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Biomedical subjects

E M Badley

Publications and source records attributed to E M Badley.

At least 37 records · Page 2Linked to original sources
PubMed1998

Arthritis and the aging population: projections of arthritis prevalence in Canada 1991 to 2031.

OBJECTIVE: To develop Canadian projections for the prevalence and numbers of people with arthritis and arthritis disability, overall and in major age groups. METHODS: Age and sex specific data from the 1991 General Social Survey and the 1994 National Population Health Survey on the prevalence of arthritis and arthritis disability were applied to population projections for Canada for every 5 years between 1991 and 2031. RESULTS: Between 1991 and 2031 we project that the prevalence of arthritis diagnosed by a health professional as a longterm condition in Canada will increase from 10.7 to 15.7%, an increase of 46.7%, and the number of people with arthritis will increase from 2.9 to 6.5 million, an increase of 124%. Comparable changes in prevalence and numbers of people with self-reported arthritis are 17.1% (4.7 million) to 23.6% (9.7 million). Most of the increase will be in the population aged 45+, and not until after 2020 will the comparative increase in the 65+ age group be greater than that for the 45-64 age group. Disability attributed to arthritis in the population aged 15+ is projected to increase from a prevalence of 2.3% (595,000) in 1991 to 3.3% (1.13 million) in 2031. CONCLUSION: There are large projected increases in both the prevalence and numbers of people with arthritis and arthritis related disability that, at least in the next 20 years, will be split between the older half of the working population and those aged 65 and older.

Adolescent↗
PubMed1998

A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis.

OBJECTIVE: To evaluate the short term efficacy of a community based physical therapy (PT) program for people with rheumatoid arthritis (RA) through a single blind randomized controlled trial. METHODS: Adults with active RA were referred by their physician for community based PT. Participants were randomized to either an immediate intervention group [experimental group (EG)] or a wait list control group (CG). The intervention was a standardized program of education and exercise consisting of at least 4 visits or 3 h of PT over 6 weeks. Baseline, 6, and 12 week assessments were by a blinded independent assessor. The primary outcome instrument was the Stanford Arthritis Self-Efficacy Scale (SES) and secondary outcome measures included the ACREU Rheumatoid Arthritis Knowledge Questionnaire (KQ) and visual analog scale for pain (VAS). Duration of morning stiffness, grip strength, and tender joint count were also collected at each assessment. Outcome analysis was conducted using analysis of variance. RESULTS: Of 150 eligible and randomized participants, 127 completed the study according to protocol. Baseline analysis showed no differences between the EG and CG for demographics, disease status, or other characteristics. At the 6 week assessment, primary outcome analysis for those who completed the protocol identified a mean change (improvement) of 13.5% in the EG and 5.8% in the CG, representing a 7.7% difference in change scores between the 2 groups [F(1,121) = 6.03; p = 0.015]. A statistically significant difference in change scores was also identified for the KQ [F(1,120) = 6.67; p = 0.011], but not for the VAS. Disease status measures did not change, except for duration of morning stiffness, which improved by 68.8 min in the EG and 8.3 min in the CG (F(1,121) = 4.50; p = 0.036]. CONCLUSION: Four hours of a community based PT intervention delivered over 6 weeks significantly improved self-efficacy, disease management knowledge and morning stiffness in people with RA.

Adult↗
PubMed1997

Development of an instrument to measure knowledge in individuals with rheumatoid arthritis: the ACREU rheumatoid arthritis knowledge questionnaire.

OBJECTIVE: Education is an important component of community based rehabilitation programs for people with rheumatoid arthritis (RA). This study describes the development of a questionnaire to measure knowledge in this context. METHODS: Items were generated using focus group methodology and covered the domains of prognosis, pain management, medications, joint protection, energy conservation, exercise, and coping strategies. RESULTS: After extensive pretesting, the questionnaire was administered to 252 people with RA. The final 31 item questionnaire had acceptable internal consistency (Cronbach's alpha: 0.76, n = 185), test-retest reliability (r = 0.91, p < or = 0.001), content and construct validity. Sensitivity to change was confirmed in the context of a 6 week home based physiotherapy educational intervention. CONCLUSION: The RA knowledge questionnaire is a reliable, valid, and sensitive instrument for measuring the effect of a RA educational intervention.

Adult↗
PubMed1996

Management of the early and late presentations of rheumatoid arthritis: a survey of Ontario primary care physicians.

