Willem De Hertogh | Universiteit Antwerpen (original) (raw)

Papers by Willem De Hertogh

Background: Tinnitus is a very common symptom that often causes distress and decreases the patien... more Background: Tinnitus is a very common symptom that often causes distress and decreases the patient's quality of life. Apart from the well-known causes, tinnitus can in some cases be elicited by dysfunctions of the cervical spine or the temporomandibular joint (TMJ). To date however, it is unclear whether alleviation of these dysfunctions, by physical therapy treatment, also decreases the tinnitus complaints. Such physical therapy could be an interesting treatment option for patients that are now often left without treatment.

Trials, 2014

The anterolateral approach is a commonly used technique for total hip replacement. It requires th... more The anterolateral approach is a commonly used technique for total hip replacement. It requires the detachment of a large part of the gluteus medius muscle. However, it is known that this muscle has a great impact on hip stability. Using the percutaneous assisted approach the damage to the gluteus medius can be limited. The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome. This study uses a prospective, randomized, parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery. The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach. Prior to surgery patients will undergo baseline measurements. These will consist of gluteus medius measurements (sur...

Trials, 2015

There is a consensus that exercise therapy should be used as a therapeutic approach in chronic lo... more There is a consensus that exercise therapy should be used as a therapeutic approach in chronic low back pain (CLBP) but little consensus has been reached about the preferential type of therapy. Due to the heterogeneity of the population no clear effect of specific therapy interventions are found. Probably a specific subgroup of the investigated population will benefit from the intervention and another subgroup will not benefit, looking at the total investigated population no significant effects can be found. Therefore there is a need for the development of clinical prediction rules (CPRs). Objectives for this trial are first, the derivation of CPRs to predict treatment response to three forms of exercise therapy for patients with nonspecific CLBP. Secondly, we aim to validate a CPR for the three forms of exercise therapy for patients with nonspecific CLBP. The study design is a randomized controlled trial. Patients with nonspecific CLBP of more than three months duration are recruit...

SPINE, 2015

Retrospective Cohort OBJECTIVE.: Our aim was to identify prognostic indicators for success after ... more Retrospective Cohort OBJECTIVE.: Our aim was to identify prognostic indicators for success after a back rehabilitation program (BR) in patients with nonspecific chronic low back pain (CLBP). Exercise therapy is recommended for patients with nonspecific CLBP. Consensus on the type of exercises is lacking, largely due to heterogeneity in the studied patient samples. The identification of subgroups through the identification of prognostic indicators is therefore needed. To our knowledge, no specific prognostic indicators for BR are described in the literature. We retrospectively analyzed the patient files of 49 nonspecific CLBP patients who followed a BR. Patients were selected based on predefined in- and exclusion criteria. All underwent 43 therapy sessions, two times per week. Primary outcome measure and dependent variable was the change in Oswestry Disability Questionnaire (ODI) score. Potential predictive variables were tested for association with the primary outcome and consequently entered in a logistic regression model. In this study, the post hoc calculated power was 91%. Based on the change in ODI scores, 24 patients were considered as therapy success (8 points or 50% improvement on change in ODI score) and 25 as therapy failure. Univariate and multiple regression analysis revealed only one significant prognostic indicator: higher scores on the physical function subscale of the SF36 (PF-SF36) corresponded with high risk of therapy failure (odds ratio of 0.791 (95%CI = 0.662-0.945); sensitivity of 0.79 and specificity of 0.68). Potentially, the preset exercises of the BR in this study design were not appropriate for the identified subgroup. The results of this study should be replicated in a RCT design that conforms to the necessary methodological steps in the identification of prognostic indicators and clinical prediction rules (CPRs). 3.

Stimulus, 2003

De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uitkomstmate... more De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uitkomstmaten in hoofdpijnonderzoek. De gemakkelijkste manier om ze te inventariseren is een hoofdpijndagboek. De pijnkarakteristieken op zichzelf (intensiteit, frequentie en duur) zijn niet voldoende om een beeld te krijgen van de ernst van de hoofdpijnklacht. Daarvoor is ook een meting van de beperking in activiteiten of participatieproblemen noodzakelijk. De drie vragenlijsten die in dit artikel besproken zijn, hebben verschillende zwaartepunten (beperking/verband pijnintensiteit-ervaren beperkingen/functionele en emotionele implicaties). De keuze van de vragenlijst kan afhangen van wat de clinicus/onderzoeker wil inventariseren. Fysiologische functiestoornissen vormen het aangrijpingspunt voor kine/fysio/manueel therapeutische behandeling. Het meten/evalueren hiervan past bij het zoeken naar deze aangrijpingspunten. Al deze verschillende aspecten kunnen in kaart gebracht worden als aanzet tot de behandeling of om een behandeleffect te evalueren.

