Biomedical subjects

J B Sobel

Publications and source records attributed to J B Sobel.

6 recordsLinked to original sources

PubMed2000

Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study.

OBJECTIVE: To develop and assess the reliability of a group of cervical nonorganic physical signs to be used as a simple screening tool for identifying patients with low neck pain who exhibit abnormal illness behavior. DESIGN: Survey, consecutive sample. DATA SET: Double masked. SETTING: Functional restoration program. PATIENTS: Twenty-six consecutive patients with complaints of chronic neck pain (greater than 4 months duration). Each patient was evaluated by a physician and then again by either a physical or occupational therapist, for the presence of specific cervical nonorganic signs. Both of the evaluations occurred on the same day. MAIN OUTCOME MEASURES: Five categories consisting of eight tests were appraised: (1) tenderness, (2) simulation, (3) range of motion, (4) regional disturbance, and (5) overreaction. RESULTS: The percent agreement between raters ranged from a high of 100% for regional sensory disturbance, to a low of 68% for one of the simulation tests. The average agreement between raters across all of the nonorganic test signs was 84.6%. Likewise, kappa coefficients ranged from 1.00 to .16, reflecting differences in strength of agreement. CONCLUSION: For many years, the lumbar nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable.

Adult↗

PubMed2000

Long-term exercise adherence after intensive rehabilitation for chronic low back pain.

PURPOSE: The purpose of this study was to examine exercise compliance in patients with chronic low back pain (CLBP) after participation in an intensive spine rehabilitation program. METHODS: Exercise behaviors in 122 consecutive subjects with CLBP who completed a program of quota based exercise were examined. Frequency per week of performance of four exercise activities, Oswestry disability scores, and visual analog scale (VAS) scores were assessed at evaluation, 3-month, and 12-month follow-up by patient-completed questionnaires. RESULTS: Percentage of patients responding to initial, 3-month, and 12-month questionnaires were 100%, 86%, and 71%, respectively. Frequencies of exercise behaviors were compared by Wilcoxon signed-rank test and were found to increase significantly between evaluation and 3 months (P < 0.000), and evaluation and 12-month follow-up (P < 0.000). The percentages of patients reporting three or more times weekly performance of the following activities at evaluation and at three month follow-up, respectively, were: 1) stretching for the back and legs, 35% and 93%; 2) aerobic exercise, 44% and 87%; 3) back-strengthening exercises, 15% and 82%; and, 4) weight training, 6% and 71%. Evaluation and follow-up Oswestry disability and visual analog scale (VAS) scores for back pain were compared using Student's t-test. Significant improvements (P < 0.000) were noted for each of these scales at 3-month follow-up that were maintained at 12-month follow-up. CONCLUSION: It is concluded that exercise behaviors can be increased and maintained in CLBP patients without adversely affecting pain or function.

Adolescent↗

PubMed1997

The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain.

STUDY DESIGN: In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared. OBJECTIVES: To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts. BACKGROUND: Previous studies have produced conflicting results concerning this issue. METHODS: Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota-based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables. RESULTS: The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group. CONCLUSIONS: In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions.

Adult↗

PubMed1996

Low back and cervical spine disorders.

Neck and back pain are common work-related complaints. The natural history of these symptoms favors rapid recovery. Medical management of workers with these complaints relies on carefully managing this natural history, while attempting to minimize the resulting disability. Medical advice should focus on decreasing patients' fears and encouraging a rapid return to function (including work) as acute pain symptoms improve. Interventions should be as limited as possible and promote self care. Patients with radicular symptoms may require additional interventions but, there, too, the natural history is favorable. Surgery may be necessary in a small percentage of patients with catastrophic and severe neurologic symptoms or persistent, severe pain. Chronic neck and back pain symptoms are commonly encountered. Medical and reversible causes of pain should be sought in such patients. When none is found, interventions aimed at maximizing back and neck function and improving tolerance for physical activities may be beneficial in returning these workers to productive lifestyles.

Humans↗

PubMed1994

Comparison of total lumbosacral flexion and true lumbar flexion measured by a dual inclinometer technique.

STUDY DESIGN: This study investigated the interrelationship between total lumbosacral flexion and true lumbar flexion in a population of chronic low back pain sufferers, measured with a dual inclinometer technique. Correlations with self-reported disability also were assessed. Self-reported disability was measured with the Million Visual Analog Scale. OBJECTIVES: To assess whether total lumbosacral flexion could be substituted for true lumbar flexion in the clinical evaluation of trunk mobility. To determine which measure of flexion is a better predictor of self-reported disability after an intensive rehabilitation program for chronic spinal disorders. SUMMARY OF BACKGROUND DATA: Eighty-nine consecutive patients with chronic low back pain were evaluated. Fourteen subjects were excluded because of previous surgery. Seventy-five meet inclusion criteria and underwent quantification of lumbar mobility. Sixty-four met literacy criteria and were administered the Million Visual Analog Scale. Thirty-six patients completed rehabilitation and were re-evaluated at program completion for lumbar mobility. Thirty-three were re-evaluated with the Million Visual Analog Scale. RESULTS: Pearson's correlation coefficients for lumbar versus total flexion were r = 0.88 for initial evaluation and r = 0.84 after treatment. Correlation coefficients also were calculated for lumbar flexion and total flexion with disability scores. Before treatment, both measurements accounted for similar amounts of the variance in disability scores. However, after treatment, total flexion correlated higher with self-reported disability (r = -0.62 versus r = -0.43). CONCLUSIONS: Our results suggest that total lumbosacral flexion may be as equally relevant as true lumbar flexion in the measurement of trunk mobility in the clinical examination of patients with chronic low back pain. Regarding their relationship to self-reported disability, total flexion seems to be more relevant to outcome after intensive rehabilitation.

Adolescent↗

PubMedDate not supplied

Inhalation injury: a decade without progress.

Despite major advances in the management of patients with critical burn injuries, inhalation injury continues to be a major determinant of death resulting from burn injuries. Two cohort groups of victims with burn and inhalation injuries, separated by a decade, were retrospectively reviewed in an effort to determine the impact of newer treatment modalities. Patients were categorized as being at "high" or "low" risk on the basis of primary and secondary diagnostic criteria. Despite a statistically significant decrease in the percent of total body surface injury, no change in mortality rate was noted between the two groups. The advent of sophisticated diagnostic and management techniques does not appear to have decreased the mortality rate associated with inhalation injury.

Adolescent↗