Biomedical subjects

Jill Dawson

Publications and source records attributed to Jill Dawson.

14 recordsLinked to original sources

PubMed2006

A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus.

BACKGROUND: A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. METHODS: We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. CONCLUSIONS: The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

Adult↗

PubMed2006

Pain and overall health status in older people with hip and knee replacement: a population perspective.

OBJECTIVE: To investigate the health-related quality of life and presence of hip or knee pain according to whether or not people had had previous hip or knee arthroplasty. STUDY DESIGN AND SETTING: Cross-sectional survey representing randomly selected sample of 5500 elderly (65+) people. Pain prevalence rates obtained from standard screening questions. Standard pain severity ratings obtained for each hip and knee. RESULTS: People with a past arthroplasty had worse health status compared to other people (p < 0.001 for all but two SF-36 dimensions). Hip or knee pain was more prevalent amongst people with past hip or knee replacement than amongst those without (62.5% versus 36.5% respectively; following adjustment for age and sex: Mantel-Haenszel combined odds ratio = 2.90, 95% CI 2.30-3.68, p < 0.001). More replaced knee joints were symptomatic than replaced hip joints (OR = 1.62, p = 0.022). CONCLUSIONS: Elderly people with a past hip or knee arthroplasty have significantly greater health and social care needs than other people--especially those related to pain and mobility. This may reflect the generalised nature of the underlying disease process.

Aged↗

PubMed2006

Prevalence and predictors of angina pectoris one month after myocardial infarction.

Angina pectoris (AP) is a treatable symptom that is associated with mortality and decreased quality of life. The prevalence and predictors of AP 1 month after a myocardial infarction (MI), a time when additional treatments might be offered, have not been described. We prospectively enrolled 2,094 patients with MI from 19 centers in the United States and evaluated angina symptoms 1 month after discharge with the Seattle Angina Questionnaire. Multivariable logistic regression analysis was performed to identify patient and treatment characteristics associated with 1-month AP. At 1 month, 571 patients (27.3%) had AP. Women (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.09 to 1.74), younger patients (OR 1.33 per 10-year increment, 95% CI 1.20 to 1.47), those with previous coronary artery bypass (OR 1.47, 95% CI 1.05 to 2.05), smokers (OR 1.35, 95% CI 1.09 to 1.77), and those who developed postinfarct AP during the index hospitalization (OR 1.85, 95% CI 1.20 to 2.65) were more likely to have AP at follow-up. In contrast, patients who were treated with coronary artery bypass surgery during their index admission were less likely to have AP at 1 month (OR 0.5, 95% CI 0.33 to 0.77). The strongest correlate was the frequency of AP before patients' MI. Compared with those without AP before MI, those with AP < 1 time per week (OR 1.86, 95% CI 1.45 to 2.41), weekly (OR 4.24, 95% CI 3.09 to 5.82), and daily (OR 6.12, 95% CI 3.62 to 10.3) were more likely to have AP 1 month later. In conclusion, > 1 in 4 patients reported AP 1 month after an MI.

Angina Pectoris↗

PubMed2005

A response to issues raised in a recent paper concerning the Oxford knee score.

In a recently published paper, authors were critical of the Oxford Knee Score (OKS) patient based measure. We discuss a number of the interesting issues that this paper raised and point out some obvious misunderstandings. The OKS, whilst not perfect, has been shown in independent comparative studies to perform more satisfactorily than other measures. It remains one of a small number of measures with satisfactory measurement properties. It would be a great pity if clinicians were deterred from using the OKS on the basis of comments made in the recent publication.

Aged↗

PubMed2005

Impact of persistent hip or knee pain on overall health status in elderly people: a longitudinal population study.

