Maurits van Tulder

Publications (345) View all

• Article: Effectiveness and cost-effectiveness of rehabilitation after lumbar disc surgery (REALISE): design of a randomised controlled trial.

  Teddy Oosterhuis, Maurits van Tulder, Wilco Peul, Judith Bosmans, Carmen Vleggeert-Lankamp, Lidwien Smakman, Mark Arts, Raymond Ostelo
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  ABSTRACT: BACKGROUND: Patients who undergo lumbar disc surgery for herniated discs, are advocated two different post-operative management strategies: a watchful waiting policy, or referral for rehabilitation immediately after discharge from the hospital. A direct comparison of the effectiveness and cost-effectiveness of these two strategies is lacking. METHODS: A randomised controlled trial will be conducted with an economic evaluation alongside to assess the (cost-) effectiveness of rehabilitation after lumbar disc surgery. Two hundred patients aged 18--70 years with a clear indication for lumbar disc surgery of a single level herniated disc will be recruited and randomly assigned to either a watchful waiting policy for first six weeks or exercise therapy starting immediately after discharge from the hospital. Exercise therapy will focus on resumption of activities of daily living and return to work. Therapists will tailor the intervention to the individual patient's needs. All patients will be followed up by the neurosurgeon six weeks postoperatively. Main outcome measures are: functional status, pain intensity and global perceived recovery. Questionnaires will be completed preoperatively and at 3, 6, 9, 12 and 26 weeks after surgery. Data will be analysed according to the intention-to-treat principle, using a linear mixed model for continuous outcomes and a generalised mixed model for dichotomous outcomes. The economic evaluation will be performed from a societal perspective. DISCUSSION: The results of this trial may lead to a more consistent postoperative strategy for patients who will undergo lumbar disc surgery.Trial registration: Trial registration number: NTR3156.
  BMC Musculoskeletal Disorders 04/2013; 14(1):124. · 1.58 Impact Factor
• Source

  Available from: Sidney M Rubinstein

  Dataset: RubinsteinSM SpineDec2008

  Maurits van Tulder, Sidney Rubinstein, Dirk Knol, Charlotte Leboeuf-Yde
• Article: Process evaluation of a lifestyle intervention to prevent diabetes and cardiovascular diseases in primary care.

  Jeroen Lakerveld, Sandra Bot, Mai Chinapaw, Maurits van Tulder, Lise Kingo, Giel Nijpels
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  ABSTRACT: Effective, cost-effective, safe, and feasible interventions to improve lifestyle behavior in at-risk populations are needed in primary care. In the Hoorn Prevention Study, the authors implemented a theory-based lifestyle intervention in which trained practice nurses used an innovative combination of motivational interviewing (MI) and problem-solving treatment (PST). This article presents the intervention's reach, effectiveness in terms of process outcomes, adoption, and implementation. Recruitment strategy and participant flow were documented accurately. The effectiveness in terms of determinants of behavioral change was measured using a validated questionnaire. Questionnaires were also used to assess participant satisfaction and compliance, as well as practice nurses' confidence in providing the intervention. Counseling sessions were tape recorded to assess MI, PST, and general counseling competence. The findings indicate that the recruitment strategy was adequate and resulted in a reasonably extensive reach of the target population. Practice nurses were competent and confident in their provision of MI and PST, and participant satisfaction was high. Nevertheless, the number of sessions attended was low, and almost no effects were seen on determinants of behavioral change. The authors conclude that implementing this type of intervention in primary care is feasible, but more is needed to effectively facilitate changes in determinants of lifestyle behavior in this population.
  Health Promotion Practice 07/2012; 13(5):696-706.
• Article: Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

  Fatma Karapinar-Çarkit, Sander D Borgsteede, Jan Zoer, Toine C G Egberts, Patricia M L A van den Bemt, Maurits van Tulder
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  ABSTRACT: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs. To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included. Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10). Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.
  Annals of Pharmacotherapy 03/2012; 46(3):329-38. · 2.13 Impact Factor
• Source

  Available from: Maurits van Tulder

  Article: A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain.

  Andrea D Furlan, Fatemeh Yazdi, Alexander Tsertsvadze, Anita Gross, Maurits Van Tulder, Lina Santaguida, Joel Gagnier, Carlo Ammendolia, Trish Dryden, Steve Doucette, Becky Skidmore, Raymond Daniel, Thomas Ostermann, Sophia Tsouros
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  ABSTRACT: Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.
  Evidence-based Complementary and Alternative Medicine 01/2012; 2012:953139. · 4.77 Impact Factor