When planning a study measuring the effects of a neurodevelopmental treatment (NDT), we were confronted with the methodological problem that while measuring the effects of NDT, a rival hypothesis is that the decision to implement the NDT might be related to the quality of nursing care. Therefore, we measured the quality of nursing care as a possible confounding variable in relation to this outcome study. The quality of nursing care was measured on 12 wards participating in the experimental and control groups of the outcome study. Data were collected from 125 patients and 71 nurses and patients' records. The findings showed no significant differences in the quality of nursing care between the 2 groups of wards (P = .49). This method may be useful to other researchers conducting outcome research and who are confronted with a similar methodological problem.
Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies.However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance–outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance–outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N= 2126 families,Mage youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of theassociations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r= .183,p< .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seekingrather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r= .281,p= .067), and no significant correlation was found between split alliances and treatment outcome (r= .106,p= .343). However, the number of included studies reporting onalliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families
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Background: Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient’s risk of persistent disabling pain. Mode of care delivery can be matched to the patient’s suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. Methods: This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient’s risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient’s suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. Discussion: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.
Hoewel cariës (gaatjes in het gebit) eenvoudig te voorkomen is heeft bijna de helft van alle vijfjarige kinderen cariës. Hiervan leidt naar schatting 10% aan ernstige cariës. Ernstige cariës op jonge leeftijd beperkt de algemene gezondheid, de kwaliteit van leven en belemmert de algemene ontwikkeling. Hoewel het een wettelijke basistaak van jeugdgezondheidszorg is, ontbreekt bij het consultatiebureau (CB) de focus op mondzorg. Adviezen op het CB over mondzorg en bezoek aan een mondzorgprofessional vanaf twee jaar blijken niet effectief. Slechts 33% van de kinderen in de leeftijd van 0-4 jaar heeft eenmaal een tandarts bezocht. Preventie in mondgezondheid bij peuters komt te laat en dit raakt met name kinderen uit de lagere sociale klassen. De schade is dan vaak al aanzienlijk en bij ernstige cariës is behandeling onder algehele anesthesie vaak vereist. Naast het feit dat kinderen te laat een mondzorgprofessional bezoeken, zijn er in Nederland geen interventies ter bevordering van mondgezondheid van peuters die voldoende onderbouwd, transparant en (kosten)effectief zijn. In dit gerandomiseerde praktijkonderzoek wordt het effect geëvalueerd van een preventief mondzorgprogramma gericht op het verbeteren van de mondgezondheid bij peuters in vergelijking met usual care. Daarmee wordt tegemoet gekomen aan de urgentie van de evaluatie van preventieve en zelfzorg bevorderende interventies gericht op jonge kinderen en het reduceren van ongelijkheden binnen de mondzorg. Gebaseerd op het succesvolle Schotse Childsmile zal er vanuit de eerstelijns mondzorg een mondzorgcoach (MZC) bij het consultatiebureau gedetacheerd worden om deze JGZ basistaak te ondersteunen. De MZC zal tijdens reguliere CB-bezoeken geïndividualiseerd preventief mondzorgadvies geven aan ouders op basis van het effectief gebleken non–operative caries treatment and prevention (NOCTP) principe. Bij succes van de MZC wordt een forse stijging verwacht van het aantal cariësvrije peuters (30%), een aanmerkelijke cariësreductie per kind (30%, ofwel circa 1,5 gaatje) en een significante kostenreductie.
