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Biomedical subjects

J Latimer

Publications and source records attributed to J Latimer.

At least 19 recordsLinked to original sources
PubMed2002

Effect of applying different "levels of evidence" criteria on conclusions of Cochrane reviews of interventions for low back pain.

The objective of this study was to examine the consistency of conclusions of Cochrane systematic reviews when different criteria are used to determine levels of evidence. We reanalyzed the data in six Cochrane reviews of conservative treatment of low back pain by applying three additional sets of "levels of evidence" criteria. Overall agreement between the conclusions attained with the different levels of evidence criteria was only "fair" (multirater kappa coefficient 0.33; 95% CI 0.28 to 0.38). For example, the four sets of levels of evidence criteria produced four conclusions on the efficacy of back school: "strong evidence that back schools are effective," "weak evidence," "limited evidence," and "no evidence." Pairwise agreement between the four pooling systems ranged from slight to substantial (kappas ranging from 0.10 to 0.80). Different rules for determining levels of evidence in systematic reviews produce markedly different conclusions on treatment efficacy. Crown

Evidence-Based Medicine↗
PubMed2002

Prediction of the position of the intraparotid portion of the facial nerve on MRI and CT.

Despite developments in imaging technology, visualisation of the intraparotid portion of the facial nerve is not possible. Three separate radiological techniques have been described to predict the position of the facial nerve: Conn's arc; a plane extending posteriorly from the outer surface of the mandibular ramus; and soft-tissue structures, including the posterior belly of the digastric muscle, the retromandibular vein and the lateral border of the masseter muscle. We investigated the reliability of these techniques in predicting the relationship of tumours to the facial nerve. Cross-sectional imaging of the parotid glands was performed prior to the removal of a parotid mass in 26 patients. Twenty patients underwent MRI, and six had CT scans. We removed 14 malignant neoplasms, nine benign lesions and three non-neoplastic lesions. The relationship of the tumour to the facial nerve was assessed radiologically by each of the three techniques, and compared with the findings at surgery. In 18 patients the tumour involved the parotid gland deep to the facial nerve. The above techniques predicted the position of the facial nerve in 69%, 58% and 46% of cases, respectively. When planning parotid surgery, it is important that the surgeon understands the advantages and limitations of the radiological assessment of the position of parotid tumours in relation to the facial nerve.

Adult↗
PubMed2002

Manual examination of accessory movements--seeking R1.

Movement diagrams are used by physiotherapists to depict the behaviour of resistance through the available range of accessory and physiological joint movement. It is generally accepted that for an asymptomatic joint, the resistance first felt by the therapist (R1) occurs towards the end of range. R1 is considered to be at the transition point between the toe and linear region of a load displacement curve. The aim of this study was to more accurately define R1 from force displacement curves of accessory movement to the spine and peripheral joints using a validated instrument, the Spinal Assessment Machine (SAM). Thirty archived force displacement curves obtained using the SAM, which applied a posteroanterior force of 100N at a frequency of 0.5 Hz to L3 spinous process, were examined. In addition force displacement curves were similarly obtained from the tibiofemoral joint, glenohumeral joint and radiocarpal joint of one asymptomatic individual. In all cases resistance to a PA movement commenced at the beginning of range, the curve ascending as soon as the force was applied. While in most cases there was a low stiffness 'toe' region there was no unambiguous point where it could be said that the toe region ended. It is concluded that for spinal and peripheral accessory movements both the onset of resistance and the toe occurs at the beginning of range. Therapists should therefore depict R1 at the beginning of range not toward the end of range as is current practice.

Humans↗
PubMed2001

Indenter head area and testing frequency effects on posteroanterior lumbar stiffness and subjects' rated comfort.

