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Biomedical subjects

C J Main

Publications and source records attributed to C J Main.

At least 37 records · Page 2Linked to original sources
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

Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio.

OBJECTIVE: To develop a reliable and repeatable way to monitor changes in the flexion relaxation phenomenon of the lumbar paraspinal muscles during forward flexion by the development of a flexion relaxation ratio and observation of the sEMG activity in standing and during forward flexion in patients with chronic low back pain (CLBP) and healthy controls. DESIGN: Two experiments were conducted, the first to assess the test-retest reliability of the measure in a group of CLBP (n = 11) patients; the second compared the results between a group of normal healthy controls (n = 20) and a group of CLBP patients (n = 70). RESULTS: Repeated measurements over 4 weeks demonstrated between session reliability of between 0.81 and 0.98 for the dynamic activity. The levels of sEMG activity in the fully flexed position was significantly greater in the fully flexed position in the CLBP group than the controls. The flexion relaxation ratio (FRR), a comparison of the maximal sEMG activity during 1 s of forward flexion with activity in full flexion, demonstrated significantly lower values in the CLBP than the control group. The combined discriminant validity for the FRR for all four sites resulted in 93% sensitivity and 75% specificity. CONCLUSION: The FRR clearly discriminated the patients from the healthy controls. These results indicate that dynamic sEMG activity of the paraspinal muscles can be reliably measured and is useful in differentiating CLBP patients from normal controls. RELEVANCE: Analysis of the pattern of different levels of muscle activity during a forward flexion can be used in CLBP where normalization of the sEMG signal to the maximum voluntary contraction may be difficult. The FRR may be used in the assessment of change in the flexion relaxation phenomenon following treatment interventions.

Journal Article↗
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↗
PubMed1992

The Distress and Risk Assessment Method. A simple patient classification to identify distress and evaluate the risk of poor outcome.

The integration of physical and psychological assessment is frequently problematic. Psychological tests are often cumbersome and difficult to interpret. There would appear to be a need for a simple assessment method that would identify distress and help alert the clinician to the need for a more comprehensive assessment. The Distress and Risk Assessment Method is derived from a simple set of scales validated for use with patients with low-back pain. It offers a simple classification of patients into those showing no psychological distress, those at risk of developing major psychological overlay, and those clearly distressed. Four patient types can be identified on the basis of scores on two short questionnaires. The construction of the Distress and Risk Assessment Method is described and validity data (both clinical and psychological) are presented. The use of the Distress and Risk Assessment Method in the prediction of outcome of treatment is presented, and the paper concludes with general guidelines for its use.

Adult↗
PubMed1991

Pain: psychological and psychiatric factors.

Recent research in the field of chronic pain has highlighted the importance of the assessment of psychological factors as part of the overall assessment of the chronic pain patient. Reliance only on self report of pain is inadequate. A number of different approaches have been taken to psychological evaluation, ranging from formal assessment of psychiatric illness to self-report questionnaires and clinical evaluation. In this chapter, each of the major types of assessment is described and illustrated with examples of specific tests or assessment instruments. The chapter highlights research which has attempted to appraise the relative value of different sorts of psychological information in assessment of the impact of pain or in the patient's response to treatment. Recommendations for the design of a simple comprehensive system for chronic pain are made.

Chronic Disease↗
PubMed1990

A psychometric evaluation of adult patients with type 1 (insulin-dependent) diabetes mellitus: prevalence of psychological dysfunction and relationship to demographic variables, metabolic control and complications.

The relationship between psychosocial traits and glycaemic control and complications was examined in 130 adults (83 men, 47 women) with insulin-dependent diabetes mellitus. Abnormal depression ratings were observed in more women (19.1%) than men (12.0%), p less than 0.01, whilst obsessive symptoms were recorded more frequently in men (41.0 v 21.3%, p less than 0.01). Abnormal anxiety ratings were present in roughly 8-13% of men and women, although a notably low feeling of insecurity rating was observed more frequently in men (56.5%) than in women (38.3% of cases), p less than 0.05. Psychological scores were related to age, employment status and social class, but not to duration of diabetes or glycaemic control. The anxiety, depression and obsessive ratings correlated with one another (rs range 0.24-0.62, all p less than 0.001). Higher anxiety and depression ratings or overt psychological dysfunction was recorded in patients with neuropathic symptoms and signs, impotence, macrovascular disease or proliferative retinopathy. It is concluded that the presence of diabetic complications and adverse social circumstances are more relevant to psychological status than glycaemic control.

Adolescent↗