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Biomedical subjects

J Nyiendo

Publications and source records attributed to J Nyiendo.

At least 19 recordsLinked to original sources
PubMed2001

Practice-based research: the Oregon experience.

BACKGROUND: Practice-based research links community-based physicians and their patients with investigators at academic institutions. In 1992, Western States Chiropractic College developed an infrastructure, the Center for Outcomes Studies, to support practice-based research. The Low Back Pain Study, undertaken in collaboration with Oregon Health Sciences University, 111 medical physicians, and 60 chiropractors, relied on the Center for Outcomes Studies infrastructure for support in project implementation and maintenance. RESULTS: Challenges, many of them critical, were a regular occurrence: dealing with unforeseen obstacles, establishing and maintaining physician buy-in, establishing and maintaining staff buy-in, implementing the protocol as directed and with minimal intrusiveness, maintaining enthusiasm for the project over time, and knowing where (and where not) to allocate the Study's time, energy, and money. Strategies were developed to overcome or minimize the impact of problems on a case-by-case basis. CONCLUSIONS: Successful practice-based research requires an awareness of study design issues and an appreciation of clinical practice logistics and priorities. Every effort must be made to include doctors and office staff in the implementation of the study in a manner that minimizes the study's intrusiveness and its economic impact on office organization, routine, and personnel. Investigators must understand and accept that there will be areas of the research environment over which they have no direct control. The challenges will be many, but they will be diminished by the rewards.

Algorithms↗
PubMed2001

Patient characteristics and physicians' practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians.

BACKGROUND: Chronic low back pain sufferers are among those who account for the greatest usage of health care resources. Primary care medical (MD) physicians and chiropractic (DC) physicians treat most of these patients. OBJECTIVES: To study patient characteristics and physician practice activities for patients with chronic low back pain treated by DC physicians and MD physicians. METHODS: A longitudinal, practice-based observational study was undertaken in 14 general practice and 51 DC community-based clinics. A total of 2945 consecutive patients with ambulatory low back pain of mechanical origin were enrolled; 835 patients were in the chronic subgroup. Patients were followed for 12 months. Data were obtained on all of the following: patient demographics, health status, and psychosocial characteristics; history, duration, and severity of low back pain and disability; physicians' practice activities; and low back complaint status at 1 year. RESULTS: Patients treated by MD physicians were younger and had lower incomes; their care was more often paid for by a third party; their baseline pain and disability were slightly greater. In addition, patients treated by MD physicians had one fourth as many visits as patients treated by DC physicians. Utilization of imaging procedures by enrolling physicians was equivalent for the two provider groups. Medications were prescribed for 80% of the patients enrolled by MD physicians; spinal manipulation was administered to 84% of patients enrolled by DC physicians. Physical modalities, self-care education, exercise, and postural advice characterized low back pain management in both provider groups. Patients' care-seeking was not exclusive to one provider type. Most patients experienced recurrences (patients treated by MD physicians, 59.3%; patients treated by DC physicians, 76.4%); 34.1% of patients treated by MD physicians and 12.7% of patients treated by DC physicians reported 12 months of continuous pain. Only 6.7% of patients treated by MD physicians and 10.9% of patients treated by DC physicians reported 1 resolved episode during the year. CONCLUSIONS: Differences in sociodemographics, present pain intensity, and functional disability may distinguish patients with chronic low back pain seeking care from primary care medical physicians from those seeking care from DC physicians. Although the primary treatment modality differs, the practice activities of MD physicians and DC physicians have much in common. Long-term evaluation suggests that chronic back pain is persistent and difficult to treat for both provider types.

Adult↗
PubMed2001

Pain, disability, and satisfaction outcomes and predictors of outcomes: a practice-based study of chronic low back pain patients attending primary care and chiropractic physicians.

