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Biomedical subjects

Ian D Learmonth

Publications and source records attributed to Ian D Learmonth.

11 recordsLinked to original sources
PubMed2006

Personal impact of disability in osteoarthritis: patient, professional and public values.

BACKGROUND: Osteoarthritis (OA) is a leading cause of disability. Numerous tools are available to assess this, but they fail to place a patient value upon disability. In rheumatoid arthritis, research has shown patients have different importance values for similar disabilities, and these individual values can be used to weight disability levels, creating a measure of personal impact. OBJECTIVES: Firstly, to determine if the Health Assessment Questionnaire (HAQ) can be used as the basis for an importance value scale by assessing if it includes activities considered important by OA patients. Secondly, to determine if the weights used for the value scale should be based on population, healthcare professional or patient values. METHOD: Twenty-five OA patients, 25 healthy controls and 25 healthcare professionals rated the importance of the items on the HAQ and shortened Modified HAQ (MHAQ). Prior to completing the HAQ, patients generated a list of activities that were important to them. RESULT: The HAQ contained 69% of items that patients considered important. No items were consistently deemed unimportant by patients. There was low agreement within and between groups about the importance of the items on the HAQ and MHAQ. CONCLUSION: The HAQ is a suitable basis for a value scale for an OA disability impact score. Importance values for function differed for patients, healthcare professionals and the general population; therefore individual patient weightings need to be used. Further work is under way to validate a measure of the personal impact of disability in patients with lower limb OA.

Activities of Daily Living↗
PubMed2006

Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia.

BACKGROUND: Total knee arthroplasty is an effective treatment for severe osteoarthritis of the knee. Our aim was to determine whether patients from the United Kingdom, United States, and Australia have different preoperative expectations regarding total knee arthroplasty and whether these expectations have an impact on outcomes and patient satisfaction. METHODS: Patients from the United Kingdom, the United States, and Australia were recruited into a prospective observational study of primary total knee arthroplasty for the treatment of osteoarthritis. Preoperative expectations, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) scores, and demographic, socioeconomic, and follow-up data, including satisfaction with outcome, were obtained from self-administered patient questionnaires. RESULTS: A total of 598 patients with a mean age of sixty-nine years at the time of the index arthroplasty were recruited; 58% were women. The majority of patients expected to have no pain at twelve months after the surgery, and with the numbers available there was no significant difference among the countries with regard to pain expectations. Australian patients were more likely than patients in the United Kingdom or the United States to expect better function at twelve months after the surgery. With the numbers available, satisfaction scores at twelve months did not differ significantly among the countries and were not influenced by preoperative expectations. Australian patients were more likely than patients in the United Kingdom or the United States to be unwilling to undergo total knee arthroplasty again at twelve months under similar circumstances. CONCLUSIONS: Patients from different countries have different expectations regarding total knee arthroplasty, which are not fully explained by differences in sociodemographic factors, clinical characteristics, and pain and functional status. Australian patients had the highest expectations but, despite reporting similar outcomes and satisfaction following total knee arthroplasty, they were more likely not to want to have the surgery again under similar circumstances.

Adult↗
PubMed2005

The Oxford hip score: the patient's perspective.

BACKGROUND: In the last 25 years, assessment of orthopaedic intervention has become patient focused, with the development of self-completion patient-centred outcome measures. The Oxford hip score (OHS) is a joint specific outcome measure tool designed to assess disability in patients undergoing total hip replacement (THR). Although the psychometric properties of the OHS have been rigorously examined, there is little research on the patient's perspective of the OHS. Therefore, the aim of this study is to assess whether the OHS is an adequate disability measure from the patient's perspective using qualitative analysis of annotations written on the OHS by patients. METHODS: In total, 276 orthopaedic patients completed an OHS between April 2004 and May 2005. One hundred and fifty six pre-operative patients listed for a THR completed the OHS during a pre-admission assessment clinic, and 120 post-operative patients completed the OHS postally in the home setting. Patient's unprompted annotations in response to the questions on the OHS were recorded and grouped into thematic categories. RESULTS: In total, 46 (17%) patients made 52 annotations when completing the OHS. These annotations identified five main areas of difficulty that patients experienced: lack of question clarity (particularly concerning the use of aids), difficulty in reporting measurements of pain, restrictive and irrelevant questions, the influence of co-morbidities on responses, and double-barrelled questions. CONCLUSION: Although the OHS is a useful short tool for the assessment of disability in patients undergoing THR, this study identified several problem areas that are applicable to patient-centred outcome tools in general. To overcome these current limitations, further work is underway to develop a more individualised patient-centred outcome measure of disability for use in patients with osteoarthritis.

