital central hypothyroidism (CH-C). Design: Systematic review with individual patient data (IPD) meta-analysis. Methods: OVID MEDLINE, EMBASE and PsycInfo were searched from inception to June 11th, 2019. Studies in patients with CH-C, either isolated or with multiple pituitary hormone deficiency (MPHD), were included if CH-C patients could be separated from any additional patient groups. Primary outcomes were full-scale intelligence quotient (FSIQ) and motor outcome; secondary outcome was QoL. Following data-extraction, one-stage IPD meta-analysis was performed, fitting a linear mixed model with FSIQ as dependent variable. Random intercepts were fitted for each study. Results: Six studies measuring FSIQ were eligible for meta-analysis, comprising 30 CH-C patients (20 males; 27 MPHD patients). FSIQ range was wide (64-123). Mean weighted FSIQ was 97 (95% CI: 88-105). Twenty-seven percent had an FSIQ below 85 (≥1 s.d. below norm score), and 10% below 70 (≥2 s.d. below norm score). There was no significant association between FSIQ and sex or age. Age at treatment initiation was available from three studies only, thus impeding a reliable analysis of this parameter. Motor outcome and QoL were each studied in one study; no quantitative analyses could be performed for these outcomes. Conclusion: A wide range in FSIQ scores was observed in CH-C patients. Results should be interpreted with caution, because included patients mainly had MPHD and age at treatment initiation was unknown for the majority of patients.

Evaluation of a multidisciplinary treatment for patients with chronic non-specific upper-limb musculoskeletal disorders: a pilot study.

BACKGROUND: Upper-limb musculoskeletal disorders (ULMSDs) are considered a major health and socio-economic problem. However, knowledge about the effect of treatment programmes is scarce. Objective To evaluate the effect of a multidisciplinary treatment programme on well-being, disability and return to work in patients with chronic non-specific upper-limb disorders. METHODS: A longitudinal and uncontrolled design with pre-post measurements was used. Forty-one patients on long-term sick leave attended for multidisciplinary treatment aimed at training in personal coping strategies and improving activities of daily living. Outcome measures were generic well-being (SF-36), disability (DASH) and return to work (working hours). RESULTS: General well-being improved significantly between pre-treatment and post-treatment. Level of disability declined significantly between pre-treatment and post-treatment. In 63% of the patients, return to own work was complete at follow up, 4 months post-treatment. CONCLUSION: The results of this uncontrolled intervention study suggest that multidisciplinary treatment programmes improve general well-being, reduce disability and facilitate return to work in patients with chronic non-specific ULMSDs.

Validating the MPI-DLV using experience sampling data.

The present study investigates the relationship between scale scores on the Dutch version of the Multidimensional Pain Inventory (MPI-DLV) and data derived from comparable items from an experience sampling procedure. Fifty-seven chronic pain patients participated in the study, which lasted 6 consecutive days. Special attention was given to the relationship between the MPI-DLV pain intensity score and the mean experience sampling pain intensity score. Significant correlations were found between the MPI-DLV scales Pain Severity, Interference, Solicitous, Punishing and Distracting Responses, and Household Chores and their experience sampling analogues. A marginally significant correlation was found with regard to the MPI-DLV Life Control scale. The General Activity and Affective Distress scales had no relationship with the analogous experience sampling items. The significant correlations were regarded as further validation of the MPI-DLV. A regression analysis revealed that 58% of the variance of the experience sampling pain intensity score could be explained by the MPI-DLV present pain intensity item score.