Publications by authors named "Marc Du Bois"

13 Publications

  • Page 1 of 1

Implant failure following pedicle based dynamic stabilization of the lumbar spine.

Acta Orthop Belg 2021 Mar;87(1):191-196

Pedicle-based dynamic stabilization (PBDS) devices such as Dynesys are promoted as an alternative and less invasive option for rigid stabilization of one and even more levels of the lumbar spine. Promising features of the Dynesys system, as well as shortcomings, became obvious in several clinical studies. Since 2012, we started using a new PBDS device as an alternative for the Dynesys, to avoid the screw loosening and the kyphosing effect. The objective is to compare failure rates between the Dynesys and Balan-C type PBDS implant and factors affecting outcome. In a retrospective study we investigated a total of 90 patients with lumbar pedicle screw dynamic stabilization (a group of 64 patiënts with Dynesys stabilization is compared to a group of 26 patients with Balan-C stabilization). Mean follow-up was 48 and 38 months, respectively. Using logistic regression analysis the impact of baseline characteristics such as gender, age, body mass index (BMI), indication for surgery, primary or revision surgery, single versus more level surgery, surgeon's experience and type of the implant on implant failure was analyzed. We found a statistically significant difference in failure rates between the two systems (13% in the Dynesys group versus 62% in the Balan-C group). In multivariate analysis, type of implant was associated with implant failure (odds ratio : 13). Our current results call for an optimization of the pre-and post-marketing surveillance of pedicle-based dynamic stabilization.
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March 2021

Motivation in the return to work process: a self-determination cluster approach.

Disabil Rehabil 2020 Oct 5:1-10. Epub 2020 Oct 5.

Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.

Purpose: Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation.

Materials And Methods: A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored.

Results: Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation.

Conclusions: Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided.Implications for RehabilitationAssessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools.Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner.Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others.Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.
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http://dx.doi.org/10.1080/09638288.2020.1826584DOI Listing
October 2020

Psychosocial determinants predicting long-term sickness absence: a register-based cohort study.

J Epidemiol Community Health 2020 11 13;74(11):913-918. Epub 2020 Jul 13.

Environment and Health, KU Leuven, Leuven, Belgium.

Background: This study assessed the psychosocial determinants as explanatory variables for the length of the work disability period. The aim was to estimate the predictive value of a selected set of psychosocial determinants from the Quickscan questionnaire for the length of the sick leave period. A comparison was also made with the most common biomedical determinant: diagnosis.

Methods: In a cohort study of 4 981 insured Belgian patients, the length of the sick leave was calculated using Kaplan-Meier. Predictive psychosocial determinants were selected using backward conditional selection in Cox regression and using concordance index values (C-index) we compared the predictive value of the biomedical to the psychosocial model in a sample subset.

Results: Fourteen psychosocial determinants were significantly (p<0.10) related to the length of the sick leave: health perception of the patient, physical workload, social support management, social support colleagues, work-health interference, psychological distress, fear of colleagues' expectations, stressful life-events, autonomy, learning and development opportunities, job satisfaction, workload, work expectations and expectation to return to work. The C-index of this biopsychosocial model including gender, age and labour status was 0.80 (CI: 0.78; 0.81) (n=4 981). In the subset of 2 868 respondents with diagnostic information, the C-index for the same model was .73 (CI: 0.71; 0.76) compared with 0.63 (CI: 0.61; 0.65) for the biomedical model.

Conclusions: A set of 14 psychosocial determinants showed good predictive capacity (C-index: 0.80). Also, in a subset of the sample, the selected determinants performed better compared with diagnostic information to predict long-term sick leave (>6 months).
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http://dx.doi.org/10.1136/jech-2020-214181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576578PMC
November 2020

Correction to: Assessment of long-term sickness absence: content and face validity of a new questionnaire based on qualitative data from nominal groups.

BMC Med Res Methodol 2019 Dec 4;19(1):224. Epub 2019 Dec 4.