Although several mechanical devices have been developed to objectively assess posteroanterior (PA) stiffness of the lumbar spine, no standardized testing protocol has been adopted. Two factors that may vary across protocols, and that effect measured stiffness and the comfort of the test subject, are the size of the indenter head used to apply the PA pressure, and indenting frequency. Three variables; PA stiffness, defined as the slope of the stiffness curve (K), the displacement of the indenter at 30N (D30), and rating of perceived comfort, were measured in 36 subjects asymptomatic for low back pain. For each subject nine tests were conducted, using three different indenter head sizes (300mm(2), 720mm(2)and 1564mm(2)) at each of three different testing frequencies (0.25 Hz, 0.5 Hz and 2 Hz). Machine testing with a large indenter head produced a lower K value, an increased D30 value and higher perceived comfort, while a fast testing frequency produced a higher K value and a lower D30 value. An indenter size by frequency interaction showed small indenter heads to be least comfortable at slow speed. The differences found suggest that the indenter head size and the testing frequency should be standardized during mechanical spinal stiffness testing.

Acute Disease↗
PubMed2001

Development of an instrumented couch to measure forces during manual physiotherapy treatment.

This paper reports on an instrumented couch developed to measure the forces applied during posteroanterior (PA) mobilization to the lumbar spine. The couch was evaluated for reliability by applying known weights to the empty couch, while accuracy was investigated by applying weights both to the empty couch and to a human subject lying on the couch. The equipment appears highly reliable when measuring forces in three directions (ICC(2,1); 99% CI=0.99-1.00) and also demonstrates acceptable accuracy; a maximum error of less than 2% being obtained when measuring forces applied to human subjects. The results demonstrate a highly linear relationship (r2=0.99) between the force readings and the known weights. In conclusion, the instrumented couch demonstrates suitable accuracy and reliability for measuring the force applied to a subject during the application of PA mobilization to the lumbar spine.

Beds↗
PubMed2001

Contribution of pelvic rotation to lumbar posteroanterior movement.

Variability in lumbar PA stiffness has been found to relate to many factors. Sagittal pelvic rotation has been suggested as one determinant of lumbar PA stiffness. Previous studies have shown that decreased pelvic rotation is associated with increased lumbar PA stiffness. However, it is not known whether variations in pelvic rotation cause changes in PA stiffness. This study aimed to investigate the role of pelvic rotation in determining lumbar PA stiffness, and to investigate whether this role varies with vertebral level of the applied load. A mechanical device was used to apply PA forces to the skin overlying the spinous processes of L2-L5 with the pelvis constrained and unconstrained in 37 subjects without low back pain. Significantly higher PA stiffness (P<0.05) was found when the pelvis was constrained. The degree of increase in PA stiffness depended upon the vertebral level being loaded, with loads at L5 producing the greatest increase in stiffness (24%) and loads at L2 producing a non-significant increase (6%). The findings indicate that sagittal pelvic rotation plays a significant part in the lumbar PA stiffness at L5 but has a lesser influence at more cephalad vertebral levels.

Adult↗
PubMed2000

Short-term effects of lumbar posteroanterior mobilization in individuals with low-back pain.

OBJECTIVE: To establish the short-term effects of lumbar posteroanterior mobilization in patients with low-back pain, compared with a control intervention. DESIGN: Self-controlled cross-over design. MAIN OUTCOME MEASURES: The force-displacement characteristics of the spine in response to the application of a posteroanterior force, lumbar flexion, and extension range of movement; pain during flexion, extension, and on worst movement; pain on posteroanterior loading; and overall pain relief. PATIENTS: Twenty-six patients with nonspecific low-back pain who experienced pain on flexion or extension and whose pain settled quickly after provocation, from a physiotherapy clinic and university campus. METHODS: Patients received posteroanterior mobilization and a control intervention in an order that was randomly allocated. The magnitude of force in treatment dose was selected by the treating physiotherapist. An observer who was blinded to the order of interventions performed all measurements. Outcome measures were recorded before and after each intervention, and change scores were calculated to quantify the effect of the intervention. RESULTS: No significant differences were found between the mobilization and control interventions in relation to posteroanterior response or range of movement. The score for pain on worst movement showed significantly greater improvement for the mobilization than for the control procedure. CONCLUSIONS: Lumbar posteroanterior mobilization was not observed to produce any objectively measurable change in the mechanical behavior of the lumbar spine of patients with low-back pain. Improvement in some pain variables was observed in comparison with a control procedure, but this may be due to a placebo effect.

