Biomedical subjects

Elaine Thomas

Publications and source records attributed to Elaine Thomas.

At least 19 recordsLinked to original sources

PubMed2006

Multiple joint pain and lower extremity disability in middle and old age.

PURPOSE: To determine whether the extent of multiple-site lower extremity joint pain contributes to disability in middle and old age and describe patterns of severity in site-specific measures amongst those with multiple-site pain. METHOD: Population-based, cross-sectional postal survey. Adults aged 50 years and over registered with three general practices and reporting pain lasting one month or longer in the previous year in at least one hip, knee, or foot were included. Respondents completed a generic measure of physical function and site-specific measures of severity for each relevant joint pain. RESULTS: Of 2429 eligible participants, 1801 reported multiple-site lower limb joint pain. Lower limb joint pain count was independently associated with reduced physical function after adjusting for a range of covariates. The severity of pain and disability attributed to each site increased as the number of painful sites increased. CONCLUSION: Many older people with joint pain in the lower limb have more than one joint affected. Generic and site-specific measures of disability both show the same pattern of reduced physical function. Treatment targeted at a single joint may have only a marginal effect on reducing disability in individuals with multiple joint involvement unless treatment is also conferring benefit at other sites.

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PubMed2006

The assessment of the prognosis of musculoskeletal conditions in older adults presenting to general practice: a research protocol.

BACKGROUND: Musculoskeletal conditions represent a common reason for consulting general practice yet with the exception of low back pain, relatively little is known about the prognosis of these disorders. Recent evidence suggests that common 'generic' factors may be of value when assessing prognosis, irrespective of the location of the pain. This study will test a generic assessment tool used as part of the general practice consultation to determine prognosis of musculoskeletal complaints. METHODS/DESIGN: Older adults (aged 50 years and over) presenting to six general practices with musculoskeletal complaints will be assessed as part of the routine consultation using a generic assessment of prognosis. Participants will receive a self-completion questionnaire at baseline, three, six and 12 months post consultation to gather further data on pain, disability and psychological status. The primary outcome measure is participant's global rating of change. DISCUSSION: Prognosis is considered to be a fundamental component of scientific medicine yet prognostic research in primary care settings is currently neglected and prognostic enquiry is disappearing from general medical textbooks. This study aims to address this issue by examining the use of generic prognostic factors in a general practice setting.

Age Factors↗

PubMed2006

The effect of age on the onset of pain interference in a general population of older adults: prospective findings from the North Staffordshire Osteoarthritis Project (NorStOP).

Pain that interferes with daily life appears to be strongly age-related in cross-sectional studies, although the nature of this relationship over time has not been established. We have investigated the onset and persistence of pain and pain interference over a 3-year period to determine their association with age in older people. A 3-year follow-up postal survey was conducted of adults aged 50 years and over (n=5366) who had previously been recruited as part of the North Staffordshire Osteoarthritis Project. Four thousand two-hundred and thirty-four completed questionnaires were received (adjusted response 84.7%). The occurrence of pain interference at 3 years was 19.7% in persons free of such pain at baseline, higher in females than males (6.0% difference; 95% CI: 2.6%, 9.3%), and showed a clear age-related trend with a more than twofold increase from 50 to 59 years (16.0%) to the 80+ years (35%). Any pain at follow-up was reported by 48% of those pain-free at recruitment, and this figure was similar for males and females, and across 10-year age-groups. Persistence of pain interference (72.1%) at 3 years was high. In adults aged 50 years and over, the onset of pain that interferes with life shows a clear gender difference and a consistent rise with age into the oldest age-group. This was in strong contrast to the onset of pain which showed no gender or age-related trends. The implications for public health, as for the treatment of the individual, are twofold, relating to efforts to prevent disabling pain from occurring and to understand the factors that accelerate the impact which pain has on everyday life when people reach the oldest ages.

Activities of Daily Living↗

PubMed2006

Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial.