Katholieke Universiteit Leuven, Centre for Environment and Health, Kapucijnenvoer 35/5, 3000, Leuven, Belgium.

In the original publication of this article [1] the author Marc Du Bois was omitted. In this correction article the author and the corresponding details are provided. The publisher apologizes to the readers and authors for the inconvenience.
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http://dx.doi.org/10.1186/s12874-019-0872-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891970PMC
December 2019

Assessment of long-term sickness absence: content and face validity of a new questionnaire based on qualitative data from nominal groups.

BMC Med Res Methodol 2019 11 8;19(1):205. Epub 2019 Nov 8.

Katholieke Universiteit Leuven, Centre for Environment and Health, Kapucijnenvoer 35/5, 3000, Leuven, Belgium.

Background: Increasing rates of long-term sickness absence are a worldwide problem. Belgium is the first country in Europe that aims to screen its entire population of sick leavers (sick leave > 6 weeks) for the risk of long-term sickness absence in order to focus resources on the high-risk group and to provide adequate return-to-work support. Our aim was to investigate content and face validity of a newly designed questionnaire (Quickscan) using item prioritization of patients and professionals in the field of long-term sickness absence. This questionnaire was developed based on a review of the literature and existing instruments (Goorts et al, J Public Health Res 7:1419, 2018).

Methods: Qualitative data were collected using the nominal group technique. The data were gathered exploring factors that influence return-to work restrictions or opportunities.

Results: Participants indicated 20 out of 21 of the questionnaire factors as important reasons that might influence the return-to-work process. Additionally, 16 factors were discussed that were not yet included in the Quickscan but that might provide useful information on return-to-work issues, according to the participants. In the prioritization of items, we found considerable diversity among participants.

Conclusions: Our findings demonstrate the validity of the Quickscan items to ask patients about important return-to-work barriers or opportunities. However, additional factors were identified that may improve the assessment of risk for long-term sickness absence.
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http://dx.doi.org/10.1186/s12874-019-0852-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842172PMC
November 2019

Quickscan assesses risk factors of long-term sickness absence: A cross-sectional (factorial) construct validation study.

PLoS One 2019 11;14(1):e0210359. Epub 2019 Jan 11.

University of Leuven, Centre for Environment and Health, Leuven, Belgium.

Objectives: The number of sick-listed employees has increased dramatically worldwide. Therefore, many countries aim to stimulate early and sustainable return to work opportunities to obtain better health outcomes and lower costs for disability pensions. To effectively orientate resources to patients with a high risk of not resuming work spontaneously, it is necessary to screen patients early in their sickness absence process. In this study, we validate "Quickscan", a new instrument to assess return-to-work needs and to predict risks of long-term sick leave.

Methods: As part of the Quickscan validation process, we tested and compared the reliability and construct validity of the questionnaire in two different populations. First, we conducted a cross-sectional study in which the screening instrument was sent to sick-listed individuals in healthcare insurance. In a second cross-sectional study, sick-listed workers who consulted the occupational health physician for return-to-work assessment were asked to fill out the questionnaire. We compared both samples for descriptive statistics: frequencies, means and standard deviations. Reliability of the scales was calculated using Cronbach's alpha. Confirmatory factor analysis was performed to evaluate the construct (factorial) validity of the studied scales using software package AMOS 24.

Results: The screening tool was shown to be an instrument with reliable scales (except for the perfectionism and health perception patient scale) in both populations. The construct validity was satisfactory: we found that the hypothesized measurement models with the theoretical factors fitted the data well in both populations. In the first sample, the model improved for scales concerning stressful life events and showed worse fit for person-related factors. Work-related factors and functioning factors both showed similar fit indices across samples. We found small differences in descriptive statistics, which we could explain by the differences in characteristics of both populations.

