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Biomedical subjects

C J Main

Publications and source records attributed to C J Main.

At least 19 recordsLinked to original sources
PubMed2000

Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity.

STUDY DESIGN: Prospective study on individuals with asymptomatic lumbar disc abnormalities detected in magnetic resonance imaging. OBJECTIVES: To determine the natural history of asymptomatic disc abnormalities in magnetic resonance imaging and to identify predictors of future low back pain-related medical consultation and work incapacity. SUMMARY OF BACKGROUND DATA: The natural history of individuals with asymptomatic disc herniations has not been well established, but the high rate of lumbar disc alterations recently detected in asymptomatic individuals by magnetic resonance imaging demands reconsideration of a pathomorphology-based explanation of low back pain and sciatica. METHODS: Forty-six asymptomatic individuals who had a high rate of disc herniations (73%) were observed for an average of 5 years (range, 54-72 months). Four classes of variables (medical data including magnetic resonance imaging-identified disc abnormalities, general psychological factors, physical job characteristics, and psychosocial aspects of work) were assessed at baseline and follow-up. RESULTS: Disc herniations and neural compromise did not significantly worsen at follow-up, whereas disc degeneration progressed in 17 individuals (41.5%). Minor episodes of low back pain occurred in 19 individuals (41.3%), 6 of whom had to seek medical treatment and 5 of whom had to stop work temporarily. The requirement for low back pain-related medical consultation was predicted with high accuracy by listlessness, job satisfaction, and working in shifts (P < 0.001). Work incapacity was best predicted by physical job characteristics, job disaffection, and working in shifts (P < 0.01). CONCLUSION: Physical job characteristics and psychological aspects of work were more powerful than magnetic resonance imaging-identified disc abnormalities in predicting the need for low back pain-related medical consultation and the resultant work incapacity. However,the conclusions are still preliminary, and replication of the findings in larger and more representative study samples is needed.

Adult↗
PubMed1999

The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy.

In a prospective controlled trial on 46 patients undergoing lumbar discectomy, three classes of variables (medical data including MRI-identified morphological abnormalities, general psychological factors and psychosocial aspects of work) were analyzed with regard to their predictive value for the outcome of lumbar disc surgery at 2 year follow-up. Multiple regression analyses were used to identify the best predictor variables of four different outcome measures (i.e. pain relief, reduction of disability in daily activities, return to work and surgical outcome). MRI-identified nerve root compromise and social support from the spouse were independent predictors of pain relief 2 years after surgery (R2 = 0.40, P < 0.01). Return to work 2 years after surgery was best predicted by depression and occupational mental stress (R2 = 0.36, P < 0.001). MRI-identified extent of herniation and depression were significant predictors of a good surgical outcome after lumbar discectomy (R2 = 0.61, P < 0.001). This study has demonstrated that the outcome of discectomy is critically dependent on which outcome variables are selected and that different sorts of predictor variables have a distinct influence on the various outcome variables. Obvious morphological alterations (i.e. disc extrusions, nerve root compromise) proved to be significant predictors of postoperative pain relief and improvement of disability in daily activities justifying a surgical treatment approach in these cases. The most important finding of this study was that return to work was not influenced by any clinical findings or MR-identified morphological alterations, but solely by psychological factors (i.e. depression) and psychological aspects of work (i.e. occupational mental stress).

Activities of Daily Living↗
PubMed1999

Psychological aspects of pain.

Manual therapy is based on a biomedical model of illness and places considerable reliance on the patient's report of pain. Reported pain intensity is assumed to bear a close relationship with underlying nociception but research has shown that the experience of pain is also influenced by a wide range of psychological factors. Firstly, response to pain provocation (whether palpation or induction of biomechanical stress) can be affected by fear of an adverse outcome (such as pain) and fear of injury. Secondly, a patient's global rating of their pain may be widely influenced by factors in addition to nociception such as distress, fear and mistaken beliefs about the nature of pain and likely outcome of treatment. The manual therapist needs, therefore, to conduct and understand biomedical assessment within a biopsychosocial framework. In appraising the patient's response, the therapist may find it helpful to incorporate specific assessment of subjectively reported fear or behavioural indicators of fear such as guarded movements or behavioural signs. Therapists need to understand that in manual therapy, they are frequently managing the patient's pain behaviour and distress, rather than simply the nociceptive component of their pain.

Adaptation, Psychological↗
PubMed1999

Patients with psoriasis and their compliance with medication.