Clinical Journal of Sport Medicine, 2012

To determine whether the multiple hop test should be used as an evaluative or a discriminative in... more To determine whether the multiple hop test should be used as an evaluative or a discriminative instrument for chronic ankle instability (CAI). Blinded case-control study. : University research laboratory. Twenty-nine healthy subjects (21 men, 8 women, mean age 21.8 years) and 29 patients with CAI (17 men, 12 women, mean age 24.9 years) were selected. Subjects performed a multiple hop test and hopped on 10 different tape markers while trying to avoid any postural correction. Minimal detectable changes (MDC) of the number of balance errors, the time value, and the visual analog scale (VAS) score (perceived difficulty) were calculated as evaluative measures. For the discriminative properties, a receiver operating characteristic curve was determined and the area under curve (AUC), the sensitivity, specificity, diagnostic accuracy (DA), and likelihood ratios (LR) were calculated whether 1, 2, or 3 outcomes were positive. Based on their MDC, outcomes should, respectively, change by more than 7 errors (41%), 6 seconds (15%), and 27 mm (55%, VAS score) before considering it as a real change. Area under curves were, respectively, 79% (errors), 77% (time value), and 65% (VAS score). The most optimal cutoff point was, respectively, 13.5 errors, 35 seconds, and 32.5 mm. When 2 of 3 outcomes were positive, the sensitivity was 86%, the specificity was 79%, the DA was 83%, the positive LR was 4.2, and the negative LR was 0.17. The multiple hop test seems to be more a discriminative instrument for CAI, and its responsiveness needs to be demonstrated.

BMC …, 2009

Background: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is... more Background: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness. Due to this common combination of headache and neck pain, physical treatments of the cervical spine are often considered. The additional value of these treatments to standard medical care or usual care (UC) is insufficiently documented.

Background: Treatment of headache disorders is not always optimal. Patients are treated in multip... more Background: Treatment of headache disorders is not always optimal. Patients are treated in multiple ways, and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies.

Trials, 2012

Background: Central sensitization has recently been documented in patients with knee osteoarthrit... more Background: Central sensitization has recently been documented in patients with knee osteoarthritis (OAk). So far, the presence of central sensitization has not been considered as a confounding factor in studies assessing the pain inhibitory effect of tens on osteoarthritis of the knee. The purpose of this study is to explore the pain inhibitory effect of burst tens in OAk patients and to explore the prognostic value of central sensitization on the pain inhibitory effect of tens in OAk patients. Methods: Patients with knee pain due to OAk will be recruited through advertisements in local media. Temporal summation, before and after a heterotopic noxious conditioning stimulation, will be measured. In addition, pain on a numeric rating score, WOMAC subscores for pain and function and global perceived effect will be assessed. Patients will be randomly allocated to one of two treatment groups (tens, sham tens). Follow-up measurements will be scheduled after a period of 6 and 12 weeks. Discussion: Tens influences pain through the electrical stimulation of low-threshold A-beta cutaneous fibers. The responsiveness of central pain-signaling neurons of centrally sensitized OAk patients may be augmented to the input of these electrical stimuli. This would encompass an adverse therapy effect of tens. To increase treatment effectiveness it might be interesting to identify a subgroup of symptomatic OAk patients, i.e., non-sensitized patients, who are likely to benefit from burst tens.

The Journal of Headache and Pain, 2013

Headache only triggered by coughing is a rather uncommon condition. The aim of the present review... more Headache only triggered by coughing is a rather uncommon condition. The aim of the present review is to present an overview of the diagnosis, clinical characteristics, pathophysiology and treatment of both primary and symptomatic cough headache and discuss other relevant headache disorders affected by coughing. The diagnosis of primary cough headache is made when headache is brought on and occurs only in association with coughing, straining or a Valsalva manoeuvre and in the absence of any abnormalities on neuro-imaging. In case an underlying pathology is identified as a cause of the headache, the diagnosis of symptomatic cough headache is made. The vast majority of these patients present with a Chiari malformation type I. Other frequently reported causes include miscellaneous posterior fossa pathology, carotid or vertebrobasilar disease and cerebral aneurysms. Consequently, diagnostic neuroimaging is key in the diagnosis of cough-related headache and guides treatment. Besides primary and symptomatic cough headache, several other both primary and secondary headache disorders exist where coughing acts as a trigger or aggravator of headache symptomatology.

