Frieke Vonk

Erasmus MC, Rotterdam, South Holland, Netherlands

Are you Frieke Vonk?

Claim your profile

Publications (6)13.21 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Schellingerhout JM, Verhagen AP, Heymans MW, Pool JM, Vonk F, Koes BW, De Vet HCW. Een beslismodel voor aspecifieke nekpijn. Huisarts Wet 2009;52(8):384-90. Doel Het ontwikkelen van een beslismodel dat aangeeft welke subgroepen van patiënten met aspecifieke nekpijn het meest gebaat zijn bij fysiotherapie, manuele therapie of een afwachtend beleid. Methode We combineerden gegevens van drie recente Nederlandse gerandomiseerde onderzoeken met een overeenkomstige opzet, die zijn uitgevoerd in de eerste lijn. In totaal betrof het 329 volwassenen (18 tot 70 jaar) die voor aspecifieke nekpijn de huisarts bezochten. De uitkomstmaat was door de patiënt gerapporteerd ervaren herstel. Deze bepaalden we aan het eind van de behandeling en na 52 weken follow-up. We identificeerden tien prognostische variabelen met behulp van een multivariabele logistische regressieanalyse en testten deze op interactie met behandeling. Op grond van de gegevens van deze analyse maakten we een beslismodel voor behandelkeuze. Resultaten We identificeerden drie factoren die gerelateerd zijn aan herstel en die interactie toonden met behandeling: pijnintensiteit op de korte termijn, leeftijd en aan-/afwezigheid van lage rugpijn op de lange termijn. Als men rekening houdt met deze prognostische factoren kan men een tot 25% grotere kans op herstel realiseren. Conclusie Wij identificeerden drie prognostische factoren die een gerichte behandelingskeuze bij patiënten met aspecifieke nekpijn mogelijk maken en daarmee de kans op herstel vergroten: pijnintensiteit, leeftijd en aan-/afwezigheid van lage rugpijn. onderzoek-nekklachten-fysiotherapie-manuele therapie-behandeling-meta-analyse
    Huisarts en wetenschap 01/2009; 52(8):384-390.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study is to identify subgroups of patients with non-specific neck pain who are more likely to benefit from either physiotherapy, spinal manipulation therapy, or usual care, on the short- and long-term. Data of three recently finished randomised controlled trials, with similar design and setting, were combined. The combined study population consisted of 329 patients with non-specific neck pain in an adult (18-70years) primary care population in the Netherlands. The primary outcome measure was global perceived recovery and was measured at the end of the treatment period and after 52 weeks of follow-up. Fourteen candidate variables were selected for the analysis. Predictors were identified by multivariable logistic regression analysis and were tested for interaction with treatment. Based on the multivariable models with interaction terms a decision model for treatment choice was developed. The analysis revealed three predictors for recovery of which the effect is modified by treatment: pain intensity (0-10 scale) in the short-term model, age and (no) accompanying low back pain in the long-term model. With these predictors a clinically relevant improvement in recovery rate (up to 25% improvement) can be established in patients receiving a tailored instead of a non-advised treatment. In conclusion we identified three characteristics that facilitate a deliberate treatment choice, to optimise benefit of treatment in patients with non-specific neck pain: age, pain intensity, and (no) accompanying low back pain.
    Pain 10/2008; 139(3):670-80. · 5.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic neck pain is a common complaint in the Netherlands with a point prevalence of 14.3%. Patients with chronic neck pain are often referred to physiotherapy and, nowadays, are mostly treated with exercise therapy. It is, however, unclear which type of exercise therapy is to be preferred. Therefore, this study evaluates the effectiveness of behaviour graded activity (BGA) compared with conventional exercise (CE) for patients with chronic neck pain. Eligible patients with non-specific chronic neck were randomly allocated to either BGA or CE. Primary treatment outcome is the patient's global perceived effect concerning recovery from complaint and daily functioning. Outcome assessment was performed at baseline, and at 4, 9, 26, and 52 weeks after randomization. Effectiveness was examined with general estimating equations analyses. Baseline demographics and patient characteristics were well balanced between the two groups. Mean age was 45.7 (SD 12.4) years and the median duration of complaints was 60 months. The mean number of treatments was 6.6 (SD 3.0) in BGA and 11.2 (SD 4.1) in CE. No significant differences between treatments were found in their effectiveness of managing patients with chronic neck pain. In both BGA and CE some patients reported recovery from complaints and daily function but the proportion of recovered patients did not exceed 50% during the 12-month follow-up period. Both groups showed clinically relevant improvements in physical secondary outcomes. International Standard Randomised Controlled Trial Number: ISRCTN88733332.