OBJECTIVES: To evaluate the effectiveness of two primary care strategies for delivering evidence based care to people aged 55 or over with knee pain: enhanced pharmacy review and community physiotherapy. DESIGN: Pragmatic multicentre randomised clinical trial. SETTING: 15 general practices in North Staffordshire. PARTICIPANTS: 325 adults aged 55 years or over (mean 68 years) consulting with knee pain; 297 (91%) reached six month follow-up. INTERVENTIONS: Enhanced pharmacy review (pharmacological management in accordance with an algorithm); community physiotherapy (advice about activity and pacing and an individualised exercise programme); control (advice leaflet reinforced by telephone call). MAIN OUTCOME MEASURE: Change in Western Ontario and McMaster Universities osteoarthritis index (WOMAC) at 3, 6, and 12 months. RESULTS: Mean baseline WOMAC pain score was 9.1 (SD 3.7), and mean baseline function score was 29.9 (SD 12.8). At three months, the mean reductions in pain scores were 0.41 (SD 2.8) for control, 1.59 (3.2) for pharmacy, and 1.56 (3.4) for physiotherapy; reductions in function scores were 0.80 (8.5), 2.61 (9.8), and 4.79 (10.8). Compared with control, mean differences in change scores for physiotherapy were 1.15 (95% confidence interval 0.2 to 2.1) for pain and 3.99 (1.2 to 6.8) for function; those for pharmacy were 1.18 (0.3 to 2.1) for pain and 1.80 (-0.8 to 4.5) for function. These differences were not sustained to six or 12 months. Significantly fewer participants in the physiotherapy group reported consulting their general practitioner for knee pain in the follow-up period, and use of non-steroidal anti-inflammatory drugs was lower in the physiotherapy and pharmacy groups than in the control group. CONCLUSIONS: Evidence based care for older adults with knee pain, delivered by primary care physiotherapists and pharmacists, resulted in short term improvements in health outcomes, reduced use of non-steroidal anti-inflammatory drugs, and high patient satisfaction. Physiotherapy seemed to produce a shift in consultation behaviour away from the traditional general practitioner led model of care. TRIAL REGISTRATION: UK National Research Register N0286046917; Current Controlled Trials ISRCTN55376150 [controlled-trials.com] .

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PubMed2006

The prevalence of person-perceived participation restriction in community-dwelling older adults.

OBJECTIVE: To estimate the prevalence, nature and distribution of person-perceived participation restriction, in community-dwelling older adults. METHOD: Population based cross-sectional postal survey of 11,055 adults aged 50 years and over in North Staffordshire, United Kingdom. Person-perceived participation restriction was measured using the Keele Assessment of Participation which covers 11 different aspects of life mapped to the World Health Organization's International Classification of Functioning. Four-week period prevalence was calculated for restriction in any, multiple and for each aspect separately. Prevalence estimates were calculated for the total sample, and for each age and gender stratum. RESULTS: A total of 7,878 subjects responded (adjusted response--71.3%). The 4-week period prevalence of any participation restriction was 51.8%; 3.3% had substantial restriction. Participation restriction increased with age (p<0.001) and, for moderate and substantial restriction, was more frequent in women. The prevalence of restricted participation in individual aspects of life ranged from 3.8% (work) to 25.9% (mobility outside the home). CONCLUSION: Some restriction of participation 'as and when we want it' is common in the general population and increases with age, although severe restriction only affects a minority. The distribution of person-perceived participation restriction is similar to that of impairments and activity limitation in community-dwelling older adults.

Age Factors↗

PubMed2006

Staging joint pain and disability: a brief method using persistence and global severity.

OBJECTIVE: Joint pain in older adults is a problem commonly presented to primary care. In contrast to methods for defining and staging the most likely underlying disease (osteoarthritis), clinically practicable methods for staging pain and associated disability are lacking. Our objective was to test a method of brief pain assessment and clinical staging based on recognized focal features of chronic pain and preexisting measurement tools. METHODS: A total of 781 adults ages > or =50 years who were registered with 3 general practices and were experiencing knee pain within the previous 6 months attended research clinics between August 2002 and September 2003. Pain and associated disability were staged on the basis of self-completed questions on knee pain persistence and global severity (Chronic Pain Grade). These were then compared with participants' appraisals of their knee problem, its perceived importance, negative health states, and consultation behavior. RESULTS: Knee pain global severity was associated with symptom dissatisfaction, patient prioritizing, oral analgesic intake, mood, mobility limitation, poorer general health, and consultation behavior. Fewer independent associations were found with knee pain persistence. Staging could be performed using only 4 simple questions. CONCLUSION: Although the usefulness of this approach still needs to be determined in routine clinical settings and across other joint pain sites, our findings suggest that focal characteristics of chronic pain (persistence, global severity) can be used as the basis of brief, simple assessment and staging of joint pain in older adults.