Trials, 2014

The anterolateral approach is a commonly used technique for total hip replacement. It requires th... more The anterolateral approach is a commonly used technique for total hip replacement. It requires the detachment of a large part of the gluteus medius muscle. However, it is known that this muscle has a great impact on hip stability. Using the percutaneous assisted approach the damage to the gluteus medius can be limited. The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome. This study uses a prospective, randomized, parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery. The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach. Prior to surgery patients will undergo baseline measurements. These will consist of gluteus medius measurements (sur...

Jaarboek Fysiotherapie Kinesitherapie 2012, 2012

Stimulus, 2003

ABSTRACT De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uit... more ABSTRACT De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uitkomstmaten in hoofdpijnonderzoek. De gemakkelijkste manier om ze te inventariseren is een hoofdpijndagboek. De pijnkarakteristieken op zichzelf (intensiteit, frequentie en duur) zijn niet voldoende om een beeld te krijgen van de ernst van de hoofdpijnklacht. Daarvoor is ook een meting van de beperking in activiteiten of participatieproblemen noodzakelijk. De drie vragenlijsten die in dit artikel besproken zijn, hebben verschillende zwaartepunten (beperking/verband pijnintensiteit-ervaren beperkingen/functionele en emotionele implicaties). De keuze van de vragenlijst kan afhangen van wat de clinicus/onderzoeker wil inventariseren. Fysiologische functiestoornissen vormen het aangrijpingspunt voor kine/fysio/manueel therapeutische behandeling. Het meten/evalueren hiervan past bij het zoeken naar deze aangrijpingspunten. Al deze verschillende aspecten kunnen in kaart gebracht worden als aanzet tot de behandeling of om een behandeleffect te evalueren.

Fysiotherapeutische casuïstiek, 2006

Stimulus, 2004

Samenvatting Bij de analyse van het klachtenpatroon van patie¨nten met nekgerelateerde klachten m... more Samenvatting Bij de analyse van het klachtenpatroon van patie¨nten met nekgerelateerde klachten maakt men veelal gebruik van een grondige anamnese, met daaropvolgend een gericht functieonderzoek. Uit onderzoek blijkt dat klachtenvrije personen kunnen worden onderscheiden van personen met chronische klachten als gevolg van whiplash op basis van een gestoorde nekmobiliteit . De nekmobiliteit kan in kaart gebracht worden door manuele procedures (palpatie, visuele vergelijking links ten opzichte van rechts) en door meettoestellen. De manuele procedures worden het meest frequent toegepast in de dagelijkse praktijk. Wil men de resultaten echter zo nauwkeurig en objectief mogelijk noteren, dan zal men gebruik moeten maken van een meettoestel.

Otology & Neurotology, 2015

Trials, 2015

There is a consensus that exercise therapy should be used as a therapeutic approach in chronic lo... more There is a consensus that exercise therapy should be used as a therapeutic approach in chronic low back pain (CLBP) but little consensus has been reached about the preferential type of therapy. Due to the heterogeneity of the population no clear effect of specific therapy interventions are found. Probably a specific subgroup of the investigated population will benefit from the intervention and another subgroup will not benefit, looking at the total investigated population no significant effects can be found. Therefore there is a need for the development of clinical prediction rules (CPRs). Objectives for this trial are first, the derivation of CPRs to predict treatment response to three forms of exercise therapy for patients with nonspecific CLBP. Secondly, we aim to validate a CPR for the three forms of exercise therapy for patients with nonspecific CLBP. The study design is a randomized controlled trial. Patients with nonspecific CLBP of more than three months duration are recruited at the Antwerp University Hospital (Belgium) and Apra Rehabilitation Hospital. After examination, patients are randomly assigned to one of three intervention groups: motor control therapy, general active exercise therapy and isometric training therapy. All patients will undergo 18 treatment sessions during nine weeks. Measurements will be taken at baseline, nine weeks, six months and at one year. The primary outcome used is the Modified Oswestry Disability Questionnaire score. For each type of exercise therapy a CPR will be derived and validated. For validation, the CPR will be applied to divide each treatment group into two subgroups (matched and unmatched therapy) using the baseline measurements. We predict a better therapeutic effect for matched therapy. A randomized controlled trial has not previously been performed for the development of a CPR for exercise therapy in CLBP patients. Only one CPR was described in a single-arm design for motor control therapy in sub-acute non-radicular LBP patients. In this study, a sufficiently large sample will be included in both the derivation and validation phase. This trial was registered with Clinicaltrials.gov on 10 February 2014, registration number: NCT02063503.