BACKGROUND: Poor compliance with treatment advice in chronic conditions, such as psoriasis, represents a major challenge to health care professionals. Previous research suggests that the rate of noncompliance in chronic conditions may be as high as 40%. OBJECTIVE: This study was designed to examine self-reported compliance in patients with psoriasis. METHODS: We undertook an anonymous postal survey sent to consecutive patients with psoriasis attending a tertiary psoriasis specialty clinic. RESULTS: Thirty-nine percent of participants reported that they did not comply with the treatment regimen recommended. The noncompliant group had a higher self-rated severity of psoriasis (t = -2.16, P =. 03), were younger (t = 3.28, P =.001), and had a younger age at onset (t = 2.35, P =.02) than those who were compliant. The noncompliant group reported that psoriasis had a greater impact on daily life (t = -2.23, P =.028), but general well-being was not significantly different from those who complied (t =.47, P = not significant). CONCLUSION: Patients who reported intentional noncompliance with treatment advice were more likely to believe that both psoriasis and its treatment interfered with their quality of life but not overall well-being. The impact of treatment on daily life highlights the importance of joint decision making in planning treatment.

Adolescent↗
PubMed1998

Behavioral responses to examination. A reappraisal of the interpretation of "nonorganic signs".

Waddell et al in 1980 developed a standardized assessment of behavioral responses to examination. The signs were associated with other clinical measures of illness behavior and distress, and are not simply a feature of medicolegal presentations. Despite clear caveats about the interpretation of the signs, they have been misinterpreted and misused both clinically and medicolegally. Behavioral responses to examination provide useful clinical information, but need to be interpreted with care and understanding. Isolated signs should not be overinterpreted. Multiple signs suggest that the patient does not have a straightforward physical problem, but that psychological factors also need to be considered. Some patients may require both physical management of their physical pathology and more careful management of the psychosocial and behavioral aspects of their illness. Behavioral signs should be understood as response affected by fear in the context of recovery from injury and the development of chronic incapacity. They offer only a psychological "yellow-flag" and not a complete psychological assessment. Behavioral signs are not on their own a test of credibility or faking.

Disability Evaluation↗
PubMed1998

Pain drawings in the assessment of nerve root compression: a comparative study with lumbar spine magnetic resonance imaging.

STUDY DESIGN: Prospective comparative study of pain drawings with findings on lumbar spine magnetic resonance imaging. OBJECTIVES: To assess the ability of the pain drawing to predict the presence of nerve root compression. SUMMARY OF BACKGROUND DATA: Most research work has concentrated on the ability of the pain drawing to act as a screening method for psychological distress with less work directed at the influence the anatomic abnormality has on the pain drawing. METHODS: One hundred thirty-four consecutive outpatients attending for lumbar magnetic resonance imaging in the investigation of back and leg pain completed pain drawings and psychological testing immediately before the examination. The pain drawing was analyzed by previously reported criteria, and the magnetic resonance imaging was assessed independently for the presence of nerve compression by three radiologists. Multivariate stepwise discriminant analysis was used to identify patients with nerve compression on the basis of their pain drawing. RESULTS: Nerve compression was predicted by numbness in the anterolateral aspect of the foot. There was considerable overlap in the appearances of the pain drawings between patients with and without nerve compression, and the pain drawing correctly classified only 58% of patients with nerve compression. CONCLUSIONS: The pain drawing is not a good predictor of nerve compression on magnetic resonance imaging in a group of patients investigated for back and leg pain. It should be interpreted with caution and in light of the full clinical picture.

Adult↗
PubMed1998

What patients with psoriasis believe about their condition.

BACKGROUND: Patients' beliefs about their disease have been shown to be of fundamental importance in adjustment to their condition. OBJECTIVE: We investigated patients' beliefs about their psoriasis and examined the relationship between these beliefs and clinical severity, symptom report, and other clinical and demographic variables. METHODS: A total of 162 patients with psoriasis (84 male, 78 female) completed the illness perception questionnaire that provides a standardized assessment of beliefs about causes, consequences, chronicity or recurrence, controllability, and symptoms of the condition. RESULTS: The most commonly reported agents of causation were stress (60.1%) and genetic factors (55.5%)--the latter group being significantly more likely to have a family history of psoriasis (P=.0001). Forty-six percent of patients believed that their behavior could improve or worsen their psoriasis, whereas 32% believed that treatment would be curative. Desquamation and pruritus were experienced "frequently" or "all the time" by 80% and 76% of patients respectively. Overall clinical severity was not associated with any of the beliefs held by patients or with symptom report. CONCLUSION: The beliefs held and symptoms experienced by patients with psoriasis are not governed by overall clinical severity of the disease.