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PubMed2006

The Knee Clinical Assessment Study-CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population: baseline recruitment and retention at 18 months.

BACKGROUND: Selective non-participation at baseline (due to non-response and non-consent) and loss to follow-up are important concerns for longitudinal observational research. We investigated these matters in the context of baseline recruitment and retention at 18 months of participants for a prospective observational cohort study of knee pain and knee osteoarthritis in the general population. METHODS: Participants were recruited to the Knee Clinical Assessment Study-CAS(K)--by a multi-stage process involving response to two postal questionnaires, consent to further contact and medical record review (optional), and attendance at a research clinic. Follow-up at 18-months was by postal questionnaire. The characteristics of responders/consenters were described for each stage in the recruitment process to identify patterns of selective non-participation and loss to follow-up. The external validity of findings from the clinic attenders was tested by comparing the distribution of WOMAC scores and the association between physical function and obesity with the same parameters measured directly in the target population as whole. RESULTS: 3106 adults aged 50 years and over reporting knee pain in the previous 12 months were identified from the first baseline questionnaire. Of these, 819 consented to further contact, responded to the second questionnaire, and attended the research clinics. 776 were successfully followed up at 18 months. There was evidence of selective non-participation during recruitment (aged 80 years and over, lower socioeconomic group, currently in employment, experiencing anxiety or depression, brief episode of knee pain within the previous year). This did not cause significant bias in either the distribution of WOMAC scores or the association between physical function and obesity. CONCLUSION: Despite recruiting a minority of the target population to the research clinics and some evidence of selective non-participation, this appears not to have resulted in significant bias of cross-sectional estimates. The main effect of non-participation in the current cohort is likely to be a loss of precision in stratum-specific estimates e.g. in those aged 80 years and over. The subgroup of individuals who attended the research clinics and who make up the CAS(K) cohort can be used to accurately estimate parameters in the reference population as a whole. The potential for selection bias, however, remains an important consideration in each subsequent analysis.

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PubMed2006

A study of the noninstrumented physical examination of the knee found high observer variability.

OBJECTIVE: This study estimated the inter- and intraobserver reliability of a set of noninstrumented physical examination measures for knee pain in older adults. STUDY DESIGN AND SETTING: Forty-five patients from primary care, and 13 patients from secondary care, were each examined by two out of a team of three physical therapists, and were reexamined by one of these observers 1 month later. The examination items were standardized and included dichotomous, ordinal and continuous variables considered relevant to a primary care context. RESULTS: For individual dichotomous items, median interobserver and intraobserver agreement (kappa) was 0.22 (interquartile range IQR=0.12-0.35) and 0.41 (IQR=0.28-0.56) respectively. For ordinally rated variables, weighted kappa ranged from -0.08 to 0.43 for interobserver agreement, and from 0.00 to 0.79 for intraobserver agreement. The median intraclass correlation coefficient for continuous examination variables was 0.80 (range 0.68-0.89) for interobserver agreement, and 0.84 (range 0.67-0.95) for intraobserver agreement. CONCLUSION: For trained but nonexpert examiners, agreement was generally poor for dichotomous and ordinal examination items; however, kappa-values are liable to be depressed by the low prevalence of clinical signs in this sample. Agreement on continuous variables was notably better.

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PubMed2006

Is chronic musculoskeletal pain in adulthood related to factors at birth? A population-based case-control study of young adults.