Trials, 2014

Background: Tinnitus occurs in a large part of the general population with prevalences ranging fr... more Background: Tinnitus occurs in a large part of the general population with prevalences ranging from 10% to 15% in an adult population. One subtype is cervicogenic somatic tinnitus, arising from cervical spine dysfunctions, justifying cervical spine assessment and treatment. This study aims to investigate the effect of a standardized physical therapy treatment, directed to the cervical spine, on tinnitus. Additionally, a second aim is to identify a subgroup within the tinnitus population that benefits from physical therapy treatment. Methods and design: This study is designed as a randomized controlled trial with delayed treatment design. Patients with severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and 90 points), in combination with neck complaints (Neck Bournemouth Questionnaire (NBQ) >14 points) will be recruited from the University Hospital of Antwerp. Patients suffering from tinnitus with clear otological etiologies, severe depression, traumatic cervical spine injury, tumors, cervical spine surgery, or conditions in which physical therapy is contra-indicated, will be excluded. After screening for eligibility, baseline data such as TFI, NBQ, and a set of cervical biomechanical and sensorimotor tests will be collected. Patients are randomized in an immediate therapy group and in a group with a delayed start of therapy by 6 weeks. Patients will receive physical therapy with a maximum of 12 sessions of 30 min for a 6-week program. Data from the TFI and NBQ will be collected at baseline (week 0), at the start of therapy (weeks 0 or 6), at the end of therapy (weeks 6 or 12), 6 weeks after therapy (weeks 12 or 18), and 3 months after therapy (weeks 18 or 24). Secondary outcome measures will be collected at baseline and 6 weeks after the therapy (weeks 12 or 18), as the maximal therapy effect on the cervical spine dysfunctions is expected at that moment.

Otology & Neurotology, 2014

To assess, characterize, and quantify cervical spine dysfunction in patients with cervicogenic so... more To assess, characterize, and quantify cervical spine dysfunction in patients with cervicogenic somatic tinnitus (CST) compared to patients suffering from other forms of chronic subjective non-pulsatile tinnitus. Cross-sectional study. Tertiary referral center. Consecutive adult patients suffering from chronic subjective non-pulsatile tinnitus were included. Ménière's disease, middle ear pathology, intracranial pathology, cervical spine surgery, whiplash trauma, temporomandibular dysfunction. Assessment comprises medical history, ENT examination with micro-otoscopy, audiometry, tinnitus assessment, temporomandibular and cervical spine investigation, and brain MRI. Patients were classified into CST and non-CST population. Cervical spine dysfunction was investigated using the Neck Bournemouth Questionnaire (NBQ) and clinical tests of the cervical spine, containing range of motion, pain provocation (adapted Spurling test, AST), and muscle tests (tenderness via trigger points, strength and endurance of deep neck flexors). Between-group analysis was performed. The prevalence of cervical spine dysfunction was described for the total group and for CST and non-CST groups. In total, 87 patients were included, of which 37 (43%) were diagnosed with CST. In comparison with the non-CST group, the CST group demonstrated a significantly higher prevalence of cervical spine dysfunction. In the CST group, 68% had a positive manual rotation test, 47% a positive AST, 49% a positive score on both, and 81% had positive trigger points. In the non-CST group, these percentages were 36, 18, 10, and 50%, respectively. Furthermore, 79% of the CST group had a positive NBQ versus 40% in the non-CST group. Significant differences between the both groups were found for all the aforementioned variables (all p < 0.005). Although a higher prevalence of neck dysfunction was found in the CST group, neck dysfunction is often in non-CST patients.

