Ivan Steenstra | Toronto Metropolitan University (original) (raw)
Papers by Ivan Steenstra
Journal of Clinical Epidemiology, 2014
Objective: To assess English-speaking reviewers' accuracy in determining the eligibility of forei... more Objective: To assess English-speaking reviewers' accuracy in determining the eligibility of foreign-language articles for a systematic review. Study Design and Settings: Systematic review of randomized controlled trials of therapy for fibromyalgia. Guided by 10 questions, English-speaking reviewers screened noneEnglish-language articles for eligibility. Teams of two native-language speakers provided reference standard judgments of eligibility.
Computer use is considered a risk factor for musculoskeletal disorders in office workers; however... more Computer use is considered a risk factor for musculoskeletal disorders in office workers; however, measuring computer use as an exposure is not consistently done. The objective of our study was to compare methods of exposure assessment: self-report, electronic monitoring and video. Self-report (SR) data was collected using web-based questionnaires. Electronic monitoring data was collected using two different software programs. One program used a commercially available mouse with a built-in transducer which recorded the time the hand was on or directly over the mouse as well as keyboard activity. Another program monitored keyboard and mouse activities. Video data was collected using a webcam and a laptop computer to store the digital video. Twenty-seven computer workers agreed to participate in this measurement study and completed both SR and EM. A subset of 12 subjects provided video data. Simple comparison between SR and EM showed moderate to low correlations between methods for computer use, keyboarding, and mouse use. More elegant comparisons showed similar findings and suggest that multiple measurements may not be helpful. The video data was not used for further comparisons due to missing data and low inter-rater reliability to capture mouse activity. Self-report and electronic monitoring may be measuring distinct constructs.
![Research paper thumbnail of Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560]](https://attachments.academia-assets.com/40186262/thumbnails/1.jpg)
](BMC musculoskeletal disorders, Jan 21, 2003
To describe the design of a population based randomized controlled trial (RCT), including a cost-... more To describe the design of a population based randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing participative ergonomics interventions between 2-8 weeks of sick leave and Graded Activity after 8 weeks of sick leave with usual care, in occupational back pain management. An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain. Interventions used are 1. Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist. 2. Graded Activity based on cognitive behavioural principles by a physiotherapist. 3. Usual care, provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain. The primary outcome measure is return to work. Secondary outcome measures are pain intensity, functional status and general improvement. Intermediate variables are kinesiop...
Occupational and Environmental Medicine, 2014
Occupational and Environmental Medicine, 2014
Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic st... more Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. Methods: Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. Results: Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. Conclusions: Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors.
Systematic reviews, 2013
Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research... more Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments. We will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in dupl...
Handbook of Work Disability, 2013
Spine, 2007
Population-based randomized controlled trial.
Spine, 2012
Systematic review. To systematically review the evidence for the effectiveness of nonoperative tr... more Systematic review. To systematically review the evidence for the effectiveness of nonoperative treatment of lumbar spinal stenosis with neurogenic claudication. Neurogenic claudication can significantly impact functional ability, quality of life, and independence in the elderly. METHODS.: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and ICL databases up to January 2011 for randomized controlled trials published in English, in which at least 1 arm provided data on nonoperative treatments. Risk of bias in each study was independently assessed by 2 reviewers using 12 criteria. Quality of the evidence was evaluated using Grades of Recommendations, Assessment, Development, and Evaluation (GRADE). From the 8635 citations screened, 56 were assessed and 21 trials with 1851 participants were selected. There is very low-quality evidence from 6 trials that calcitonin is no better than placebo or paracetamol, regardless of mode of administration or outcome. From single small trials, there is low-quality evidence that prostaglandins, and very low-quality evidence that gabapentin or methylcobalamin, improve walking distance. There is very low-quality evidence from a single trial that epidural steroid injections improve pain, function, and quality of life up to 2 weeks compared with home exercise or inpatient physical therapy. There is low-quality evidence from a single trial that exercise is of short-term benefit for leg pain and function compared with no treatment. There is low- and very low-quality evidence from 6 trials that multimodal nonoperative treatment is less effective than indirect or direct surgical decompression with or without fusion. Moderate- and high-GRADE evidence for nonoperative treatment is lacking and thus prohibiting recommendations to guide clinical practice. Given the expected exponential rise in the prevalence of lumbar spinal stenosis with neurogenic claudication, large high-quality trials are urgently needed.