Adolescent↗
PubMed1998

Medically certified work loss, recurrence and costs of wage compensation for back pain: a follow-up study of the working population of Jersey.

The 1 yr incidence, prevalence and wages compensation costs of work loss due to medically certified back pain in the working population of Jersey were identified by analysis of the Social Security database for the year 1994. A total of 2291 subjects absenting due to back pain during this period were followed for up to 3 yr to identify return to work rates and subsequent absences. Incidence and prevalence rates were 5.6 and 6.3%, respectively. The cost of wages compensation was 1.29 million pounds or 10.5% of such benefits paid. Work loss was greater for the second absence. The rate of return to work was broadly in line with that suggested by the Clinical Standards Advisory Group (CSAG), but the number still absent at 1 yr was less, suggesting that the CSAG figures for long-term absence may have been overestimated. The influence of compensation systems and unemployment on work-related absence due to back pain is highlighted.

Absenteeism↗
PubMed1997

Assessing illness-related stress in psoriasis: the psychometric properties of the Psoriasis Life Stress Inventory.

The purpose of the present study was to undertake a clinical and psychometric reappraisal of the Psoriasis Life Stress Inventory (PLSI). Total PLSI score was inversely related to age of onset of psoriasis, but bore no significant relationship to duration or to clinical severity. Similarly, patients' stress score did not differ with regards to the nature of their current treatment, to their beliefs as to what was responsible for exacerbation or improvement of their condition, or to the patients' gender. Factor analysis extracted two factors which suggested that the psychosocial impact of psoriasis results from stress associated with: (i) engaging in anticipatory/avoidance coping behavior that is effected to limit the sociocognitive intrusiveness of psoriasis; and (ii) stress resulting from patients' beliefs or actual experiences of being evaluated by others solely on the basis of their skin. The internal reliability of the scale can be improved by the deletion of three items. Revision of the PLSI is recommended to render it psychometrically and clinically acceptable for use in the UK.

Adaptation, Psychological↗
PubMed1997

Quality of life in patients with psoriasis: the contribution of clinical variables and psoriasis-specific stress.

The purpose of this study was: (i) to examine the impact of the clinical severity, anatomical location and treatment of psoriasis on patients' quality of life, and (ii) to investigate the effects of perceptions of psoriasis-related stress on patients' physical and mental health and on areas of disability in everyday life. All patients (n = 204) attending a psoriasis specialty clinic were invited to complete a multidimensional quality of life assessment comprising the Psoriasis Disability Index (PDI), the SF-36 Health Survey and the Psoriasis Life Stress Inventory (PLSI). Results (n = 150) indicated that overall clinical severity of psoriasis as assessed by the Psoriasis Area and Severity Index, and duration of psoriasis, were unrelated to impairment in any areas of quality of life. Anatomical location (social visibility) of psoriasis was associated with self-report of poor physical health (P = 0.01), and there was a modest association with patients' mental health (P = 0.04); however, anatomical location of psoriasis was not significantly associated with self-reported disability in everyday life, or stress scores. Patients who were classified as more reactive to the stress associated with psoriasis (78% of the sample) were functioning less well in terms of their mental health (P = 0.001) and also experienced significantly more disability in all areas of everyday life (P = 0.001). Differences in method of treatment for psoriasis did not significantly affect scores on the psoriasis-specific (PDI; PLSI) or generic (SF-36) quality of life measures. A multiple regression analysis demonstrated that stress resulting from anticipating other people's reactions to their psoriasis contributed more to the variance in patients' disability in everyday life than any other medical or health status variable. The results support the importance of assessing the effects of stress in patients' adjustment to their condition and may indicate a role for adjunctive psychological stress management training for a significant number of patients with psoriasis.

Activities of Daily Living↗
PubMed1996

Do attitudes and beliefs influence work loss due to low back trouble?

