http://repub.eur.nl/res/aut/7131/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/8337/ 2007-01-18T00:00:00Z Musculoskeletal disorders are a common problem that may lead to func-Ational limitations and (work) disability. It is not clear yet how improvement in Apain or functional limitations is related to return to work after an episode of sick Aleave. Furthermore, several physicians are involved in the treatment and man-Aagement of a patient is on sick leave. In the Netherlands a strict separation be-Atween treating physicians and occupational physicians exists, whereby the treating Aphysician treats the disorder and the occupational physician manages return to Awork. Will a better collaboration between occupational health and curative care Aresult in a quicker return to work? A Chapter 2 presents a systematic review of 19 articles of the effects of treat-Ament of impingement syndrome on the associated functional limitations and re-Aturn to work. For functional limitations, there is strong evidence that extracorpo-Areal shock-wave therapy is not effective, and moderate evidence that exercise Acombined with manual therapy is more effective than exercise alone, that ultra-Asound is not effective, and that open and arthroscopic acromioplasty are equally Aeffective on the long term. For all other interventions there is only limited evi-Adence. We found many studies using range of motion and pain as outcome meas-Aures but functional limitations were less often used as an outcome measure in this Atype of research. Duration of sick leave was seldom included as an outcome meas-Aure. Although recovery on functional limitations is not equal to return to work A(RTW), the effectiveness of interventions with regard to ability to work or dura-Ation of sick leave does not seem to differ from the effectiveness on functional limi-Atations. A The controlled trial in chapter 3 evaluated a training for general practitioners Aand occupational physicians for patients on sick leave due to low back pain (LBP). AThe goal of this training was to improve collaboration which might improve a pa-Atient’s recovery and shorten sick leave. In a controlled trial the intervention in one Aregion was compared with usual care in a control region. In each region 56 LBP Apatients on sick leave for 3-12 weeks were included. These patients filled out three Aquestionnaires; at inclusion, three and six months later. Information on sick leave Awas gathered from occupational health services. There was little collaboration be-Atween physicians during the project. Patients in the intervention region returned Ato work significantly later (p=0.005) but were significantly more satisfied with Atheir occupational health physician (p=0.01). No differences were found between Athe intervention and control patients for pain, disability, quality of life, and medi-Acal consumption. http://repub.eur.nl/res/pub/15731/ 2006-11-02T00:00:00Z BACKGROUND: Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advice to the patient. Therefore, we evaluated a standardized information exchange form for the exchange of relevant information between the orthopedic surgeon and the occupational physician. The main goals of this qualitative study are to evaluate whether the form improved information exchange, whether the form gave relevant information, and to generate ideas to further improve this information exchange. METHODS: The information exchange form was developed in two consensus meetings with five orthopedic surgeons and five occupational physicians. To evaluate the information exchange form, a qualitative evaluation was set up. Structured telephone interviews were undertaken with the patients, interviews with the physicians were face-to-face and semi-structured, based on a topic list. These interviews were recorded and literally transcribed. Each interview was analyzed separately in Atlas-Ti. RESULTS: The form was used for 8 patients, 7 patients agreed to participate in the qualitative evaluation. All three orthopedic surgeons involved and three of the six involved occupational physicians agreed to be interviewed. The form was transferred to 4 occupational physicians, the other 3 patients recovered before they visited the occupational physician. The information on the form was regarded to be useful. All orthopedic surgeons agreed that the occupational physician should take the initiative. Most physicians felt that the form should not be filled out for each patient visiting an orthopedic surgeon, but only for those patients who do not recover as expected. Orthopedic surgeons suggested that a copy of the medical information provided to the general practitioner could also be provided to occupational physicians. CONCLUSION: The information exchange form was regarded to be useful and could be used in practice. The occupational physician should take the initiative for using this form and most physicians felt the information should only be exchanged for patients who do not recover as expected. That means that the advantage of giving information early in the treatment is lost. http://repub.eur.nl/res/pub/15679/ 2006-03-01T00:00:00Z The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should*, rotator cuff, impingement, work, sick leave, disabilit*, function*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.