Chronic musculoskeletal pain affects one-third of the general population, yet apart from occupational and psychosocial risk factors, relatively little is known about its aetiology. Exposures in very early life may influence the development of chronic pain as a young adult. However, unlike the study of early life influences on some other common chronic diseases, little research has been conducted in this area. Using a nested case-control analysis of a population-based cross-sectional survey, this pilot study investigated associations of selected birth-related factors with chronic pain in young adults living in North Staffordshire. 858 participants responded to the survey (adjusted response 37%). 580 were included in the case-control analysis. No association was found between prematurity (OR: 0.14 95% CI: 0.0, 1.1), foetal distress (OR: 0.80 95% CI: 0.4, 1.8), artificial commencement of labour (OR: 1.04 95% CI: 0.6, 1.8), or non-vaginal delivery (OR: 1.03 95% CI: 0.5, 2.0) and chronic pain at age 18-25 years. Associations were observed between pain status and low birth weight (OR: 2.17 95% CI: 0.6, 7.0) and neonatal ITU admission (OR: 1.63 95% CI: 0.4, 7.4). Although these estimates were not statistically significant in this exploratory study they may be worthy of further investigation.

Adolescent↗

PubMed2006

Is chronic pain in adulthood related to childhood factors? A population-based case-control study of young adults.

OBJECTIVE: To investigate whether recalled childhood pain experiences and illnesses are associated with chronic pain in young adults. METHODS: A cross-sectional population-based survey recruited participants aged 18-25 years for a case-control study and obtained information on current pain and recalled childhood experiences. In total, 858 respondents were classified as either non-pain controls (n = 276), non-chronic pain cases (pain for < or = 3 months in the previous 6 months, n = 435), or chronic pain cases (pain of > 3 months' duration, n = 119). RESULTS: 858 young adults responded to the survey (adjusted response rate 37%). Of the recalled exposures in childhood, family members with pain (OR 2.48, 95% CI 1.48, 4.15), having more than 2 relatives with pain during childhood (OR 3.03, 95% CI 1.44, 6.40), being admitted to hospital during childhood (OR 1.71, 95% CI 1.04, 2.80), and having more illness than one's peer group at secondary school (OR 3.98, 95% CI 1.99, 7.96) were significantly associated with having chronic pain as a young adult, after adjustment for age, sex, and current psychological distress scores. Recall bias was assessed by comparing actual and recalled admission to the neonatal intensive care unit, with no significant differences being found between the participating groups. CONCLUSION: Several associations were observed between pain status as a young adult and selected self-reported childhood experiences of illness and pain. The role of recall bias cannot be excluded in this retrospective study, but the results emphasize the importance of family and childhood experiences of pain in potentially influencing future adult pain status.

Adolescent↗

PubMed2005

Severely disabling chronic pain in young adults: prevalence from a population-based postal survey in North Staffordshire.

BACKGROUND: Severely disabling chronic pain in the adult population is strongly associated with a range of negative health consequences for individuals and high health care costs, yet its prevalence in young adults is less clear. METHODS: All adults aged 18-25 years old registered with three general practices in North Staffordshire were invited to complete a postal questionnaire containing questions on pain within the last 6 months, pain location and duration. Severity of chronic pain was assessed by the Chronic Pain Grade. Severely disabling chronic pain was defined as pain within the last six months that had lasted for three months or more and was highly disabling-severely limiting (Grade IV). RESULTS: 858 responses from 2,389 were received (adjusted response = 37.0%). The prevalence of any pain within the previous six months was 66.9% (95%CI: 63.7%, 70.1%). Chronic pain was reported by 14.3% (95%CI: 12.0%, 16.8%) of respondents with severely disabling chronic pain affecting 3.0% (95%CI: 2.0%, 4.4%) of this population. Late responders were very similar to early responders in their prevalence of pain. Cross-checking the practice register against the electoral roll suggested register inaccuracies contributed to non-response. CONCLUSION: Pain is a common phenomenon encountered by young adults, affecting 66.9% of this study population. Previously observed age-related trends in severely disabling chronic pain in older adults extend to younger adults. Although a small minority of younger adults are affected, they are likely to represent a group with particularly high health care needs. High levels of non-response in the present study means that these estimates should be interpreted cautiously although there was no evidence of non-response bias.

Adult↗

PubMed2005

A method to determine if consenters to population surveys are representative of the target study population.