Adolescent↗
PubMed1999

The reliability and validity of the Biering-Sorensen test in asymptomatic subjects and subjects reporting current or previous nonspecific low back pain.

STUDY DESIGN: A reliability study and case-control study were conducted. OBJECTIVES: To determine the reliability and discriminative validity of the Biering-Sorensen test. SUMMARY OF BACKGROUND DATA: A low Biering-Sorensen score has been found to predict who will have nonspecific low back pain. However, the reliability of the test remains controversial, implying that some studies may have produced results that underestimated the magnitude of the predictive validity of this test. METHODS: Two raters measured the time holding a specific position (holding time) of 63 subjects (23 currently experiencing nonspecific low back pain, 20 who had had an episode, and 20 who were asymptomatic) while they performed the Biering-Sorensen test twice, 15 minutes apart. A standardized protocol was followed. Test-retest reliability was evaluated by calculating intra-class correlation coefficients (ICC 1,1), 95% confidence intervals (CI), and standard errors of the measurement (SEM) for the total group and for the subgroups. A three-way analysis of variance was used to determine whether test order, subject gender, or symptom status affected holding time. RESULTS: High reliability indices were obtained for the Biering-Sorensen test in subjects with current nonspecific low back pain (ICC [1,1], 0.88; 95% CI, 0.73-0.95; SEM, 11.6 seconds), in subjects who had had nonspecific low back pain (ICC [1,1], 0.77; 95% CI, 0.52-0.90; SEM, 17.5 seconds), and in asymptomatic subjects (ICC [1,1], 0.83; 95% CI, 0.62-0.93; SEM, 17.4 seconds). Results of an analysis of variance showed that subjects asymptomatic for low back pain had a significantly longer holding time than the other two groups (P < 0.05). CONCLUSIONS: The Biering-Sorensen test provides reliable measures of position-holding time and can discriminate between subjects with and without nonspecific low back pain.

Adult↗
PubMed1999

Plinth padding confounds measures of posteroanterior spinal stiffness.

This study investigated whether the presence of plinth padding influences measured posteroanterior spinal stiffness. Two measures of posteroanterior stiffness, the slope of the loading curve (K) and the displacement at 30 N (D30) were made at three vertebral levels: L3, T12 and T6, on a rigid and a padded plinth in 24 asymptomatic subjects. Analysis of variance demonstrated a significant reduction in K and increase in D30 when measured on the padded compared to the rigid surface and an interaction effect for both the K and D30 measures, indicating that the effect of the padding depends upon the vertebral level tested. The correlations between the padded and unpadded stiffness measures ranged from 0.70 to 0.87. The data from this study suggest that the type of plinth surface needs to be standardised when evaluating PA stiffness.

Adult↗
PubMed1999

Phylogenetic analysis of H7 avian influenza viruses isolated from the live bird markets of the Northeast United States.