BACKGROUND: Few studies exist on the prognostic value of demographic, clinical, or psychosocial factors on long-term outcomes for patients with chronic low back pain. OBJECTIVE: This study reports on long-term pain and disability outcomes for patients with chronic low back pain, evaluates predictors of long-term outcomes, and assesses the influence of doctor type on clinical outcome. METHODS: Sixty chiropractic (DC) and 111 general practice (MD) physicians participated in data collection for a prospective, longitudinal, practice-based, observational study of ambulatory low back pain of mechanical origin. The primary outcomes, measured at 6 months and 12 months, were pain (by using the Visual Analog Scale), and functional disability (by using the Revised Oswestry Disability Questionnaire). Satisfaction was a secondary outcome. RESULTS: Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P <.002). A greater proportion of chiropractic patients were satisfied with all aspects of their care (P =.0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study. CONCLUSION: Chiropractic care compared favorably to medical care with respect to long-term pain and disability outcomes. Further study is required to explore the advantage seen for chiropractic care in patients with leg pain below the knee and in the area of patient satisfaction. Identification of patient and treatment characteristics associated with better or worse outcomes may foster changes in physicians' practice activities that better serve these patients' needs.

Adult↗
PubMed2000

Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study.

BACKGROUND: Chronic low-back pain is a significant public health problem for which few therapies are supported by predictable outcomes. In this report, practice activities and 1-month outcomes data are presented for 93 chiropractic patients and 45 medical patients with chronic, recurrent low-back pain. DESIGN: A prospective, observational, community-based feasibility study involving chiropractors and family medicine physicians. SETTING: Forty private chiropractic clinics, the outpatient clinic of the Department of Family Medicine at Oregon Health Sciences University, and 5 other Portland area family medicine clinics. OUTCOMES MEASURES: The main outcome measures were pain severity, functional disability, sensory and affective pain quality at 1 month, and patient satisfaction assessed at 7 to 10 days and at 1 month. RESULTS: Although differences were noted in age, sex, education, and employment, the patients were closely matched at baseline with respect to frequency, severity, and type of low-back pain and the psychosocial dimensions of general health. The treatment of choice for chiropractors was spinal manipulation and physical therapy modalities; for medical physicians antiinflammatory agents were most frequently used. Chiropractic patients averaged 4 visits, and medical patients averaged 1 visit. On average, chiropractic patients showed improvement across all outcomes: 31% change in pain severity, 29% in functional disability, 36% in sensory pain quality, and 57% in affective pain quality. Medical patients showed minimal improvement in pain severity (6%) and functional disability (1%) and showed deterioration in the sensory (29%) and affective (26%) dimensions of pain quality. Satisfaction scores were higher for chiropractic patients. Outcomes for medical patients were heavily dependent on psychosocial status at baseline. CONCLUSION: Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians. Nonclinical factors may play an important role in patient progress. Findings from the Health Resources and Services Administration-funded project will include a report on the influence of practice activities, including more frequent visits by chiropractic patients, on the clinical course of low-back pain and patient outcomes. (J Manipulative Physiol Ther 2000;23:239-45).

Adult↗
PubMed1997

Chiropractic radiologists: a survey of chiropractors' attitudes and patterns of use.

OBJECTIVE: To assess the chiropractic use of radiography, referral patterns to both medical and chiropractic radiologists and attitudes toward radiologists. DESIGN: Random sample mail survey. PARTICIPANTS: Practicing U.S. chiropractors. RESULTS: The response rate was 46% (197 of 425). Seventy-four percent of the respondents have radiographic facilities in their offices. Contraindication screen (71%), pathological diagnosis (63%), biomechanics and posture (51%) and medicolegal protection (27%) were considered important reasons for taking radiographs. When chiropractors refer for radiographic services, 67% refer to medical radiologists and 17% to chiropractic radiologists. Eighty-five percent agreed that chiropractic radiologists are as well qualified as medical radiologists, but 36% thought that medical interpretation carried more legal authority than chiropractic interpretation. Seventy-six percent of respondents thought that the chiropractic radiologist should be consulted only for second opinions. CONCLUSIONS: Most chiropractors obtain radiographs for clinical reasons, such as confirming a diagnosis of pathology, but many continue to use radiography as a screening tool and for medicolegal protection. Prevailing attitudes seem to indicate a need for this specialty in chiropractic, but the chiropractic radiological consultant is not widely used. The disparity between the perceived need for chiropractic radiologists and the current utilization patterns requires further research.