Background: Tinnitus is a very common symptom that often causes distress and decreases the patien... more Background: Tinnitus is a very common symptom that often causes distress and decreases the patient's quality of life. Apart from the well-known causes, tinnitus can in some cases be elicited by dysfunctions of the cervical spine or the temporomandibular joint (TMJ). To date however, it is unclear whether alleviation of these dysfunctions, by physical therapy treatment, also decreases the tinnitus complaints. Such physical therapy could be an interesting treatment option for patients that are now often left without treatment.

Trials, 2014

The anterolateral approach is a commonly used technique for total hip replacement. It requires th... more The anterolateral approach is a commonly used technique for total hip replacement. It requires the detachment of a large part of the gluteus medius muscle. However, it is known that this muscle has a great impact on hip stability. Using the percutaneous assisted approach the damage to the gluteus medius can be limited. The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome. This study uses a prospective, randomized, parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery. The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach. Prior to surgery patients will undergo baseline measurements. These will consist of gluteus medius measurements (sur...

Trials, 2015

There is a consensus that exercise therapy should be used as a therapeutic approach in chronic lo... more There is a consensus that exercise therapy should be used as a therapeutic approach in chronic low back pain (CLBP) but little consensus has been reached about the preferential type of therapy. Due to the heterogeneity of the population no clear effect of specific therapy interventions are found. Probably a specific subgroup of the investigated population will benefit from the intervention and another subgroup will not benefit, looking at the total investigated population no significant effects can be found. Therefore there is a need for the development of clinical prediction rules (CPRs). Objectives for this trial are first, the derivation of CPRs to predict treatment response to three forms of exercise therapy for patients with nonspecific CLBP. Secondly, we aim to validate a CPR for the three forms of exercise therapy for patients with nonspecific CLBP. The study design is a randomized controlled trial. Patients with nonspecific CLBP of more than three months duration are recruit...

SPINE, 2015

Retrospective Cohort OBJECTIVE.: Our aim was to identify prognostic indicators for success after ... more Retrospective Cohort OBJECTIVE.: Our aim was to identify prognostic indicators for success after a back rehabilitation program (BR) in patients with nonspecific chronic low back pain (CLBP). Exercise therapy is recommended for patients with nonspecific CLBP. Consensus on the type of exercises is lacking, largely due to heterogeneity in the studied patient samples. The identification of subgroups through the identification of prognostic indicators is therefore needed. To our knowledge, no specific prognostic indicators for BR are described in the literature. We retrospectively analyzed the patient files of 49 nonspecific CLBP patients who followed a BR. Patients were selected based on predefined in- and exclusion criteria. All underwent 43 therapy sessions, two times per week. Primary outcome measure and dependent variable was the change in Oswestry Disability Questionnaire (ODI) score. Potential predictive variables were tested for association with the primary outcome and consequently entered in a logistic regression model. In this study, the post hoc calculated power was 91%. Based on the change in ODI scores, 24 patients were considered as therapy success (8 points or 50% improvement on change in ODI score) and 25 as therapy failure. Univariate and multiple regression analysis revealed only one significant prognostic indicator: higher scores on the physical function subscale of the SF36 (PF-SF36) corresponded with high risk of therapy failure (odds ratio of 0.791 (95%CI = 0.662-0.945); sensitivity of 0.79 and specificity of 0.68). Potentially, the preset exercises of the BR in this study design were not appropriate for the identified subgroup. The results of this study should be replicated in a RCT design that conforms to the necessary methodological steps in the identification of prognostic indicators and clinical prediction rules (CPRs). 3.

Stimulus, 2003

De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uitkomstmate... more De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uitkomstmaten in hoofdpijnonderzoek. De gemakkelijkste manier om ze te inventariseren is een hoofdpijndagboek. De pijnkarakteristieken op zichzelf (intensiteit, frequentie en duur) zijn niet voldoende om een beeld te krijgen van de ernst van de hoofdpijnklacht. Daarvoor is ook een meting van de beperking in activiteiten of participatieproblemen noodzakelijk. De drie vragenlijsten die in dit artikel besproken zijn, hebben verschillende zwaartepunten (beperking/verband pijnintensiteit-ervaren beperkingen/functionele en emotionele implicaties). De keuze van de vragenlijst kan afhangen van wat de clinicus/onderzoeker wil inventariseren. Fysiologische functiestoornissen vormen het aangrijpingspunt voor kine/fysio/manueel therapeutische behandeling. Het meten/evalueren hiervan past bij het zoeken naar deze aangrijpingspunten. Al deze verschillende aspecten kunnen in kaart gebracht worden als aanzet tot de behandeling of om een behandeleffect te evalueren.