Recent evidence indicates that the influence of psychosocial factors on low back disability is as great as, if not greater than, ergonomic aspects; negative attitudes and beliefs are likely to be related to absenteeism. To measure workers attitudes and beliefs about low-back trouble, pain, work and activity five questionnaires were used. Two new instruments (Back Beliefs Questionnaire and Psychosocial Aspects of Work questionnaire) were developed and tested. The attitudes and beliefs were measured among workers in a biscuit manufacturing factory, and the responses related to absenteeism. Workers who had taken in excess of one week's absence due to low-back trouble had significantly more negative attitudes and beliefs when compared with workers who had taken shorter absence (or indeed those reporting no history of back trouble). A subset of the psychosocial parameters accounted for 32% of the variance in absence. Interventions designed to reduce negative attitudes and promote positive beliefs may help to reduce detrimental, inappropriate longer-term absenteeism due to low-back trouble.

Absenteeism↗
PubMed1995

Absence resulting from low back trouble can be reduced by psychosocial intervention at the work place.

STUDY DESIGN: A 1-year prospective study in industry, assessing effects of an educational pamphlet on various psychosocial parameters and absenteeism resulting from low back trouble. OBJECTIVES: To determine the value of distributing an educational psychosocial pamphlet to reduce absenteeism resulting from back trouble. The pamphlet was designed to alter avoidance behaviors by encouraging a positive, active approach. SUMMARY OF BACKGROUND DATA: Attempts to control back-pain disability have failed. Fear of pain and activity seemingly leads to avoidance behaviors than contribute to chronicity and work loss. Avoidance behaviors are mediated by attitudes and beliefs; such attitudes and beliefs are a reasonable target for educational interventions designed to change "inappropriate" behaviors (e.g., extended absenteeism). Health education pamphlets are advocated widely but tested rarely. METHODS: Three factories participated in the study. Psychosocial data were collected by questionnaires; absence data were extracted from company records. A psychosocial pamphlet was distributed in one factory; the control subjects received either a nonspecific pamphlet or no intervention. The pamphlet emphasized a positive approach to low back trouble (reduction of negative beliefs and attitudes). RESULTS: In the company whose employees received pamphlets, a significant reduction occurred for the number of spells with extended absence and the number of days of absence (70% and 60%, respectively) compared with extrapolated values. A concomitant positive shift in beliefs concerning the locus of pain control and the inevitable consequences of low back trouble was found. CONCLUSION: A simple industrial intervention using a psychosocial pamphlet, which was designed to reduce avoidance behaviors by fostering positive beliefs and attitudes, successfully reduced extended absence resulting from low back trouble.

Absenteeism↗
PubMed1995

Psychosocial predictors of outcome in acute and subchronic low back trouble.

STUDY DESIGN: A prospective survey of patients seeking primary care for low back pain. Clinical and psychosocial data, available at presentation, were explored for predictors of outcome at 1 year. OBJECTIVES: To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis. SUMMARY OF BACKGROUND DATA: Current treatment strategies for low back pain have failed to stem the rising levels of disability. Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients, but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated. METHODS: Two hundred fifty-two patients with low back pain, presenting to primary care, underwent a structured clinical interview and completed a battery of psychosocial instruments. Follow-up was done by mail at 1 year; outcome was measured using a back pain disability questionnaire. Predictive relationships were sought between the data at presentation and disability at follow-up. RESULTS: Most patients showed improved disability and pain scores, although more than half had persisting symptoms. Eighteen percent showed significant psychological distress at presentation. Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble. Discriminant models successfully allocated typically 76% of cases to recovered/not-recovered groups, largely on the basis of psychosocial factors evident at presentation. CONCLUSIONS: Early identification of psychosocial problems is important in understanding, and hopefully preventing, the progression to chronicity in low back trouble.

Acute Disease↗
PubMed1995

The use of the pain drawing as a screening measure to predict psychological distress in chronic low back pain.

STUDY DESIGN: The ability of three new methods of scoring the Pain Drawing to predict psychological distress in two cohorts of 100 patients with chronic low back pain was investigated. OBJECTIVES: Patients completed a Pain Drawing and questionnaire measures of psychological distress and were given a standard physical examination. SUMMARY OF BACKGROUND DATA: The two cohorts were significantly different on all variables (except for disability). METHODS: The relationship between the three new scoring systems and measures of distress, physical factors, and disability was investigated. RESULTS: The new scoring methods had high reliability. Pain Sites was a more accurate predictor of distress, but was unable to do so with sufficient specificity/sensitivity. Body Map did not correlate with physical/disability measures. CONCLUSION: Using the new scoring systems, it was not possible to identify distressed patients with sufficient sensitivity/specificity, nor to differentiate between organic and nonorganic pain patterns.

Chronic Disease↗