Conclusions: We can conclude that the instrument has considerable potential to function as a screening tool for disability management and follow-up of sick-leave, provided that some adaptations and validation tests are executed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210359PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329504PMC
October 2019

Screening for the risk on long-term sickness absence.

J Public Health Res 2018 Oct 4;7(2):1419. Epub 2018 Oct 4.

University of Leuven, Centre for Environment and Health, Leuven.

Long-term sickness absence is a growing concern in Belgium and other European countries. Since 2017, Belgian physicians of the sickness funding organisations are required to assess the re-integration possibilities within the first two months of sickness absence. Given the shortage of physicians in the assessment of work disability and the growing number of people in sickness absence, there is a need for a triage tool, allowing to assign return-to work support to patients having a high-risk profile not to resume work. The current study comprises a comprehensive validation process of a screening tool that supports Belgian physicians in guiding people back to work. The study consists of a theoretical construct validation (face validity and content validity), and an empirical construct validation (concurrence validity, factorial validity, predictive validity, hypothesis testing validity and known- group validity). The screening instrument assessing the risk for long-term sickness absence is a tool developed to support physicians who work for sickness funds and for occupational health and safety organisations. Both professionals play an important role in the return to work process and the prevention of long-term sickness absence. The screening tool aims at making a distinction between people who will resume their work independently and people who will need support to do so. Generation of this prediction model will help physicians to focus effort and resources in the high-risk group. Results may also help understand the relationship between the biopsychosocial model and long-term sick-leave.
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http://dx.doi.org/10.4081/jphr.2018.1419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278872PMC
October 2018

Quickscan Assesses Risk of Long-Term Sickness Absence: A Cross-Sectional Validation Study.

J Occup Environ Med 2019 02;61(2):e43-e50

Centre for Environment and Health (Ms Goorts, Dr Vandenbroeck, Dr Du Bois, Dr Godderis); Idewe, External Service for Prevention and Protection at Work (Dr Vandenbroeck, Dr Vander Elst, Dr Godderis); Faculty of Psychology and Educational Sciences (Dr Vander Elst), University of Leuven, Leuven; Département des Sciences de la Santé publique, Ecole de santé publique, Université de Liège (Dr Rusu); and SPMT-ARISTA, External Service for Prevention and Protection at Work (Dr Rusu), Liège, Belgium.

Objective: Increasing long-term sickness absence in many countries asks for specific measures regarding return-to work.

Methods: The risk of long-term sickness absence was assessed using a questionnaire containing work-related, function-related, stressful life-events-related, and person-related factors. Additionally, workers' occupational health physician estimated the worker's chances for work resumption. Reliability, construct, and criterion validity of the questionnaire were measured.

Results: Two hundred seventy-six patients and 35 physicians participated in the study. The reliability was satisfying (α > 0.70) for all scales, except for perfectionism (α = 0.62). The results of the CFAs showed that the hypothesized factor models fitted the data well. Criterion validity tests showed that eight predictors significantly related to the estimation of the occupational physicians (ρ < 0.05).

Conclusions: The scales of the questionnaire are reliable and valid, and may be implemented to assess sick-listed workers at risk who might benefit from a rehabilitation program.
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http://dx.doi.org/10.1097/JOM.0000000000001512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416017PMC
February 2019

A decade's experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000-2009.

Eur Spine J 2012 Dec 3;21(12):2693-703. Epub 2012 Jun 3.

Occupational, Environmental and Insurance Medicine, Department of Public Health, Leuven Katholieke Universiteit Leuven, Kapucijnenvoer 35 block d, Box 7001, 3000 Leuven, Belgium.

Purpose: The purpose is to study rates, trends, geographic variations and outcome of lumbar spine surgery in the Belgian population during the last decade.