Clinical Journal of Sport Medicine, 2012

To determine whether the multiple hop test should be used as an evaluative or a discriminative in... more To determine whether the multiple hop test should be used as an evaluative or a discriminative instrument for chronic ankle instability (CAI). Blinded case-control study. : University research laboratory. Twenty-nine healthy subjects (21 men, 8 women, mean age 21.8 years) and 29 patients with CAI (17 men, 12 women, mean age 24.9 years) were selected. Subjects performed a multiple hop test and hopped on 10 different tape markers while trying to avoid any postural correction. Minimal detectable changes (MDC) of the number of balance errors, the time value, and the visual analog scale (VAS) score (perceived difficulty) were calculated as evaluative measures. For the discriminative properties, a receiver operating characteristic curve was determined and the area under curve (AUC), the sensitivity, specificity, diagnostic accuracy (DA), and likelihood ratios (LR) were calculated whether 1, 2, or 3 outcomes were positive. Based on their MDC, outcomes should, respectively, change by more than 7 errors (41%), 6 seconds (15%), and 27 mm (55%, VAS score) before considering it as a real change. Area under curves were, respectively, 79% (errors), 77% (time value), and 65% (VAS score). The most optimal cutoff point was, respectively, 13.5 errors, 35 seconds, and 32.5 mm. When 2 of 3 outcomes were positive, the sensitivity was 86%, the specificity was 79%, the DA was 83%, the positive LR was 4.2, and the negative LR was 0.17. The multiple hop test seems to be more a discriminative instrument for CAI, and its responsiveness needs to be demonstrated.

BMC …, 2009

Background: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is... more Background: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness. Due to this common combination of headache and neck pain, physical treatments of the cervical spine are often considered. The additional value of these treatments to standard medical care or usual care (UC) is insufficiently documented.

Background: Treatment of headache disorders is not always optimal. Patients are treated in multip... more Background: Treatment of headache disorders is not always optimal. Patients are treated in multiple ways, and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies.

Trials, 2012

Background: Central sensitization has recently been documented in patients with knee osteoarthrit... more Background: Central sensitization has recently been documented in patients with knee osteoarthritis (OAk). So far, the presence of central sensitization has not been considered as a confounding factor in studies assessing the pain inhibitory effect of tens on osteoarthritis of the knee. The purpose of this study is to explore the pain inhibitory effect of burst tens in OAk patients and to explore the prognostic value of central sensitization on the pain inhibitory effect of tens in OAk patients. Methods: Patients with knee pain due to OAk will be recruited through advertisements in local media. Temporal summation, before and after a heterotopic noxious conditioning stimulation, will be measured. In addition, pain on a numeric rating score, WOMAC subscores for pain and function and global perceived effect will be assessed. Patients will be randomly allocated to one of two treatment groups (tens, sham tens). Follow-up measurements will be scheduled after a period of 6 and 12 weeks. Discussion: Tens influences pain through the electrical stimulation of low-threshold A-beta cutaneous fibers. The responsiveness of central pain-signaling neurons of centrally sensitized OAk patients may be augmented to the input of these electrical stimuli. This would encompass an adverse therapy effect of tens. To increase treatment effectiveness it might be interesting to identify a subgroup of symptomatic OAk patients, i.e., non-sensitized patients, who are likely to benefit from burst tens.

The Journal of Headache and Pain, 2013

Headache only triggered by coughing is a rather uncommon condition. The aim of the present review... more Headache only triggered by coughing is a rather uncommon condition. The aim of the present review is to present an overview of the diagnosis, clinical characteristics, pathophysiology and treatment of both primary and symptomatic cough headache and discuss other relevant headache disorders affected by coughing. The diagnosis of primary cough headache is made when headache is brought on and occurs only in association with coughing, straining or a Valsalva manoeuvre and in the absence of any abnormalities on neuro-imaging. In case an underlying pathology is identified as a cause of the headache, the diagnosis of symptomatic cough headache is made. The vast majority of these patients present with a Chiari malformation type I. Other frequently reported causes include miscellaneous posterior fossa pathology, carotid or vertebrobasilar disease and cerebral aneurysms. Consequently, diagnostic neuroimaging is key in the diagnosis of cough-related headache and guides treatment. Besides primary and symptomatic cough headache, several other both primary and secondary headache disorders exist where coughing acts as a trigger or aggravator of headache symptomatology.