BACKGROUND: Searching medical records of study non-responders to investigate selection bias is no longer acceptable. We explore an alternative by comparing consultation rates in survey responders who consented to medical record review, with anonymized consultation rates for the total practice populations. METHODS: Anonymized aggregated consultation rates for the year following a population-based survey were calculated for headache and a number of other conditions (chosen to reflect a mixture of chronic and episodic conditions). These rates were compared across two groups of adults: (i) responders to the survey who consented to medical record review and (ii) a 'population group' created from records of the general practices participating in the survey to represent all patients aged 18 years and over at the mid-point in the study year. The consultation rates for the conditions were compared across the two groups using direct standardization. RESULTS: Adjusted consultation rates were similar but generally higher in the responders. CONCLUSIONS: This alternative method applied here offers one potential approach to determine whether study respondents are representative of the population from which they were sampled with respect to general practice consultations.

Adolescent↗

PubMed2005

Diagnostic discordance: we cannot agree when to call knee pain 'osteoarthritis'.

BACKGROUND: Joint pain is common in community-dwelling older adults. Osteoarthritis is the most likely cause and the most common diagnosis made in this age group by GPs. However, the level of agreement between patients and their GPs in this diagnosis is questionable and may have important implications for clinical care. OBJECTIVES: Our aim was to determine the level of agreement between GP diagnosis of knee osteoarthritis and patients' own attribution of osteoarthritis in older adults consulting their GP with knee pain. METHODS: Forty-five patients aged > or =50 years were recruited retrospectively from consecutive knee pain attenders at two general practices in North Staffordshire. All patients were assessed by trained research physiotherapists using standardized assessment procedures. Patients' attribution was assessed by the open-ended question "What do you think is the matter with your knee now?" Blind to the findings of the assessment, a researcher extracted the most recent knee-related Read code recorded by the patient's GP from the medical records to determine GP diagnosis. The physiotherapists also classified patients as osteoarthritis or non-osteoarthritis according to the American College of Rheumatology's clinical classification criteria. RESULTS: Agreement between GP diagnosis of 'knee osteoarthritis' or 'osteoarthritis NOS' and patient diagnostic attribution of knee 'arthritis' or 'osteoarthritis' was poor [kappa=-0.03; 95% confidence interval (CI) -0.32 to 0.26]. Neither the GP diagnosis nor the patient diagnostic attribution was strongly related to clinical classification using standard criteria (kappa=0.28; 95% CI -0.01 to 0.56; and kappa=-0.39; 95% CI -0.66 to -0.13, respectively). CONCLUSIONS: The level of agreement between a GP diagnostic code of osteoarthritis and patients' use of the term '(osteo)arthritis' is no greater than would be expected by chance alone. Discordance may be high in the use of the label osteoarthritis but is not direct evidence of a lack of shared understanding of this condition.

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PubMed2005

An introduction to medical statistics for health care professionals: basic statistical tests.

This article, the third and final article in the series, aims to give health care professionals (HCPs) a sound and helpful introduction to medical statistics (Thomas, 2004, 2005). A brief summary of the content of the previous articles is given in Table 1. The current article will cover the area of basic statistical tests with the aim of guiding HCPs to the correct test for a particular research question and dataset. The article will not go into great depth of the formal methods of calculation required for all the tests covered but I would suggest that the reader refer to standard textbooks (Jordan et al., 1998; Swinscow, 1998; Altman, 1994; Bland, 2000), the help sections of statistical packages (SPSS or Stata), or consult a statistician. For ease of reference within the article the tests have been grouped by the data type, i.e. numerical or categorical. Further separation within each data type has been carried out depending on the number of groups being compared, whether the groups are independent, the size of the sample, and, in the case of numerical data, the distribution of the variable. For quick reference, two other tables are also presented which summarize which analysis methods should be used in each situation.

Journal Article↗

PubMed2005

An introduction to medical statistics for health care professionals: Hypothesis tests and estimation.