    European journal of pain (London, England) 09/2008; 13(5):533-41. · 3.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Physiotherapists' treatment approach might influence their behaviour during practice and, consequently, patients' treatment outcome; however, an explicit description of the treatment approach is often missing in trials. The purpose of this prospective exploratory study was to evaluate whether the treatment approach differs between therapists who favour a behavioural graded activity (BGA) program, conservative exercise (CE) or manual therapy, and whether BGA training has influence on the treatment approach. Forty-two therapists participated. BGA therapists received a 2-day training. Treatment approach was measured at baseline and at 3-month follow-up, using the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PTs). By this method data on the adoption of biomedical or biopsychosocial approaches were generated. Differences were examined with analysis of variance (ANOVA) and independent Student's t-test. Influence of the BGA training was examined with linear regression. At baseline, there were no significant differences between BGA, CE or manual therapists use of biomedical or biopsychosocial approaches, but there was a trend for BGA therapists to score higher on the biopsychosocial approach. At follow-up, their biopsychosocial score remained higher and their biomedical score was lower compared to CE therapists. Corrected regression analysis showed a 4.4 points (95%CI -7.9; -0.8) higher decrease for therapists who followed the BGA training compared to therapists who did not. Our results indicate no significant differences in treatment approach at baseline, and that BGA training might influence therapists' treatment approach since the scores on the biomedical approach decreased.
    Manual therapy 04/2008; 14(2):131-7. · 2.32 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study is to identify subgroups of patients with non-specific neck pain who are more likely to benefit from either physiotherapy, spinal manipulation therapy, or usual care, on the short-and long-term. Data of three recently fin-ished randomised controlled trials, with similar design and setting, were combined. The combined study population consisted of 329 patients with non-specific neck pain in an adult (18–70 years) primary care population in the Netherlands. The primary outcome measure was global perceived recovery and was measured at the end of the treatment period and after 52 weeks of follow-up. Fourteen candidate variables were selected for the analysis. Predictors were identified by multivariable logistic regression analysis and were tested for interaction with treatment. Based on the multivariable models with interaction terms a decision model for treatment choice was developed. The analysis revealed three predictors for recovery of which the effect is modified by treatment: pain intensity (0–10 scale) in the short-term model, age and (no) accompanying low back pain in the long-term model. With these predictors a clinically relevant improvement in recovery rate (up to 25% improvement) can be established in patients receiving a tailored instead of a non-advised treatment. In conclusion we identified three character-istics that facilitate a deliberate treatment choice, to optimise benefit of treatment in patients with non-specific neck pain: age, pain intensity, and (no) accompanying low back pain.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Chronic neck pain is a common complaint in the Netherlands with a point prevalence of 14.3%. Patients with chronic neck pain are often referred to a physiotherapist and, although many treatments are available, it remains unclear which type of treatment is to be preferred. The objective of this article is to present the design of a randomised clinical trial, Ephysion, which examines the clinical and cost effectiveness of behavioural graded activity compared with a physiotherapy treatment for patients with chronic non-specific neck pain. METHODS: Eligible patients with non-specific neck pain persisting longer than 3 months will be randomly allocated to either the behavioural graded activity programme or to the physiotherapy treatment. The graded activity programme is based on an operant approach, which uses a time-contingent method to increase the patient's activity level. This treatment is compared with physiotherapy treatment using a pain-contingent method. Primary treatment outcome is the patient's global perceived effect concerning recovery from the complaint. Global perceived effect on daily functioning is also explored as primary outcome to establish the impact of treatment on daily activity. Direct and indirect costs will also be assessed. Secondary outcomes include the patient's main complaints, pain intensity, medical consumption, functional status, quality of life, and psychological variables. Recruitment of patients will take place up to the end of the year 2004 and follow-up measurement will continue until end 2005.
    BMC Musculoskeletal Disorders 11/2004; 5(1):34. · 1.88 Impact Factor