Attitude of Health Personnel↗
PubMed1996

The role of chiropractors in the delivery of interdisciplinary health care in rural areas.

OBJECTIVE: To examine the current and potential role of chiropractors in rural interdisciplinary health care teams. DESIGN: Information was gathered from three sources to summarize rural health care delivery needs and interdisciplinary practice as they relate to chiropractic to develop a position statement: a literature review, a series of semistructured phone interviews with health care providers and a workshop for interdisciplinary health care practitioners, rural chiropractors and chiropractic college faculty. RESULTS: The health care needs of rural populations are diverse and not adequately addressed in the current system. Interdisciplinary teams operating in a community base are recommended as one way to better serve rural needs. Chiropractors are not routinely involved on such teams. Both interprofessional barriers (no chiropractic "niche," lack of knowledge of chiropractic practice and training and lack of medical acceptance) and intraprofessional barriers (lack of consensus on scope of practice, lack of standardization of training and lack of knowledge of other professions) were identified. CONCLUSIONS: Strategies for increasing integration of chiropractic care into the health care delivery system were development of interdisciplinary preceptorships, development of post-graduate curricula for rural DCs in interdisciplinary team concepts and practices, dissemination of information about chiropractic and consensus on chiropractic scope of practice.

Chiropractic↗
PubMed1992

Lumbar motion trends and correlation with low back pain. Part II. A roentgenological evaluation of quantitative segmental motion in lateral bending.

OBJECTIVE: A radiographic study was undertaken to describe the relationship between the magnitude of coupled lumbar motion in lateral bending and the presence of low back pain: correlation between pain and motion, relationship between motion category and motion and symmetry of lumbar motion. DESIGN: Survey. SETTING: Chiropractic college student health center and private chiropractic clinic. PARTICIPANTS: 249 subjects: 114 with low back pain, 29 asymptomatic with no history and 106 asymptomatic with history. Of these, 194 were freshman volunteers and 55 were new private clinic low back pain patients. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Net lumbar segmental tilt and rotation in lateral bending: corrected and uncorrected for segmental malposition with the patient standing in the upright neutral position. RESULTS: Statistical analysis demonstrated no significant relationship between coupled lumbar motion and low back pain (p greater than .01). The presence of type II motion could account for, on average, less than 5% loss of segmental tilt in the lumbar spine. Asymmetries between left and right side motion averaged 45 to 100% of unilateral range of motion. CONCLUSIONS: This study suggests that back pain is not an indication for the routine use of lateral bending films for the identification of alterations in the magnitude of lumbar segmental motion in lateral bending. It further indicates that type II motion cannot be ruled out as a normal variant. The paucity of symmetrical lumbar motion suggests that segmental tilt or coupled rotation asymmetry, in and of itself, should not be considered an indication for spinal manipulation.

Adolescent↗
PubMed1992

The descriptive profile of low back pain patients of field practicing chiropractors contrasted with those treated in the clinics of west coast chiropractic colleges.

OBJECTIVE: To compare the demographic and clinical characteristics of low back pain patients from chiropractic college clinics and private practice settings on the west coast of the United States. DESIGN AND SETTING: A survey analysis of consecutive new patients in a specified time frame from multiple private office settings contrasted with a previous survey of consecutive new patients in a similar time frame from chiropractic college clinics. PATIENTS: In the private practice setting, new patients were selected on a consecutive basis as subjects for the study. Selection was limited to low back pain patients. INTERVENTIONS: None. This was a self-report survey only. MAIN OUTCOME: There is a strong similarity of the two low back pain patient groups, with the exception of higher levels of income, work time loss, severity and functional disability reported in the private practice setting. RESULTS: Similarities between the two low back pain patient groups were found in the distribution of gender, age, job description and education. Statistical significances were not determined due to variations in data collection. CONCLUSIONS: The two patient populations are reasonably comparable in sociodemographic variables, but clinical variation does exist. These results suggest the need to consider clinical findings when extrapolating research findings in a college clinic setting to the chiropractic profession in general.