Methods: This is a retrospective cohort study using administrative data of the largest Belgian sickness fund from January 1, 2000 through December 31, 2009. Cases included lumbar laminectomy, combined discectomy and fusion, posterior interarticular fusion, anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and standard discectomy. The main outcome measures were age- and sex-adjusted rates of lumbar spine surgery, 1-year mortality, 1-year iterative surgery, no return to work (RTW) rate 1 year after surgery and length of hospital stay. Multivariate logistic regression analysis was used to determine the association between age, sex, geographic region, type of surgery, year of intervention and duration of pre-operative sick leave on outcome.

Results: Spine surgery rates rose 44 % from 2001 through 2009 and data for 2009 showed twofold variations in spine surgery rates among 10 Belgian provinces. Reported 1-year mortality varied from 0.6 to 2.5 % among surgical procedures performed in 2008. The overall 5-year reoperation rate was 12 %. RTW rates 1 year after standard discectomy, ALIF, PLIF and combined discectomy and fusion for the follow-up sample of 2008 were 14.4, 22.7, 26.1 and 30.6 %, respectively. The median length of hospital stay significantly decreased throughout the decade. Type of surgery and geographic region were significantly related to patient outcomes.

Conclusions: Regional variations highlight professional uncertainty and controversy. The study results point to the need for peer comparisons and surgeon feedback.
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http://dx.doi.org/10.1007/s00586-012-2381-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508248PMC
December 2012

Guiding low back claimants to work: a randomized controlled trial.

Spine (Phila Pa 1976) 2012 Aug;37(17):1425-31

From the Occupational, Environmental and Insurance Medicine, Department of Public Health, Kapucijnenvoer 35, Leuven, Belgium.

Study Design: A single-blinded, randomized controlled trial.

Objective: To determine the impact of information and advice during a disability evaluation by medical advisers on the return to work (RTW) rate and recurrence of sick leave of claimants with low back pain (LBP).

Summary Of Background Data: There is evidence on the importance of advice during the course of subacute LBP. The effect of informative interventions on RTW rates in workers receiving sickness benefit is not clear.

Methods: A total of 506 claimants with LBP were randomly assigned to the control group (disability evaluation) or the intervention group (combined counseling and disability evaluation). RTW, sick leave recurrence, subsequent surgery, and sick leave duration were measured during a 12-month follow-up.

Results: Patients who were provided information and advice showed a higher RTW rate, which was statistically significant at 1 year. That result is mainly attributable to the lower relapse rate in the intervention group (38%) than in the control group (60%). There were no differences between the 2 groups regarding subsequent surgery for LBP and duration of sick leave.

Conclusion: Claimants should be routinely reassured and advised about LBP to allow early and safe RTW during a disability evaluation before any side effects of being sick-listed have settled.
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http://dx.doi.org/10.1097/BRS.0b013e31824e4adaDOI Listing
August 2012

Outcome and cost of spinal fractures and spinal tumors.

Eur Spine J 2010 Mar 11;19 Suppl 1:S74-8. Epub 2009 Aug 11.

Department of Occupational, Environmental and Insurance Medicine, School of Public Health, Katholieke Universiteit Leuven, Kapucijnenvoer 35/5, 3000, Leuven, Belgium.

The aim of the study was to delineate rates of surgery, length of hospital stay, return to work, iterative surgery rates and cost to society of spinal tumor (ST) and spinal fracture (SF) surgery in Belgium. Overall surgery rates were obtained from the National Institute for Health Care and Disability Insurance. Medical and financial claims data were abstracted from the administrative database of the Alliance of Christian Sickness Funds which includes data of 42% of the mandatory insured Belgian population. All records including the reimbursement codes for ST and SF surgery in 2005 were identified. A logistic regression model was developed to determine the socio-demographic, surgery-related and sick leave predictors of return to work. Our database contained information about 3.791 patients who underwent surgery for SF and 2.322 patients who had surgery for ST. Year-to-year surgery rate growth for SF was estimated at 15%. The yearly increase in surgery rates for ST was calculated at 11%. The return to work rate was 90% 1 year after surgery for both SF and ST. Sixty percent of patients who underwent radiotherapy and surgery for ST were still alive 1 year after surgery. Length of hospital stay ranged from 1 to 27 days after surgery for ST and from 1 to 16 days after surgery for SF. Repeat surgery was performed in 8% of the ST cases and in 12% of the SF patients. Return to work rate remained significantly lower for blue collar workers, self-employed workers and patients with a longer sick leave before surgery. Patients who were absent from work for more than 3 months at time of surgery represent a high-risk group with regard to successful functional recovery.
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http://dx.doi.org/10.1007/s00586-009-1115-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899716PMC
March 2010