OBJECTIVE: To examine primary care physicians' management of rheumatoid arthritis, ascertain the determinants of management and compare management with that recommended by a current practice panel. DESIGN: Mail survey (self-administered questionnaire). SETTING: Ontario. PARTICIPANTS: A stratified computer-generated random sample of 798 members of the College of Family Physicians of Canada. OUTCOME MEASURES: Proportions of respondents who chose various items in the management of two hypothetical patients, one with early rheumatoid arthritis and one with late rheumatoid arthritis. Scores for investigations, interventions and referrals for each scenario were generated by summing the recommended items chosen by respondents and then dividing by the total number of items recommended in that category. The scores were examined for their association with physician and practice characteristics and physician attitudes. RESULTS: The response rate was 68.3% (529/775 eligible physicians). Recommended investigations were chosen by more than two thirds of the respondents for both scenarios. Referrals to physiotherapy, occupational therapy and rheumatology, all recommended by the panel, were chosen by 206 (38.9%), 72 (13.6%) and 309 (58.4%) physicians respectively for early rheumatoid arthritis. These proportions were significantly higher for late rheumatoid arthritis (p < 0.01). In multiple regression analysis, for early rheumatoid arthritis, internship or residency training in rheumatology was associated with higher investigation and intervention scores, for late rheumatoid arthritis, older physicians had higher intervention scores and female physicians had higher referral scores. CONCLUSIONS: Primary care physicians' investigation of rheumatoid arthritis was in accord with panel recommendations. However, rates of referral to rheumatologists and other health care professionals were very low, especially for the early presentation of rheumatoid arthritis. More exposure to rheumatology and to the role of physiotherapy, occupational therapy and social work during primary care training is strongly recommended.

Adult↗
PubMed1996

Determining suitability for home versus community-based ambulatory therapy services for adults with arthritis.

OBJECTIVE: A survey of clients seen by a community-based arthritis therapy service was conducted to investigate how characteristics of clients might provide information to assist in the development of guidelines for services delivered in the home versus in a community-based ambulatory setting. METHODS: Clients completed a self-administered questionnaire, which included the Health Assessment Questionnaire, and a mobility handicap measure. Two indicator variables selected as criteria for suitability for ambulatory therapy were the therapists' rating of client suitability and the clients' report of going out more than once weekly. RESULTS: Based on these indicator variables, 60-76% of clients currently receiving home therapy by this service could potentially receive services in a community-based ambulatory setting. CONCLUSION: The results demonstrate the usefulness of considering client characteristics when deciding whether clients need to be seen at home. This study emphasizes the need to determine the most efficient and effective methods of providing services to people in the community with chronic conditions.

Activities of Daily Living↗
PubMed1996

Unmet service needs of children with rheumatic diseases and their parents in a metropolitan area.

OBJECTIVE: To identify perceived unmet service needs of children with rheumatic diseases and their parents in a metropolitan area in order to better plan and coordinate services. METHODS: A pretested questionnaire was sent to 327 families identified from the caseloads and mailing lists of local agencies and a parent support group. RESULTS: After 2 mailings and a telephone followup, 65.0% had responded, 34.4% with complete questionnaire data. The predominant diagnosis was juvenile rheumatoid arthritis (JRA), 58% of parents completing the questionnaire (children 45%) identified a need for additional services, most frequently education (newsletters/books) and teen support groups. Parents of male children selected more services. Problems in school, most commonly related to gym, mobility, and attendance, were reported by 45.5% of the school age children (by parents 49.1%). CONCLUSION: Services for children with rheumatic diseases need to address problems in school, the educational needs of parents and children, and the support needs of the teen group. These results will be used by the agencies involved to plan a more coordinated approach to care for these children.

Adolescent↗
PubMed1996

Determinants of physician confidence in the primary care management of musculoskeletal disorders.

OBJECTIVE: To examine the determinants of confidence in managing musculoskeletal (MSK) disorders among primary care physicians. METHOD: A self-administered questionnaire was mailed to a stratified (by urban/rural location) random sample of 798 Ontario primary care physicians who were members of the College of Family Physicians of Canada. Two mailings and a reminder postcard were used to increase response. As the main outcome measure, confidence was measured on a 10 point Likert-type scale. RESULTS: The overall response rate was 68.3%. Most respondents were practising in a full time group setting; their average age was 40.3 years. Respondents were significantly more confident in performing a comprehensive cardiovascular examination than a MSK examination. Highest levels of confidence were observed for using nonsteroidal antiinflammatory drugs and managing common MSK disorders. Lower scores were reported for doing a joint injection/aspiration. Rural physicians were more confident than urban physicians in doing a joint injection/aspiration and monitoring patients who were taking disease modifying agents. Previous continuing medical education (CME) was significantly (p < 0.01) related to all confidence outcomes using multiple regression analysis. For many outcomes, men reported higher confidence scores than women after adjustment for various demographic characteristics. CONCLUSION: CME may be the most important and modifiable variable to improve physician management of MSK disorders.

Adult↗
PubMed1996

Using Labour Force Survey and census data to generate denominators for occupational injury rates: an application and expansion of Haggar-Guénette's method.