Trials, 2014

The anterolateral approach is a commonly used technique for total hip replacement. It requires th... more The anterolateral approach is a commonly used technique for total hip replacement. It requires the detachment of a large part of the gluteus medius muscle. However, it is known that this muscle has a great impact on hip stability. Using the percutaneous assisted approach the damage to the gluteus medius can be limited. The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome. This study uses a prospective, randomized, parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery. The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach. Prior to surgery patients will undergo baseline measurements. These will consist of gluteus medius measurements (sur...

Jaarboek Fysiotherapie Kinesitherapie 2012, 2012

Stimulus, 2003

ABSTRACT De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uit... more ABSTRACT De hoofdpijnintensiteit, -frequentie, -duur en het medicatiegebruik zijn belangrijke uitkomstmaten in hoofdpijnonderzoek. De gemakkelijkste manier om ze te inventariseren is een hoofdpijndagboek. De pijnkarakteristieken op zichzelf (intensiteit, frequentie en duur) zijn niet voldoende om een beeld te krijgen van de ernst van de hoofdpijnklacht. Daarvoor is ook een meting van de beperking in activiteiten of participatieproblemen noodzakelijk. De drie vragenlijsten die in dit artikel besproken zijn, hebben verschillende zwaartepunten (beperking/verband pijnintensiteit-ervaren beperkingen/functionele en emotionele implicaties). De keuze van de vragenlijst kan afhangen van wat de clinicus/onderzoeker wil inventariseren. Fysiologische functiestoornissen vormen het aangrijpingspunt voor kine/fysio/manueel therapeutische behandeling. Het meten/evalueren hiervan past bij het zoeken naar deze aangrijpingspunten. Al deze verschillende aspecten kunnen in kaart gebracht worden als aanzet tot de behandeling of om een behandeleffect te evalueren.

Fysiotherapeutische casuïstiek, 2006

Stimulus, 2004

Samenvatting Bij de analyse van het klachtenpatroon van patie¨nten met nekgerelateerde klachten m... more Samenvatting Bij de analyse van het klachtenpatroon van patie¨nten met nekgerelateerde klachten maakt men veelal gebruik van een grondige anamnese, met daaropvolgend een gericht functieonderzoek. Uit onderzoek blijkt dat klachtenvrije personen kunnen worden onderscheiden van personen met chronische klachten als gevolg van whiplash op basis van een gestoorde nekmobiliteit . De nekmobiliteit kan in kaart gebracht worden door manuele procedures (palpatie, visuele vergelijking links ten opzichte van rechts) en door meettoestellen. De manuele procedures worden het meest frequent toegepast in de dagelijkse praktijk. Wil men de resultaten echter zo nauwkeurig en objectief mogelijk noteren, dan zal men gebruik moeten maken van een meettoestel.

Otology & Neurotology, 2015

Trials, 2015

There is a consensus that exercise therapy should be used as a therapeutic approach in chronic lo... more There is a consensus that exercise therapy should be used as a therapeutic approach in chronic low back pain (CLBP) but little consensus has been reached about the preferential type of therapy. Due to the heterogeneity of the population no clear effect of specific therapy interventions are found. Probably a specific subgroup of the investigated population will benefit from the intervention and another subgroup will not benefit, looking at the total investigated population no significant effects can be found. Therefore there is a need for the development of clinical prediction rules (CPRs). Objectives for this trial are first, the derivation of CPRs to predict treatment response to three forms of exercise therapy for patients with nonspecific CLBP. Secondly, we aim to validate a CPR for the three forms of exercise therapy for patients with nonspecific CLBP. The study design is a randomized controlled trial. Patients with nonspecific CLBP of more than three months duration are recruited at the Antwerp University Hospital (Belgium) and Apra Rehabilitation Hospital. After examination, patients are randomly assigned to one of three intervention groups: motor control therapy, general active exercise therapy and isometric training therapy. All patients will undergo 18 treatment sessions during nine weeks. Measurements will be taken at baseline, nine weeks, six months and at one year. The primary outcome used is the Modified Oswestry Disability Questionnaire score. For each type of exercise therapy a CPR will be derived and validated. For validation, the CPR will be applied to divide each treatment group into two subgroups (matched and unmatched therapy) using the baseline measurements. We predict a better therapeutic effect for matched therapy. A randomized controlled trial has not previously been performed for the development of a CPR for exercise therapy in CLBP patients. Only one CPR was described in a single-arm design for motor control therapy in sub-acute non-radicular LBP patients. In this study, a sufficiently large sample will be included in both the derivation and validation phase. This trial was registered with Clinicaltrials.gov on 10 February 2014, registration number: NCT02063503.

