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Biomedical subjects

D Beaton

Publications and source records attributed to D Beaton.

12 recordsLinked to original sources
PubMed2001

A comparison of patients' responses about their disability with and without attribution to their affected area.

The purpose of this study was to determine whether individual items in a disability questionnaire were answered differently depending on whether or not the questions were attributed to the upper limb (i.e., "do you have difficulty eating due to your arm or hand problem?" or "do you have difficulty eating?", respectively). The a priori hypothesis was that the same or more disability would be detected by nonattributed items. Four hundred sixty-seven patients with upper extremity disorders completed the SF-36 general health survey, which does not attribute health problems to affected areas. Patients also completed six additional questions, modified from the SF-36, regarding work (four questions) and social function with friends and family (two questions), which attributed their disability to their affected upper extremity. Of 467 patients, 419-431 (89-92%) responded to both versions of the questions. Although we demonstrated a significant order effect (Generalized Estimating Equation; P=.003), comparison of the responses to the six questions showed that for five of the six questions (Generalized Estimating Equation; P< or = .001) patients reported more disability when the questions were worded with attribution to the upper extremity. Even considering the order effect, patients demonstrated a counterintuitive result by reporting more disability when questions were attributed to their affected area. Thus, both the wording of questions and order of questions can significantly affect patients' responses about their disability and raises questions about the validity of patients' reports of their disability.

Adult↗
PubMed2001

Minimal clinically important differences: review of methods.

Determining a minimal clinically important difference to be detected in a clinical trial is a critical methodological step in the design of a study. In this review, the different methods that have been used in detecting important changes or differences are considered and categorized according to a classification system consisting of which groups are contrasted, the setting of the results, and the type of change of difference being quantified. It was found that most methods and procedures for deriving minimal clinically important differences considered important changes from the viewpoint of a group of patients. Development of methods that focus on individuals should be a goal of the future.

Clinical Trials as Topic↗
PubMed1998

Preventing disability from work-related low-back pain. New evidence gives new hope--if we can just get all the players onside.

Despite the publication in the mid-1990s of comprehensive practice guidelines for the management of acute low-back pain, both in the United States and elsewhere, this ubiquitous health problem continues to be the main cause of workers' compensation claims in much of the Western world. This paper represents a synthesis of the intervention studies published in the last 4 years and is based on a new approach to categorizing these studies that emphasizes the stage or phase of back pain at the time of intervention and the site or agent of the intervention. Current thinking suggests that medical management in the first 3-4 weeks after the onset of pain should be generally conservative. Several studies of rather heterogeneous interventions focusing on return to work and implemented in the subacute stage (3-4 to 12 weeks after the onset of pain) have shown important reductions in time lost from work (by 30% to 50%). There is substantial evidence indicating that employers who promptly offer appropriately modified duties can reduce time lost per episode of back pain by at least 30%, with frequent spin-off effects on the incidence of new back-pain claims as well. Finally, newer studies of guidelines-based approaches to back pain in the workplace suggest that a combination of all these approaches, in a coordinated workplace-linked care system, can achieve a reduction of 50% in time lost due to back pain, at no extra cost and, in some settings, with significant savings.

Absenteeism↗
PubMed1998

Prevalence of upper extremity symptoms and possible risk factors in workers handling paper currency.

The prevalence of upper extremity symptoms in the workforce is high, particularly in industries characterized by forceful, repetitive or awkward movements. A study was undertaken to assess the prevalence of upper extremity symptoms in bank workers in a paper currency processing operation and to examine the role of possible risk factors for these complaints. Thirty-nine workers of a total workforce of 47 were assessed with a questionnaire and physical examination. The questionnaire collected information about demographics, health status, symptom reporting, psychosocial work stressors and other work exposure characteristics. Overall, 59% of the workers reported having significant work-related upper extremity musculoskeletal symptoms in the preceding year, including 49% with neck and shoulder symptoms and 49% with arm and wrist symptoms. In this study the key predictive factor for upper extremity musculoskeletal symptoms was psychological job demands. The workers had similar ergonomic stressors (with little gradient of exposure) and therefore our results do not contradict the importance of ergonomic factors in the development of upper extremity symptoms. However, the results do suggest that within a group exposed to similar ergonomic stressors, psychological job demands may be an important factor associated with musculoskeletal symptoms.

Adult↗
PubMed1997

The histopathological changes in irradiated vs. nonradiated tissue-expanded skin in the porcine model.

This study examined the histological changes following irradiation on nonexpanded and tissue-expanded pigskin. Six Yorkshire pigs received 4860 cGy radiation to one flank with the opposite side serving as the control. A histopathological comparison of tissue expansion in irradiated tissue to nonradiated tissue showed a reduction in the thickness of the dermal and subcutaneous layers, with less prominent rete ridges and a thicker stratum spinosum (p < 0.05). Nonexpanded irradiated tissue showed a reduction of thickness in the dermis and subcutaneous layer, less prominent rete ridges, and a thicker stratum spinosum layer (p < 0.05) when compared with nonradiated tissue. Tissue-expanded irradiated tissue showed no significant differences (p > 0.05) in any of these parameters when compared with nonexpanded irradiated tissue. This study demonstrates that radiation produced a significant change in porcine skin, but tissue expansion did not further alter the histological changes associated with irradiation.