The calculation of rates of occupational injury claims is essential to identify groups at high risk, yet limitations of denominator data have often restricted our capacity to do this. Haggar-Guénette's method of using Statistics Canada's data on paid workers from the Labour Force Survey as denominators has been expanded by incorporating information from the Census. The method is illustrated by calculating denominators for male construction industry workers within the province of Ontario. Information for paid workers employed in construction occupations was derived from the Labour Force Survey to produce denominators for those aged 15-64, overall and by 10-year age groups. Census data on the distribution of construction occupational roles were applied to produce denominators both overall, then simultaneously by age and by occupational role. Advantages and disadvantages, including the limitations or biases due to the differing sources for denominators and numerators are identified.

Accidents, Occupational↗
PubMed1995

The impact of disabling arthritis.

OBJECTIVE: To use the WHO International Classification of Impairments, Disabilities, and Handicaps (ICIDH) as a framework to conceptualize how arthritis affects people and how the effects might be minimized. METHODS: The ICIDH framework emphasizes that the impact of arthritis in terms of handicap is a product of an interaction between a person's social and environmental setting and his or her level of impairment and disability. Data from the Canadian Health and Activity Limitation Survey are used to illustrate the impact for the handicap dimensions. RESULTS: Among persons who have arthritis, 25% cannot leave their residence or can leave only with help (mobility dimension), 45% have at least some level of physical dependence (physical independence dimension), 18% never participate in social activities (social integration dimension), 51% of those under age 65 are not in the labor force and 76% never go out to events such as sports or movies (occupation dimension), and 42% have out-of-pocket expenses because of disability (economic self-sufficiency dimension). CONCLUSION: Policies for the control of handicap require not only medical and rehabilitation interventions to reduce disability, but also consideration of environmental and other social factors.

Activities of Daily Living↗
PubMed1995

Comparison of clinical and self reported diagnosis for rheumatology outpatients.

OBJECTIVE: To examine the sensitivity of patient self reported diagnoses compared with physician diagnoses in a rheumatology outpatient population. METHODS: A mailed survey to 472 rheumatology outpatients (81% response rate) asked about joint symptoms, disabilities, and underlying rheumatic conditions. The self-reported diagnoses were linked with physician diagnoses in the rheumatology clinic computer based diagnostic registry. RESULT: Overall there was an 87% sensitivity for self reported compared with physician diagnoses when the matching criteria included compatible yet different diagnoses such as rheumatoid arthritis (RA) and osteoarthritis (OA). The sensitivity for exact match was 65%, and it varied with the underlying clinical diagnosis, and was greatest for RA (90%) and ankylosing spondylitis (AS) (100%), and intermediate for OA (52%) and psoriatic arthritis (50%). The sensitivity of self report was primarily related to the type of diagnosis (RA or AS v other rheumatic conditions; odds ratio = 16.3, 95% confidence interval (CI) 9.0 to 29.5), and also to difficulty in activities of daily living (odds ratio = 2.3, 95% CI 1.1 to 4.6) but not age, gender, duration of disease, or clinic attendance, as shown by multivariate analysis. CONCLUSIONS: This study in a rheumatology outpatient population indicated that most patients report a diagnosis which is compatible with the clinical diagnosis. These findings give an upper limit to the sensitivity of self reported diagnoses, though further research is needed to assess the extent to which our results may be generalised to other settings.

Aged↗
PubMed1995

The effect of osteoarthritis on disability and health care use in Canada.

Osteoarthritis (OA) is an important cause of longterm health problems and the most frequently reported reason for longterm disability in the population. The overall prevalence of reported arthritis (mainly OA) was 18% of the Ontario household population (age > or = 16 years), with 2.5% of the population reporting longterm disability. An appreciable proportion used health care resources and continued to do so over the long duration of the condition. Longterm disability was accompanied by a substantial effect on daily life, including troubles with mobility, dependence, and difficulty with everyday living activities, social isolation, curtailment of leisure and employment activities, and low income.

Activities of Daily Living↗
PubMed1995

The impact of musculoskeletal disorders in the population: are they just aches and pains? Findings from the 1990 Ontario Health Survey.

