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.
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.
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...
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.
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.
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