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Biomedical subjects

Derick Wade

Publications and source records attributed to Derick Wade.

11 recordsLinked to original sources
PubMed2006

The Rivermead Post Concussion Symptoms Questionnaire: a confirmatory factor analysis.

OBJECTIVE: To investigate the factor structure of the Rivermead Post Concussion Symptoms Questionnaire (RPQ) among individuals seen as part of routine follow-up following traumatic brain injury. METHODS: RPQ data from 168 participants was examined (mean age 35.2, SD 14.3; 89% with post traumatic amnesia duration<24 hours) six months after admission to an Accident & Emergency Department following TBI. Structural equation modelling was carried out to evaluate proposed models of the underlying structure of post-concussion symptoms (PCS). RESULTS: The results support the existence of separate cognitive, emotional and somatic factors, although there was a high degree of covariation between the three factors. A two-factor model that collapsed the emotional and somatic factors together showed a similar goodness-of-fit to the data, whilst a one-factor model proved a poor fit. CONCLUSION: The results support the notion of post-concussion symptoms as a collection of associated but at least partially separable cognitive, emotional and somatic symptoms, although questions persist regarding symptom specificity. The use of the RPQ is discussed, and classification bands for use in clinical practice are suggested.

Adolescent↗
PubMed2006

The association of physical deconditioning and chronic low back pain: a hypothesis-oriented systematic review.

PURPOSE: Does physical deconditioning (loss of cardiovascular capacity and strength/endurance of paraspinal muscles) exist in patients with chronic low back pain (CLBP) and are treatments specifically aimed to reduce these signs effective? METHOD: Systematic literature search in PUBMED, MEDLINE, EMBASE and PsycINFO until December 2004 to identify observational studies regarding deconditioning signs and high quality RCTs regarding the effectiveness of cardiovascular and/or muscle strengthening exercises. Internal validity of the RCTs was assessed by using a checklist of nine methodology criteria in accordance with the Cochrane Collaboration. RESULTS: There is conflicting evidence that cardiovascular deconditioning is present in CLBP and limited evidence for wasting of the multifidus muscle. No study examined the effectiveness of cardiovascular training specifically. General and lumbar muscle strengthening are equally effective as other active treatments. Only moderate evidence is available for the effectiveness of intensive low back extensor muscle strengthening compared to less intensive strengthening. CONCLUSION: Probably reactivation caused by active treatment and not the reconditioning itself is the important factor in the reduction of disability. Further prospective and evaluative research into the role of physical deconditioning is necessary. It seems more promising to further explore the interplay between biological, social and psychological factors.

Cardiovascular Deconditioning↗
PubMed2006

Why physical medicine, physical disability and physical rehabilitation? We should abandon Cartesian dualism.

Adjectives are supposed to describe the associated noun more fully or definitively, and the adjective physical is sometimes added to words such as medicine, rehabilitation and disability. What increase in description does its use allow? The adjective was probably added when rehabilitation started to develop for several reasons: it contrasted the mode of treatment with pharmacology and surgery; it contrasted the nature of the supposed aetiology with emotionally generated disorders, especially shell-shock; and it justified the presence of rehabilitation within the profession of medicine. Its continued use, however, perpetuates a Cartesian, dualist philosophy. This editorial uses the World Health Organization International Classification of Functioning (WHO ICF) model of illness to analyse its continued use, and concludes that its continued use may disadvantage both patients and the practice of rehabilitation.

Persons with Disabilities↗
PubMed2005

Borg's rating of perceived exertion scales: do the verbal anchors mean the same for different clinical groups?