The presence of low-pathogenic H7 avian influenza virus (AIV), which is associated with live-bird markets (LBM) in the Northeast United States, was first detected in 1994 and, despite efforts to eradicate the virus, surveillance of these markets has resulted in numerous isolations of H7 AIVs from several states from 1994 through 1998. The hemagglutinin, nonstructural, and matrix genes from representative H7 isolates from the LBM and elsewhere were sequenced, and the sequences were compared phylogenetically. The hemagglutinin gene of most LBM isolates examined appeared to have been the result of a single introduction of the hemagglutinin gene. Evidence for evolutionary changes were observed with three definable steps. The first isolate from 1994 had the amino acid threonine at the -2 position of the hemagglutinin cleavage site, which is the most commonly observed amino acid at this site for North American H7 AIVs. In January 1995 a new genotype with a proline at the -2 position was detected, and this genotype eventually became the predominant virus isolate. A third viral genotype, detected in November 1996, had an eight-amino-acid deletion within the putative receptor binding site. This viral genotype appeared to be the predominant isolate, although isolates with proline at the -2 position without the deletion were still observed in viruses from the last sampling date. Evidence for reassortment of multiple viral genes was evident. The combination of possible adaptive evolution of the virus and reassortment with different influenza virus genes makes it difficult to determine the risk of pathogenesis of this group of H7 AIVs.

Amino Acid Sequence↗
PubMed1999

The dark at the bottom of the stairs: performance and participation of hospitalized older people.

Like all social actors, older people draw on cultural meanings to perform identity. However, when advanced aging brings loss of status as full persons, particularly when it is associated with sickness and dependency, older people can be deemed unsuitable for active medical treatment and care. In addition, loss of status may make it difficult for older people to influence how they and their needs and wants are identified, and how their future life (or death) is conceived. This article discusses how some older people who are admitted to hospital as acute medical emergencies participate in staff's discursive practices to establish a positive clinical identity. By lying low and effacing their distinctiveness as individuals and as social beings, some older people are able to maintain their inclusion in positive medical categories. The article argues that older people are committed to their inclusion in the medical domain because their association with positive medical categories helps them keep at bay the inchoate, the dark at the bottom of the stairs.

Aged↗
PubMed1999

Endurance training of the trunk extensor muscles in people with subacute low back pain.

BACKGROUND AND PURPOSE: Clinicians treating patients with low back pain often use exercise to reduce pain and improve function. The aim of this study was to evaluate the effectiveness of trunk extensor endurance training in reducing pain and decreasing disability in subjects with subacute low back pain (ie, onset of back pain within 7 days to 7 weeks). SUBJECTS AND METHODS: Patients were randomly assigned to either an experimental group or a control group. A visual analog scale and the pain rating index (PRI) of the McGill Pain Questionnaire (MPQ) were used to obtain baseline measurements of pain. The Roland Morris Disability Questionnaire (RMDQ) was used to measure disability, and the Sorensen Test was used to measure trunk extensor endurance. Subjects in the experimental group attended exercise sessions 3 times a week for 6 weeks. Subjects in the control group did not do exercises. Both groups were given back care advice and hot packs for 15 minutes, 3 to 5 times per week. Reassessments were carried out at 3 and 6 weeks. RESULTS: There were differences between the 2 groups at 3 weeks in regard to pain intensity during the evaluation session and pain experienced over the preceding 24 hours, the total MPQ PRI, the sensory component of the MPQ PRI, and the RMDQ. At 6 weeks, no differences were found for pain measurements, disability scores, and holding time on the Sorensen Test. CONCLUSION AND DISCUSSION: Trunk extensor endurance training reduced pain and improved function at 3 weeks but resulted in no improvement at 6 weeks when compared with the control group. Endurance exercise is considered to expedite the recovery process for patients with an acute episode of low back pain.

Adult↗
PubMed1998

Organizing context: nurses' assessments of older people in an acute medical unit.

The paper presents findings from a study of how older people are assessed and cared for in an acute medical unit. The aim of the study was to reconsider nurses' assessment practices in relation to organisational context. Drawing together ethnographic methods with discourse analysis, the study develops an approach to studying nurses' assessment practices and aims to demonstrate that nurses go beyond entering their relationships with patients as individuals. Rather, nurses' assessments of patients can be considered as processes of alignment that help nurses accomplish complicit managerial and medical objectives, and shape their own identities.

Acute Disease↗
PubMed1998

An investigation of the reliability and validity of posteroanterior spinal stiffness judgments made using a reference-based protocol.