Adolescent↗
PubMed2003

An in-vitro investigation of the CPS-Plus femoral stem: influence of the proximal centraliser on cement pressurisation during stem insertion.

The CPS-Plus stem is designed for use with a proximal and distal stem centraliser. This in-vitro study examined the cement pressurisation achieved during insertion of the CPS-Plus femoral stem into a model femur. Cement pressures were measured at proximal, mid and distal stem levels. Pressures were recorded during insertion of the CPS-Plus stem with both proximal and distal centralisers and compared with those achieved when only a distal centraliser was used with digital occlusion of the proximal femur. The CPS-Plus with a proximal centraliser generated significantly greater cement pressures than the CPS-Plus without a proximal centraliser at proximal and mid-stem regions. The use of a proximal stem centraliser may improve the cement-bone interdigitation and shear strength at the cement-bone interface, particularly in the region of the proximal femur.

Biomechanical Phenomena↗
PubMed2002

Mechanical characteristics of antibiotic-laden bone cement.

We studied the mechanical characteristics of cement-antibiotic combinations in vitro. Palacos R was tested without antibiotics, with gentamicin alone and with gentamicin plus vancomycin or flucloxacillin. Palacos LV was studied only with gentamicin added. CMW 1 was studied with gentamicin added, with gentamicin plus vancomycin, and with gentamicin plus flucloxacillin. We performed four-point bending tests on beams of cement to establish bending strength and modulus, and compared the values to ISO standards. Density was also assessed. Palacos R was the strongest of the cements (bending strength 80 MPa). Palacos formulations (apart from Palacos LV) had a higher density and bending modulus than CMW 1. Statistical comparison of various cements with plain Palacos R showed lower density in 4 of the mixtures, and lower bending strength and modulus in 6 of the mixtures. Palacos R/gentamicin plus vancomycin and CMW 1/gentamicin plus vancomycin had bending strength slightly above minimum ISO standards, suggesting that the addition of vancomycin during cement mixing may compromise the outcome in revision surgery for sepsis.

Anti-Bacterial Agents↗
PubMed2002

The treatment of nonunion after intracapsular fracture of the proximal femur.

Nonunion is a frequent complication of displaced intracapsular fractures of the femoral neck and occurs in as many as 43% of patients. The incidence can be reduced by prompt anatomic reduction and stable fixation. The treatment of an established nonunion depends on numerous factors including the age of the patient, the vascularity and sphericity of the femoral head, alignment of the neck and shaft, and potential limb length discrepancy. An algorithm constructed from literature-based evidence of the results of available procedures for treatment of nonunion is presented and the roles of refixation, osteotomy, grafting, and prosthetic replacement are considered.

Adolescent↗
PubMedDate not supplied

Quantifying the quasi-static angle and base of gait: a preliminary investigation comparing footprints and a clinical method.

Although the angle and base of gait are useful parameters commonly measured in podiatric medical practice, a standardized procedure has yet to be defined. Static footprints and clinical tracings of the perimeters of both feet were investigated in 25 asymptomatic subjects (17 women and 8 men). The intrarater reliability of each measurement condition was assessed using intraclass correlation coefficients and ranged from 0.965 to 0.981 for the angle of gait and from 0.979 to 0.986 for the base of gait. Both sets of data were compared using paired t-tests and demonstrated no significant differences (P > .001) for the angle and base of gait. The results suggest that footprint data and a simple clinical tracing of the foot are similar, providing a useful clinical tool for static assessment of the angle and base of gait.

Adult↗