OBJECTIVE: To examine the interpretation of the verbal anchors used in the Borg rating of perceived exertion (RPE) scales in different clinical groups and a healthy control group. DESIGN: Prospective experimental study. SETTING: Rehabilitation center. PARTICIPANTS: Nineteen subjects with brain injury, 16 with chronic low back pain (CLBP), and 20 healthy controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects used a visual analog scale (VAS) to rate their interpretation of the verbal anchors from the Borg RPE 6-20 and the newer 10-point category ratio scale. RESULTS: All groups placed the verbal anchors in the order that they occur on the scales. There were significant within-group differences ( P >.05) between VAS scores for 4 verbal anchors in the control group, 8 in the CLBP group, and 2 in the brain injury group. There was no significant difference in rating of each verbal anchor between the groups ( P >.05). CONCLUSIONS: All subjects rated the verbal anchors in the order they occur on the scales, but there was less agreement in rating of each verbal anchor among subjects in the brain injury group. Clinicians should consider the possibility of small discrepancies in the meaning of the verbal anchors to subjects, particularly those recovering from brain injury, when they evaluate exercise perceptions.

Adult↗
PubMed2005

Investigating the effectiveness of rehabilitation professions--a misguided enterprise?

Some research studies investigate the effects of 'professional therapies' (such as physiotherapy) given to certain classes of patient. This presupposes that therapists (a) only deliver treatments and (b) all deliver the same treatment(s), and neither assumption is true. Moreover the study design usually ignores the fact that rehabilitation is or should be a team activity. It is rarely valid to investigate one part of a team's activity in isolation from the activities of other team members. Therefore the research is often flawed, and cannot answer the question(s) posed. Two consequences arise. First, invalid conclusions may be drawn, especially that the input of a therapy profession is ineffective. Second, purchasers may fail to learn that rehabilitation is a team activity, where the team needs to encompass a range of knowledge and skills rather than comprise specific professions, and may stop funding effective rehabilitation by not funding (enough) input from specific professions. The better approach is to investigate the rehabilitation processes and specific interventions that should be specifically described.

Humans↗
PubMed2005

'But is the difference clinically significant?'.

The statement that a difference or change found in a research study is statistically significant is frequently met with the response, 'but is it clinically significant?'. This question seems entirely reasonable and uncontentious until one asks how to determine or define clinical significance. Significance must always have an object; significant to whom? Furthermore it needs elaboration; significant in what way? Once these questions are raised, it becomes apparent that the slick, apparently sensible question is in fact extremely difficult to answer and may have multiple answers: the patient may value being free of discomfort, but the payer may only value achieving less cost in long-term care and the clinician may wish to see change in activities. The use of this question by funding organizations may disadvantage rehabilitation. This Editorial explores the substance of this question, concluding that the question can only be answered by the individual patient concerned, and that research studies should perhaps explore more fully what is actually of significance to patients.

Chronic Disease↗
PubMed2004

An audit of the editorial process and peer review in the journal Clinical rehabilitation.

OBJECTIVE: To investigate the editorial process on papers submitted to a scientific journal. DESIGN: Descriptive and correlational analysis. SETTING: A single specialist rehabilitation journal from mid-1999 to mid-2003. SUBJECTS: The Editor, peer reviewers and authors. INTERVENTIONS: Submitted papers were initially screened, the majority were subject to review, and a decision was made on whether or not to publish. Reviewers scored papers on 11 items using a 0 (bad)-10 (good) scale. MEASURES: Time delays and rating of each paper on a pro-forma. RESULTS: The number of papers submitted each year increased from 136 to 209. Between 19% and 31% were rejected without review and 17-24% were rejected later. The proportion accepted dropped from 64% to 47%. The median delay between arrival and first author contact in papers subject to review was stable between 67 and 76 days. Agreement between reviewers was low with an intraclass correlation coefficient (ICC) varying between 0.12 and 0.27 and disagreement of 3 or more points in 32-51%. The main factor associated with eventual acceptance was the sum of the 'overall recommendation score' given by the two reviewers, but 20% of the variance in final decision was unexplained by the reviewers' scoring. The number of randomized trials published increased from 5 in 1996 to 21 in 2002. CONCLUSIONS: The influence of the Editor on final decisions remains significant, particularly for papers 'on the margin'; decisions on publication in this journal are guided by but not determined by reviewers.