Adult↗
PubMed1992

Diagnostic utility of the McGill Pain Questionnaire and the Oswestry Disability Questionnaire for classification of low back pain syndromes.

Verbal pain description and assessment of functional limitations are key components in the clinical evaluation of patients with low back pain syndromes. Using the McGill Pain Questionnaire (MPQ) to quantify the pain experience and the Oswestry Disability Questionnaire (ODQ) to quantify functional disability, a study was undertaken to determine the efficiency with which the MPQ and ODQ were capable of enhancing the differential diagnosis of three broad categories of low back syndromes. Three discriminative models were employed. The combined discriminant model (MPQ/ODQ) yielded the highest accuracy, 0.90, and it was the only model with acceptable predictive power. The greatest utility of the discriminant models was found to be ruling out nonspecific low back pain and ruling in radiculopathy, with and without neurological deficits. Subjective pain and disability appear to have the potential for successfully differentiating broad categories of low back pain. Further studies need to be performed to assess the discriminant power of the MPQ and ODQ for specific diagnostic entities.

Activities of Daily Living↗
PubMed1991

Disabling low back Oregon Workers' Compensation claims. Part II: Time loss.

This paper reports on time loss incurred by chiropractic (DC) and medical (MD) claimants with disabling low back work-related injuries in Oregon. Clinical categorization was accomplished using medical records and was based on reported symptomatology, objective clinical findings and functional impairment. The median time loss days for cases with comparable clinical presentation (severity) was 9.0 for DC cases and 11.5 for MD cases. Chiropractic claimants had a higher frequency of return to work with 1 wk or less of time loss. No difference was seen in time loss days for MD or DC claimants with no documented history of low back pain. However, for claimants with a history of chronic low back problems, the median time loss days for MD cases was 34.5 days, compared to 9 days for DC cases. It is suggested that chiropractors are better able to manage injured workers with a history of chronic low back problems and to return them more quickly to productive employment.

Absenteeism↗
PubMed1991

Disabling low back Oregon workers' compensation claims. Part III: Diagnostic and treatment procedures and associated costs.

Claimants in Oregon with disabling low back injuries attending chiropractors were found to have more treatments over a longer duration and at greater cost than claimants attending medical physicians with similar clinical presentations. These findings are attributed to: a) a higher proportion of chiropractic claimants than medical physician claimants with low back risk factors which may have adversely affected the course of recovery (chronic or recurrent low back conditions, obesity, extremity symptomatology, frequency of exacerbations); b) differences in age and gender of DC and MD claimants; c) the greater physician-patient contact hours characteristic of chiropractic practice; d) differences in therapeutic modalities employed; and e) the physician reimbursement permitted under Oregon workers' compensation law. The findings of this study emphasize the need for prospective studies of treatment outcome.

Age Factors↗
PubMed1990

Interrater reliability of roentgenological evaluation of the lumbar spine in lateral bending.

Interrater reliability is described for the evaluation of lumbar motion and motion coupling patterns in lateral bending. Upright neutral and lateral bending lumbar films of 58 student volunteers were marked by three examiners. Segmental tilt, segmental rotation and motion categories were computed. The performance of the examiners was evaluated using the Kappa statistic and a comparison of rater discrepancy to the experimental measurement error. Although all three raters were proficient within the context of calculated measurement error, good reliability was not universally demonstrated. Concordance for rotation was moderate to good, while agreement for lateral bending was of questionable interpretation. Reliability for the segmental motion categories was good for L1-L4, but unacceptable at L5. The poor reliability at L5 resulted in unacceptable concordance for the lumbar global motion category for three raters. The use of lateral bending radiographs for categorization of the lumbar spine in clinical practice is questioned.