A screening questionnaire to predict no return to work within 3 months for low back pain claimants.

Eur Spine J 2008 Mar 3;17(3):380-385. Epub 2008 Jan 3.

Department of Occupational, Environmental and Insurance Medicine, Katholieke Universiteit Leuven, Kapucijnenvoer 35/5, 3000, Leuven, Belgium.

The objective of the present study was to develop a short prediction questionnaire for estimating the risk of no return to work (RTW) within 3 months of sick leave to facilitate triage and management of a patient population of subacute low-back pain (LBP) sufferers. We conducted a prospective study with a 3-month follow-up on 186 patients with LBP introducing a claim for sickness benefits to the largest sickness fund in Belgium. Patients completed a screening questionnaire within 2 weeks after claim submission. All patients were invited for clinical assessment, at 6-8 weeks of sick leave, by the medical adviser. Patients' work status was recorded by the sickness fund. About 20% of the patients did not resume work at 3 months' sick leave. They were more likely to experience pain below the knee, to have an own previous prediction of a 100% no RTW and to have a severe interference of pain on daily activities. The screening tool based on these three items correctly classified 73.7% of the non-resumers and 78.4% of the resumers at a cut-off score of 0.22. The findings of this study provide evidence of the utility of a short screening questionnaire for future use in intervention studies in a social security setting.
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http://dx.doi.org/10.1007/s00586-007-0567-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2270393PMC
March 2008

Comparison between spinal surgery blood transfusion services costs and associated treatment practices in the United States and Belgium.

Curr Med Res Opin 2007 Nov;23(11):2793-804

Center for Pharmacoeconomic and Outcomes Research, Lovelace Respiratory Research Institute, Albuquerque, NM 87108, USA.

Objective: This study assessed utilization and cost of allogeneic blood transfusion (ABT) associated with spinal surgery in the United States (US) and Belgium.

Methods: A retrospective cohort of 292,864 spinal surgery inpatients in US hospitals was pooled with a cohort of 27,952 inpatients who had similar procedures in Belgian hospitals. Utilization and cost data were derived from hospital accounting systems. Costs were converted to US dollars. Descriptive and multivariate statistics were used to describe the factors associated with the use and cost of ABT. Missing data, confounding, and variable measurement error were addressed using standard approaches for observational studies.

Results: US hospitalizations cost $12,044 (SD = 15,920) over 3.6 days compared to $4010 (SD = 3586) over 10.3 days in Belgium. Low molecular weight heparin was used by 78% of Belgian patients and 4% of US patients. Red blood cell utilization occurred in approximately 7% of patients from both countries; however US patients received 6 units compared to 3 units by Belgian patients. US patients spent 3.5 (p < 0.0001) less days in hospital, 1.0 (p < 0.0001) more days in an intensive care unit, used 64% more allogeneic blood (OR = 1.64, 95% CI 1.53-1.75), and incurred $13,647 (p < 0.0001) more per hospitalization than Belgian patients.

Conclusions: US patients used more blood products, had shorter hospital stays, and incurred greater costs than Belgian patients. Specialists as attending physicians were associated with lower utilization of ABT; this may be an administrative change that hospitals can implement to reduce utilization and costs.
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http://dx.doi.org/10.1185/030079907x233421DOI Listing
November 2007
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