Animals↗
PubMed1993

Measurement of wrist, metacarpophalangeal joint, and thumb extension strength in a normal population.

An objective method of measuring isometric wrist, finger (metacarpophalangeal joints) and thumb extension strength was developed, and values for a normal population were defined. Disability due to extensor dysfunction was not assessed in this study. The testing technique involved the use of a load cell myometer held in a specially constructed jig. A total of 2232 measurements in 372 persons were made. Mean values for the strength of extension were as follows: men--wrist, 13 kg; metacarpophalangeal joint, 6 kg; thumb, 3 kg; women--wrist, 7 kg; metacarpophalangeal joint, 4 kg; thumb, 2 kg. Strength was greatest in the third decade and decreased in each subsequent age group. Wrist extension strength was 10% greater in the dominant hand. Interrater and test-retest reliability were assessed and found to be satisfactory. The method is proposed primarily as a clinical research tool, providing the clinician with an objective means of assessing wrist, metacarpophalangeal joint, and thumb extensor function. Potential applications include measurements of recovery after radial nerve injury or grafting and after other reconstructive procedures to restore extensor function.

Adult↗
PubMed1993

Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines.

Clinicians and researchers without a suitable health-related quality of life (HRQOL) measure in their own language have two choices: (1) to develop a new measure, or (2) to modify a measure previously validated in another language, known as a cross-cultural adaptation process. We propose a set of standardized guidelines for this process based on previous research in psychology and sociology and on published methodological frameworks. These guidelines include recommendations for obtaining semantic, idiomatic, experiential and conceptual equivalence in translation by using back-translation techniques and committee review, pre-testing techniques and re-examining the weight of scores. We applied these guidelines to 17 cross-cultural adaptation of HRQOL measures identified through a comprehensive literature review. The reporting standards varied across studies but agreement between raters in their ratings of the studies was substantial to almost perfect (weighted kappa = 0.66-0.93) suggesting that the guidelines are easy to apply. Further research is necessary in order to delineate essential versus optional steps in the adaptation process.

Cross-Cultural Comparison↗
PubMed1990

Epitope mapping and use of anti-idiotypic antibodies to the L6 monoclonal anticarcinoma antibody.

Mouse monoclonal anti-idiotypic antibodies (anti-ids) were raised against L6, a murine IgG2a monoclonal antibody specific for a cell surface antigen expressed by many human carcinomas. Ten distinct anti-ids were generated. Eight anti-ids were shown to inhibit the binding of L6 to its target antigen and were characterized in detail. The heavy and light chain variable region gene segments of the monoclonal antibody L6 linked to human constant regions (chimeric L6) were expressed separately or together, to map the epitopes recognized by the anti-ids. Individual anti-ids were shown to recognize heavy chain, light chain, or combinatorial variable region determinants. Defining these specificities enabled us to select particular anti-ids for assays to monitor the pharmacokinetics of either murine or chimeric L6 antibodies in the circulation of human patients. A quantitative enzyme-linked immunosorbent assay developed with two anti-ids accurately detects less than 5 ng/ml. Anti-ids specific for light chain variable region-encoded determinants were capable of recognizing L6 antigen-binding fragments bound to the surface of human carcinoma cells. These anti-ids can be used to study the binding of chimeric L6 antibody at the surface of tumor cells in histological sections of tumor biopsies.

Animals↗
PubMedDate not supplied

Assessing the reliability and responsiveness of 5 shoulder questionnaires.

The purpose of this study was to compare the test-retest reliability and responsiveness of 5 different shoulder questionnaires in a sample of patients with shoulder pain. Ninety-nine patients completed the following shoulder questionnaires on 2 occasions: Subjective Shoulder Rating Scale, Simple Shoulder Test, Modified-American Shoulder and Elbow Surgeons Form, Shoulder Severity Index, and the Shoulder Pain and Disability Index. The Short Form-36 was also included. Test-retest reliability was assessed with intraclass correlation coefficients. Standardized response means were calculated to assess responsiveness. This procedure was done on 33 subjects who underwent rotator cuff surgery or total shoulder arthroplasty and who believed that they had improved between testings. All questionnaires had acceptable reliability (coefficients > 0.75) except the Subjective Shoulder Rating Scale (coefficient = 0.71) and were more responsive (0.65 < Standardized response mean < 1.23) than the Short Form-36 (0.08 < Standardized response mean < 0.43) except for pain (0.91). In this longitudinal study a direct comparison of 5 shoulder questionnaires was carried out. We found the Subjective Shoulder Rating Scale to have lower reliability and responsiveness. The other 4 questionnaires including 1 developed to measure whole extremity function (Modified American Shoulder and Elbow Surgeons Form) rather than the shoulder only were comparable with good reliability and responsiveness. The results indicate that the shoulder questionnaires were more sensitive to change in patients with shoulder pain than the generic questionnaire (Short Form-36), and both types of questionnaires should be used in outcome evaluations.

Activities of Daily Living↗