Peer Review, Research↗
PubMed2004

Combined analysis of two randomized trials of community physiotherapy for patients more than one year post stroke.

BACKGROUND: Some patients continue to have mobility problems as a long-term consequence of stroke and it is unclear whether routine, further contact with a physiotherapy service is beneficial. Two single-centre, randomized controlled trials of physiotherapy for patients more than one year post stroke have been undertaken in Oxford and Bradford in the UK and the results from these two trials have been combined to give a more precise estimate of effectiveness. METHOD: The computerized databases from both trials were combined for a joint analysis. Outcome measures common to both trials were: Rivermead Mobility Index; gait speed measured over 10 metres; Barthel Index; Frenchay Activities Index; Hospital Anxiety and Depression Scale. RESULTS: There were 264 patients available for the combined analysis (Oxford = 94; Bradford = 170). There was a significant but clinically small improvement in mobility at three months in the combined treatment group measured by the Rivermead Mobility Index (median of the differences = 0 (95% confidence interval (CI) 0, 1); interpolated values = 0.43 (95% CI 0.08, 0.80)) and gait speed (treatment effect 2.7 m/min (95% CI 0.94, 4.46)). There were no other significant differences. Intervention given in both studies was at the discretion of the physiotherapists and was of similar and low intensity (mean visits Oxford = 4 (SD 2.5); Bradford = 5 (SD 4.5)). CONCLUSION: A more effective physiotherapy intervention is required for stroke patients with persisting mobility problems after stroke.

Aged↗
PubMed2002

Short-term effectiveness of intensive multidisciplinary rehabilitation for people with Parkinson's disease and their carers.

OBJECTIVE: To evaluate the short-term effectiveness of an intensive multidisciplinary rehabilitation programme for people with Parkinson's disease and their carers. DESIGN: Observational, with assessments before and after intervention. SETTING: An elderly care day unit in a district general hospital in south-east England. SUBJECTS: One hundred and eighteen people with Parkinson's disease and no cognitive impairment, and their carers. INTERVENTION: Participants attended the day hospital in groups of six patients with their carers for one day per week over six consecutive weeks. After assessment, they received individual treatment from a specialist team. Weekly group activities included relaxation and talks from experts. OUTCOME MEASURES: Patients and carers were assessed for: health-related quality of life, psychological well-being, social services need, perceptions of the programme. Patients were additionally assessed for mobility, gait and speech. Carers were assessed for strain. RESULTS: After treatment significant improvements were recorded in patients' mobility and gait (p < 0.05), speech (p < 0.001), depression (p = 0.029), health-related quality of life (p = 0.001). People with more advanced disease at baseline gained significantly more from treatment (p < or = 0.04). Carers were less depressed and had higher health-related quality of life than patients at baseline (p < 0.001) and no improvements in these indicators were recorded after treatment. A high unmet need for social services was identified in 31% of participants, and 10% of carers were found in danger of being unable to continue caring. Participants reported knowledge gains and high levels of satisfaction with both individual therapies and group activities. CONCLUSIONS: This intensive co-ordinated programme provided immediate benefits to people with Parkinson's disease and their carers.

Aged↗
PubMedDate not supplied

Rehabilitation following acquired brain injury: concise guidance.

The national clinical guidelines for Rehabilitation following acquired brain injury were developed by a multidisciplinary working party convened by the British Society of Rehabilitation Medicine, and are published in collaboration with the Royal College of Physicians (2003). They have been produced to complement the National Institute of Clinical Excellence head injury guidelines, and to address the medium- to longer-term needs of patients with acquired brain injury and of their families/carers. This article serves as an introduction to make physicians aware of the guidelines, and to highlight in particular the advice to doctors in the acute services regarding early discharge and referral to rehabilitation.

Adult↗