BACKGROUND AND PURPOSE: The reliability and criterion-related validity of ratings of posteroanterior (PA) spinal stiffness made using reference values for comparison have not been investigated. In this study, mechanical reference stimuli for points on an 11-point rating scale were used to determine whether using a reference scale may be feasible. Subjects. Five different raters took part in 2 studies in which they rated 40 subjects who were asymptomatic for low back pain. METHODS: The interrater reliability of ratings was evaluated with intraclass correlation coefficients (ICCs) and standard errors of the measurement (SEMs). Criterion-related validity was evaluated by correlating judgments of PA spinal stiffness assessed manually with measurements of PA spinal stiffness provided by a mechanical device, the "Stiffness Assessment Machine" (SAM). RESULTS: Although the reliability indices were generally high, with ICCs reaching .77 and with SEMs as low as 0.72 points, the evidence for criterion-related validity (i.e., the ability of the examiner to judge spinal stiffness levels) was not strong, with correlations reaching only .56. CONCLUSIONS AND DISCUSSION: The reference-based protocol allows for more reliable measures of PA stiffness judgments than previous protocols have; however, the human ratings are not highly correlated with the SAM measures. The protocol will have clinical value if judgments made using it are shown to be reliable in clinically relevant subjects and to have validity for clinical management of patients.

Biomechanical Phenomena↗
PubMed1997

Primary care. Defining role.

There is no nationally agreed definition of nurse practitioners or of the training required. The extent of the need for nurses to take on doctors' work needs to be established. A clear training framework is required.

Health Care Surveys↗
PubMed1997

Plinth padding and measures of posteroanterior lumbar stiffness.

OBJECTIVE: To investigate whether measurement of posteroanterior (PA) lumbar stiffness is affected by the presence of padding on the testing plinth. DESIGN: Within a repeated-measures design, measurements were made of lumbar PA stiffness in subjects without low back pain on both a rigid and a padded plinth surface. SUBJECTS: Nineteen subjects with no history of any low back pain requiring treatment over the preceding 12 months participated in this study. METHODS: PA stiffness was measured at L3 on two occasions under two different conditions. The first condition involved measurement of lumbar stiffness on a rigid plinth surface; the second involved measurement on a padded plinth surface. A reliable mechanical device was used to obtain the PA stiffness measures. RESULTS: Mean lumbar PA stiffness values obtained when testing on a padded plinth were 2.86 N/mm less than those values obtained when testing the same lumbar spines on a rigid plinth. A paired t test showed a significant difference between the PA stiffness measures at L3 obtained on the padded plinth and those obtained on the rigid plinth (t = 6.66, df = 18, p < or = .0001). CONCLUSIONS: These findings suggest that to improve the reliability of lumbar PA stiffness assessment, testing should be performed under the same plinth surface conditions.

Adult↗
PubMed1996

Evaluation of a new device for measuring responses to posteroanterior forces in a patient population, Part 1: Reliability testing.

BACKGROUND AND PURPOSE: This study determined the test-retest reliability of measurements of responses to posteroanterior (PA) forces made using a recently developed instrument. SUBJECT: Twenty-two subjects with nonspecific low back pain participated. METHODS: The length of the low- stiffness or "toe" region and the slope of the linear portion of the force-displacement curve were measured on two occasions. Reliability of repeated measurements was evaluated by intraclass correlation coefficients and percentage-of-agreement scores. The presence of a systematic change in the response to PA forces was evaluated by a paired-samples t test. RESULTS: High reliability coefficients were obtained for both indices of the response to PA forces. The t test revealed no systematic change with repeated testing. CONCLUSION AND DISCUSSION: The new device provides highly reliable measurement of the lumbar PA force-displacement relationship and may prove useful in evaluating theories that have suggested a relationship between spinal symptoms and abnormal PA stiffness.

Adult↗