Spine, 2009
Exploratory subgroup analysis in a randomized controlled trial (RCT). To detect possible moderato... more Exploratory subgroup analysis in a randomized controlled trial (RCT). To detect possible moderators in the effectiveness of a workplace intervention in a population of workers with sick leave due to sub acute nonspecific low back pain. In a recently published RCT, a workplace intervention was effective on return to work, compared to usual care. Examining the heterogeneity of effect sizes within the population in this RCT (n = 196) can lead to information on the effectiveness of the intervention in subgroups of patients. A subgroup analysis was performed by adding interaction terms to the statistical model. Before analysis the following possible moderators for treatment were identified: age, gender, pain, functional status, heavy work, and sick leave in the previous 12 months. Cox regression analyses were performed and survival curves were plotted. The interaction (P = 0.02) between age (dichotomized at the median value) and the workplace intervention indicates a modifying effect. The workplace intervention is more effective for workers > or =44 years (HR, 95% CI = 2.5, [1.6, 4.1] vs. 1.2 [0.8, 1.8] for workers <44 years old). The interaction between sick leave in the previous 12 months and the workplace intervention is significant (P = 0.02). The intervention is more effective for workers with previous sick leave (HR, 95% CI = 2.8 [1.7, 4.9] vs. 1.3 [0.8, 2.0]). A modifying effect of gender, heavy work, and pain score and functional status on the effectiveness of this intervention was not found. The findings from these exploratory analyses should be tested in future RCTs. This workplace intervention seems very suitable for return to work of older workers and workers with previous sick leave. Gender, perceived heavy work, and baseline scores in pain and functional status should not be a basis for assignment to this intervention.
Occupational and Environmental Medicine, 2011
Occupational and Environmental Medicine, 2011
Occupational and Environmental Medicine, 2011
Our hypothesis is that there are factors related to low back pain (LBP), to the worker, to the jo... more Our hypothesis is that there are factors related to low back pain (LBP), to the worker, to the job and to the psychosocial environment that influence duration of an episode of sick leave. Our second hypothesis is that psychological and social issues will likely become more prominent in the sub acute and even more so in the chronic phase compared to the acute phase.
Journal of Clinical Epidemiology, 2014
Objective: To assess English-speaking reviewers' accuracy in determining the eligibility of forei... more Objective: To assess English-speaking reviewers' accuracy in determining the eligibility of foreign-language articles for a systematic review. Study Design and Settings: Systematic review of randomized controlled trials of therapy for fibromyalgia. Guided by 10 questions, English-speaking reviewers screened noneEnglish-language articles for eligibility. Teams of two native-language speakers provided reference standard judgments of eligibility.
Computer use is considered a risk factor for musculoskeletal disorders in office workers; however... more Computer use is considered a risk factor for musculoskeletal disorders in office workers; however, measuring computer use as an exposure is not consistently done. The objective of our study was to compare methods of exposure assessment: self-report, electronic monitoring and video. Self-report (SR) data was collected using web-based questionnaires. Electronic monitoring data was collected using two different software programs. One program used a commercially available mouse with a built-in transducer which recorded the time the hand was on or directly over the mouse as well as keyboard activity. Another program monitored keyboard and mouse activities. Video data was collected using a webcam and a laptop computer to store the digital video. Twenty-seven computer workers agreed to participate in this measurement study and completed both SR and EM. A subset of 12 subjects provided video data. Simple comparison between SR and EM showed moderate to low correlations between methods for computer use, keyboarding, and mouse use. More elegant comparisons showed similar findings and suggest that multiple measurements may not be helpful. The video data was not used for further comparisons due to missing data and low inter-rater reliability to capture mouse activity. Self-report and electronic monitoring may be measuring distinct constructs.
BMC musculoskeletal disorders, Jan 21, 2003
To describe the design of a population based randomized controlled trial (RCT), including a cost-... more To describe the design of a population based randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing participative ergonomics interventions between 2-8 weeks of sick leave and Graded Activity after 8 weeks of sick leave with usual care, in occupational back pain management. An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain. Interventions used are 1. Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist. 2. Graded Activity based on cognitive behavioural principles by a physiotherapist. 3. Usual care, provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain. The primary outcome measure is return to work. Secondary outcome measures are pain intensity, functional status and general improvement. Intermediate variables are kinesiop...