This article is the second in a series of three that will give health care professionals (HCPs) a sound introduction to medical statistics (Thomas, 2004). The objective of research is to find out about the population at large. However, it is generally not possible to study the whole of the population and research questions are addressed in an appropriate study sample. The next crucial step is then to use the information from the sample of individuals to make statements about the wider population of like individuals. This procedure of drawing conclusions about the population, based on study data, is known as inferential statistics. The findings from the study give us the best estimate of what is true for the relevant population, given the sample is representative of the population. It is important to consider how accurate this best estimate is, based on a single sample, when compared to the unknown population figure. Any difference between the observed sample result and the population characteristic is termed the sampling error. This article will cover the two main forms of statistical inference (hypothesis tests and estimation) along with issues that need to be addressed when considering the implications of the study results.

Journal Article↗

PubMed2005

The Keele Assessment of Participation: a new instrument to measure participation restriction in population studies. Combined qualitative and quantitative examination of its psychometric properties.

The World Health Organization has proposed participation restriction to reflect the societal consequences of health conditions. Despite its importance, participation restriction appears to be inconsistently represented or absent from the content of many health status instruments. This paper describes the development and testing of a new self-complete measure of participation restriction from the conceptual basis of participation as an individual's perception of their actual involvement in life situations. The psychometric properties (face, content and construct validity, responder burden, performance and repeatability) of the instrument were examined using qualitative and quantitative methods. Person-perceived participation restriction did not reflect the frequency of participation but was associated with participants' expectations, aspirations, and needs, as well as contextual factors. We conclude that the instrument can provide estimates of person-perceived participation restriction in population surveys.

England↗

PubMed2005

One-year follow-up of headache in an adult general population.

OBJECTIVE: To investigate variation in headache occurrence and characteristics over 1 year. BACKGROUND: Headache is a common condition which can affect the work, home, and social lives of sufferers, yet surprisingly little is known about how headache changes over time. METHODS: Postal survey to a random general population sample of 5000 adults aged 18 years plus, with follow-up survey to all baseline responders at 1 year and a subsample of 500 being surveyed at 3-monthly intervals between the baseline and 1-year surveys. RESULTS: A total of 1589 (74% response) responded to the 1-year follow-up and 282 of the subsample responded to all five surveys at 3-monthly intervals. Among 1-year respondents with recent headache at baseline (defined as occurring during the previous 3 months), nearly all (94%) also reported headache during the follow-up year. One-third of respondents without recent headache at baseline reported a new episode of headache during the follow-up year. Most (85%) respondents with recent headache at both baseline and 1-year follow-up reported a variation in at least one headache characteristic. These findings were replicated in the sample completing the 3-monthly surveys. Although most of this subgroup reported their headache occurrence status was unchanged during each 3-month period, only a few (3%) respondents with headache in each period reported no variation at all in headache characteristics during the study. CONCLUSIONS: While prevalence of recent headache was stable over time for individuals, there was considerable variation in headache characteristics.

Adolescent↗

PubMed2005

Psychological, sleep, lifestyle, and comorbid associations with headache.

OBJECTIVE: To investigate the associations of headache occurrence, severity, and frequency with psychological, sleep, and lifestyle characteristics, and comorbid conditions. BACKGROUND: Whilst associations for individual headache types, particularly migraine, have been investigated, possible associations between headache of all types and general health characteristics have not been explored. METHODS: Cross-sectional postal survey in an adult general population sample registered at five general practices in North Staffordshire, UK. RESULTS: Headache occurrence was associated with anxiety (odds ratio 4.09, 95% confidence interval 3.0, 5.6) and sleep problems (moderate sleep problems OR 3.60, 95% CI 2.5, 5.0), and the strength of the associations increased with higher levels of anxiety and sleep problem. Whilst depression showed an association with headache, this was not seen in respondents with depression in the absence of anxiety. Headache occurrence was also associated with comorbid pain anywhere in the body (OR 2.12, 95% CI 1.7, 2.6), with the strongest associations being for the neck and upper body areas compared with other areas. There was no overall link with alcohol or caffeine consumption. Increasing severity and frequency of headache resulted in stronger associations, and there were strong associations between the occurrence, severity, and frequency of headache, and both sleep problems and psychological distress. CONCLUSION: Poor sleep and anxiety appear to make a substantial contribution to the impact of headache on sufferers' lives in the general population.

Adolescent↗