OBJECTIVE: In light of the high frequency of symptoms of musculoskeletal (MSK) disorders in the population, our objective was to establish the impact of these disorders on morbidity and health care utilization. METHODS: Analysis of interview data from the 1990 Ontario Health Survey (sample size 45,650 from the household population age > or = 16 years) has provided one of the first opportunities to relate reported MSK morbidity to disability, illness duration, and use of health services. RESULTS: Overall, MSK disorders were reported as a cause of morbidity or health care utilization by 29% of the population aged > or = 16 years. The prevalence of chronic MSK disorders was 22%; this includes the 5% of the population who reported longterm disability due to MSK disorders. Of reported MSK disorders, 79% had a duration of over 6 months, and the median duration was 5 years. MSK disorders impact in the previous 2 weeks, defined as reduced activity or use of health care (seeing a health professional or taking prescription or nonprescription medication) specifically because of MSK disorders, was reported by 12% of the population, of whom 72% reported chronic MSK disorders. A health professional had been consulted within the previous year for 72% of the reported MSK disorders. The proportion with consultations was over 80% for durations of one year or less, and remained over 50% for disease durations > or = 10 years. CONCLUSIONS: Reported MSK disorders cannot be dismissed as minor problems not requiring ongoing care in view of their long duration, disabling impact, and continuing consumption of health care services and resources.

Adolescent↗
PubMed1995

The provision of specialist rheumatology care: implications from a survey of rheumatologists in Ontario, Canada.

OBJECTIVE: To describe the practice characteristics and whereabouts of rheumatologists in Ontario, Canada in order to make inferences regarding the current status of clinical rheumatology services. METHODS: All 136 identified Ontario rheumatologists received a self-administered, mailed questionnaire. RESULTS: The adjusted response rate was 74.2%. For respondents, there was a mean of 14.4 years in practice (1-42 years), 74.7% were male, and 91.3% were practising in urban and/or suburban locations. Only 6 were practising principally in remote northern locations. Sixty-three percent of respondents had a university faculty appointment; 40.4% geographic full time (GFT) and 22.3% clinical only. University appointed rheumatologists, and in particular those with GFT status, were more likely to have a particular clinical focus (p < 0.0001), saw fewer patients on fewer half days/week (p < 0.0001 and p = 0.0001, respectively), had longer waiting times to see a new patient (9.8 weeks for GFT versus 5.9 weeks and 7.0 weeks for clinical only and nonappointed, respectively; p = 0.009), and had greater research, teaching and administrative duties (p < or = 0.0001 for each). University appointment was not associated with the likelihood of having additional nonrheumatology clinical responsibilities. CONCLUSION: A major proportion of rheumatologists in Ontario are university based with significant research, teaching, and administrative responsibilities, which limits their availability as consultants. These findings have implications for the future training of rheumatologists and for future studies of rheumatology manpower requirements.

Academic Medical Centers↗
PubMed1995

An international comparison of the estimated effect of the aging of the population on the major cause of disablement, musculoskeletal disorders.

OBJECTIVE: To illustrate quantitatively the effect of the aging of the population on the prevalence of chronic disorders by comparing the projected frequency of musculoskeletal (MSK) disorders in 3 comparatively "young" countries, Australia, Canada, and the United States, and 3 comparatively "old" countries, France, the United Kingdom, and Sweden. METHODS: Age specific rates for MSK disability in Canada were applied to World Bank population estimates and projects to estimate prevalence rates and numbers of persons with MSK disability in the years 1985, 2000, 2010, and 2020. RESULTS: The age structure of the populations affected baseline rates for MSK disability. Increases in both prevalence and numbers affected are expected for all countries between 1985 and 2020, up to a 34% increase in prevalence in Canada, and an 88% increase in numbers in Australia. CONCLUSION: The aging of the population is likely to result in a disproportionate increase in the number of people with chronic disabling disorders, which will be taking place against a background of a decreasing or static number of young adults, with implications for meeting needs for health care and community support.

Adolescent↗
PubMed1994

Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario Health Survey.

OBJECTIVE: Musculoskeletal disorders (MSD) are a leading cause of morbidity in the population, yet their prominence seems to be insufficiently appreciated. We describe the ranking compared with other major body systems of the prevalence of MSD, including arthritis and rheumatism, and back/neck disorders, as a cause of chronic health problems, longterm disability, restricted activity days, consultation with health professionals, and use of both prescription and nonprescription drugs. METHODS: We analyzed data from the 1990 Ontario Health Survey, a stratified random sample of the household dwelling population in Ontario, based on 45,650 individuals aged 16 years and over. RESULTS: MSD ranked first in prevalence as the cause of chronic health problems, longterm disabilities, and consultations with a health professional and ranked 2nd for restricted activity days and use of both prescription and nonprescription drugs. No other body systems ranked invariably within the top 2 ranks for the morbidity indices examined. Even when compared to other major disease groups, arthritis and rheumatism ranked consistently in the top 3 and back/neck disorders also ranked high. MSD were mentioned as a reason for 40% of all chronic conditions, 54% of all longterm disability, 24% of restricted activity days and almost 20% of health care utilization. The impact of MSD was even greater in the 65 and over age group. CONCLUSIONS: MSD have a major role in the health profile of the population. This high burden of illness should be considered in planning health care services and setting research priorities.

Adolescent↗