Occupational and Environmental Medicine, 2014
Occupational and Environmental Medicine, 2014
Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic st... more Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. Methods: Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. Results: Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. Conclusions: Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors.
Systematic reviews, 2013
Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research... more Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments. We will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in dupl...
Handbook of Work Disability, 2013
Spine, 2007
Population-based randomized controlled trial.
Spine, 2012
Systematic review. To systematically review the evidence for the effectiveness of nonoperative tr... more Systematic review. To systematically review the evidence for the effectiveness of nonoperative treatment of lumbar spinal stenosis with neurogenic claudication. Neurogenic claudication can significantly impact functional ability, quality of life, and independence in the elderly. METHODS.: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and ICL databases up to January 2011 for randomized controlled trials published in English, in which at least 1 arm provided data on nonoperative treatments. Risk of bias in each study was independently assessed by 2 reviewers using 12 criteria. Quality of the evidence was evaluated using Grades of Recommendations, Assessment, Development, and Evaluation (GRADE). From the 8635 citations screened, 56 were assessed and 21 trials with 1851 participants were selected. There is very low-quality evidence from 6 trials that calcitonin is no better than placebo or paracetamol, regardless of mode of administration or outcome. From single small trials, there is low-quality evidence that prostaglandins, and very low-quality evidence that gabapentin or methylcobalamin, improve walking distance. There is very low-quality evidence from a single trial that epidural steroid injections improve pain, function, and quality of life up to 2 weeks compared with home exercise or inpatient physical therapy. There is low-quality evidence from a single trial that exercise is of short-term benefit for leg pain and function compared with no treatment. There is low- and very low-quality evidence from 6 trials that multimodal nonoperative treatment is less effective than indirect or direct surgical decompression with or without fusion. Moderate- and high-GRADE evidence for nonoperative treatment is lacking and thus prohibiting recommendations to guide clinical practice. Given the expected exponential rise in the prevalence of lumbar spinal stenosis with neurogenic claudication, large high-quality trials are urgently needed.
Spine, 2009
Exploratory subgroup analysis in a randomized controlled trial (RCT). To detect possible moderato... more Exploratory subgroup analysis in a randomized controlled trial (RCT). To detect possible moderators in the effectiveness of a workplace intervention in a population of workers with sick leave due to sub acute nonspecific low back pain. In a recently published RCT, a workplace intervention was effective on return to work, compared to usual care. Examining the heterogeneity of effect sizes within the population in this RCT (n = 196) can lead to information on the effectiveness of the intervention in subgroups of patients. A subgroup analysis was performed by adding interaction terms to the statistical model. Before analysis the following possible moderators for treatment were identified: age, gender, pain, functional status, heavy work, and sick leave in the previous 12 months. Cox regression analyses were performed and survival curves were plotted. The interaction (P = 0.02) between age (dichotomized at the median value) and the workplace intervention indicates a modifying effect. The workplace intervention is more effective for workers > or =44 years (HR, 95% CI = 2.5, [1.6, 4.1] vs. 1.2 [0.8, 1.8] for workers <44 years old). The interaction between sick leave in the previous 12 months and the workplace intervention is significant (P = 0.02). The intervention is more effective for workers with previous sick leave (HR, 95% CI = 2.8 [1.7, 4.9] vs. 1.3 [0.8, 2.0]). A modifying effect of gender, heavy work, and pain score and functional status on the effectiveness of this intervention was not found. The findings from these exploratory analyses should be tested in future RCTs. This workplace intervention seems very suitable for return to work of older workers and workers with previous sick leave. Gender, perceived heavy work, and baseline scores in pain and functional status should not be a basis for assignment to this intervention.
Occupational and Environmental Medicine, 2011
Occupational and Environmental Medicine, 2011
Occupational and Environmental Medicine, 2011
Our hypothesis is that there are factors related to low back pain (LBP), to the worker, to the jo... more Our hypothesis is that there are factors related to low back pain (LBP), to the worker, to the job and to the psychosocial environment that influence duration of an episode of sick leave. Our second hypothesis is that psychological and social issues will likely become more prominent in the sub acute and even more so in the chronic phase compared to the acute phase.