Trials, 2014

Background: Tinnitus occurs in a large part of the general population with prevalences ranging fr... more Background: Tinnitus occurs in a large part of the general population with prevalences ranging from 10% to 15% in an adult population. One subtype is cervicogenic somatic tinnitus, arising from cervical spine dysfunctions, justifying cervical spine assessment and treatment. This study aims to investigate the effect of a standardized physical therapy treatment, directed to the cervical spine, on tinnitus. Additionally, a second aim is to identify a subgroup within the tinnitus population that benefits from physical therapy treatment. Methods and design: This study is designed as a randomized controlled trial with delayed treatment design. Patients with severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and 90 points), in combination with neck complaints (Neck Bournemouth Questionnaire (NBQ) >14 points) will be recruited from the University Hospital of Antwerp. Patients suffering from tinnitus with clear otological etiologies, severe depression, traumatic cervical spine injury, tumors, cervical spine surgery, or conditions in which physical therapy is contra-indicated, will be excluded. After screening for eligibility, baseline data such as TFI, NBQ, and a set of cervical biomechanical and sensorimotor tests will be collected. Patients are randomized in an immediate therapy group and in a group with a delayed start of therapy by 6 weeks. Patients will receive physical therapy with a maximum of 12 sessions of 30 min for a 6-week program. Data from the TFI and NBQ will be collected at baseline (week 0), at the start of therapy (weeks 0 or 6), at the end of therapy (weeks 6 or 12), 6 weeks after therapy (weeks 12 or 18), and 3 months after therapy (weeks 18 or 24). Secondary outcome measures will be collected at baseline and 6 weeks after the therapy (weeks 12 or 18), as the maximal therapy effect on the cervical spine dysfunctions is expected at that moment.

Otology & Neurotology, 2014

To assess, characterize, and quantify cervical spine dysfunction in patients with cervicogenic so... more To assess, characterize, and quantify cervical spine dysfunction in patients with cervicogenic somatic tinnitus (CST) compared to patients suffering from other forms of chronic subjective non-pulsatile tinnitus. Cross-sectional study. Tertiary referral center. Consecutive adult patients suffering from chronic subjective non-pulsatile tinnitus were included. Ménière's disease, middle ear pathology, intracranial pathology, cervical spine surgery, whiplash trauma, temporomandibular dysfunction. Assessment comprises medical history, ENT examination with micro-otoscopy, audiometry, tinnitus assessment, temporomandibular and cervical spine investigation, and brain MRI. Patients were classified into CST and non-CST population. Cervical spine dysfunction was investigated using the Neck Bournemouth Questionnaire (NBQ) and clinical tests of the cervical spine, containing range of motion, pain provocation (adapted Spurling test, AST), and muscle tests (tenderness via trigger points, strength and endurance of deep neck flexors). Between-group analysis was performed. The prevalence of cervical spine dysfunction was described for the total group and for CST and non-CST groups. In total, 87 patients were included, of which 37 (43%) were diagnosed with CST. In comparison with the non-CST group, the CST group demonstrated a significantly higher prevalence of cervical spine dysfunction. In the CST group, 68% had a positive manual rotation test, 47% a positive AST, 49% a positive score on both, and 81% had positive trigger points. In the non-CST group, these percentages were 36, 18, 10, and 50%, respectively. Furthermore, 79% of the CST group had a positive NBQ versus 40% in the non-CST group. Significant differences between the both groups were found for all the aforementioned variables (all p < 0.005). Although a higher prevalence of neck dysfunction was found in the CST group, neck dysfunction is often in non-CST patients.