Adult↗
PubMed1990

A comparison of low back pain profiles of chiropractic teaching clinic patients with patients attending private clinicians.

A study was undertaken at six chiropractic college outpatient (teaching) clinics and 60 private chiropractic clinics, to evaluate the comparability of patients' pain quality and pain intensity in each of three low back pain diagnostic groups. The McGill Pain Questionnaire (MPQ) was employed for this purpose. There was a tremendous range of measurable pain characteristics (Pain Rating Index scores) within the three diagnostic groups in both patient samples. Overall, patients of field doctors had higher mean scores on all dimensions of pain quality measured by the MPQ, and they described a higher pain intensity than patients attending the teaching clinics. In all three diagnostic groups, patients attending teaching clinics were more likely than private patients to present with a chronic low back condition. Although patients in the field more frequently used words implying greater pain intensity, the characteristics of pain quality (descriptor profiles) showed similar trends among the two patient samples. The consistent findings of less pain intensity among teaching clinic patients support previous reports that these patients have milder complaints than patients seen by field doctors. While these findings do not rule out the use of teaching clinic patients as subjects in clinical trials, it is suggested that generalizations from teaching clinic patients to private patients should be made with caution.

Adult↗
PubMed1989

A comparison of patients and patient complaints at six chiropractic college teaching clinics.

A cooperative study was undertaken by six chiropractic colleges for the purpose of studying similarities and/or differences among the patients and patient complaints at the college outpatient (teaching) clinics. There were some notable differences among the clinics with respect to the standard demographic variables of age, education, employment and income. The sociodemographic characteristics of patients appeared to be different to the extent that the characteristics of the neighborhoods in which the clinics were located were different. Patients referred to the clinics by chiropractic student/interns were more likely to attend for routine physical exam than patients referred by other sources. Although marked differences were observed in patient attendance for routine physical examination, the health problems for which patients sought treatment were very similar among all the clinics. Low back complaints were the most frequently reported health complaint. The characteristics of the low back complaints were very similar at all six sites.

Ambulatory Care Facilities↗
PubMed1988

Visit characteristics of 217 children attending a chiropractic college teaching clinic.

The visit characteristics of 217 children attending a chiropractic teaching clinic are described. Forty-two percent suffered from musculoskeletal complaints, 20% from nonmusculoskeletal complaints and 33% attended the clinic for general physical examination. Patients who were members of the immediate family of a student intern were more likely to attend the clinic for general physical examination or for nonmusculoskeletal complaints. Previous experience with chiropractic was unrelated to the type of complaint, and, among children who had sought previous care for their presenting complaint from some other source, they were as likely to have seen a chiropractor as a medical doctor, regardless of the nature of their complaint. The study concludes that the characteristics of this patient group may be unique to the teaching clinic, reflecting a system in which friends and family are often recruited as patients. These patients might be more likely to view chiropractic care as a primary health care service.

Adolescent↗
PubMed1987

A prospective study of 2,000 patients attending a chiropractic college teaching clinic.

A prospective study was undertaken to characterize 2,000 patients attending a chiropractic teaching clinic and the effectiveness of the care they received. Fifty-two percent of the patients were between 21 and 34 years old; 41% categorized their occupation as professional and 14% as skilled blue collar; 79% presented with musculoskeletal complaints; 44% had low back pain; 41% had complaints less than 1 month; 83% had no work time loss. Eighty-one percent of musculoskeletal diagnoses were reported as strain, with less than 1% intervertebral disc syndrome. The primary treatment approach was manipulation in 90% of cases. As a group, both patients and interns had similar expectations about the likelihood of improvement following treatment and similar assessments of the degree of improvement actually attained. Eighty-two percent of patients improved during their course of treatment. An average 4.4 patient visits were encountered per episode of care, with an average total charge of $66.00.

Adolescent↗