OBJECTIVE: To investigate hip or knee symptoms in older persons from a longitudinal, population perspective, and to determine the impact of persistent hip or knee pain on general health status over time. METHODS: A postal questionnaire was sent to a random sample of 5,500 individuals ages > or = 65 years containing the Short Form 36 (SF-36) general health survey, Lequesne hip and knee indices, and a hip/knee pain severity item. Respondents reporting hip or knee symptoms at baseline received an identical questionnaire 12 months later. Respondents were classified into a persistent pain group with either hip or knee pain at both baseline and followup, and a non-persistent pain group who reported hip or knee pain at baseline but no pain at followup. RESULTS: At baseline, 1,305 (40.7%) of 3,210 eligible respondents reported hip or knee pain. At 1 year, 1,072 (82.1%) of 1,305 individuals responded, of whom 820 (76.5%) remained symptomatic (the persistent group). In multivariate analysis, baseline factors identified as strongly related to having persistent pain were maximum Lequesne score (odds ratio [OR] 1.09, P < 0.001), maximum hip/knee pain score (OR 1.61, P < 0.001), and number of painful hip and knee joints at baseline (OR 1.48, P = 0.004). Following adjustment for age, sex, and baseline score, differences in mean SF-36 change scores of the 2 groups were significant for all dimensions except for mental health. CONCLUSION: In older persons, a symptomatic hip or knee frequently progresses in terms of worsening symptoms and accrual of other symptomatic hip or knee joints. The impact of persistent symptoms on general health is substantial.

Aged↗

PubMed2005

Population survey comparing older adults with hip versus knee pain in primary care.

BACKGROUND: Knee pain is nearly twice as prevalent as hip pain in elderly people, yet knee replacement is far less common than hip replacement. AIM: To investigate whether systematic differences in the primary care management of hip versus knee problems might explain the disparate rates of joint replacement. DESIGN OF STUDY: Cross-sectional, population-based postal survey. SETTING: Random sample of 5500 Oxfordshire residents aged 65 years and above. METHOD: Screening questions were used to identify symptomatic individuals: "During the past 12 months, have you had pain in or around either of your hips/knees on most days for 1 month or longer?". Standard (Lequesne) severity ratings were obtained for each hip and knee. Logistic regression was used to estimate odds ratios (ORs) for "knee cases" versus "hip cases" for selected healthcare services and attitudes toward replacement. RESULTS: Among 3341 responders, 212 hip cases and 612 knee cases were identified. Knee pain led to a GP consultation more often than hip pain (OR = 1.76, P = 0.04), but specialist referral was no more likely (OR = 0.85, P = 0.57). Similar percentages of hip and knee cases would agree to hip/knee replacement surgery if it was offered, but hip and knee cases differed in their views on the general success of joint replacement. CONCLUSIONS: Some variations in primary care management for hip versus knee pain were apparent. People with hip pain were mostly positive about replacement outcomes, whereas people with knee pain were more uncertain about replacement. Attitudes appeared to be influenced by knowing someone who had undergone such surgery.

Aged↗

PubMed2004

Prospective study of elderly people comparing treatments following first primary care consultation for a symptomatic hip or knee.

BACKGROUND: Symptomatic knee problems in elderly people are considerably more common than hip problems, yet far more hips are replaced. OBJECTIVE: The purpose of this study was to investigate whether systematic differences occur in early primary care management of elderly patients who first consult with hip versus knee symptoms. METHODS: A prospective analysis was carried out of anonymized records in the MediPlus general practice database. This was a 3 year (1996-1998) prospective study of 310,843 patients aged 65+ regarding consultations about a new hip or knee problem. Survival analysis techniques were used to analyse time to and frequency of various interventions. RESULTS: A total of 1410 new hip and 3152 new knee consulters were identified. Baseline characteristics of the two groups were very similar. By 3 years following the first consultation, more of the hip cases had referral to a specialist (38.2% hips versus 31.5% knees, P <0.001) and joint replacement (9.6% hips versus 1.8% knees, P <0.001) recorded. Non-steroidal anti-inflammatory drug (NSAID) prescribing was high for both groups, with approximately 51% prescribed one of the safer forms and approximately 15% prescribed one with a lower safety record within 3 years. CONCLUSION: Rates of specialist referral and joint replacement in older people are much lower, or slower, for those with symptomatic knees relative to hips. In the absence of surgery, prescriptions for pain killers are similar for both groups. Elderly people with symptomatic knees are therefore at increased risk of drug side effects relative to those with symptomatic hips. This may represent another facet of unmet need for surgery in people with knee disease.

Aged↗

PubMed2004

Occupational therapy in multiple system atrophy: a pilot randomized controlled trial.

There is some evidence that rehabilitation therapies may be useful in progressive neurological conditions, but this usefulness has not been studied in multiple system atrophy (MSA) to date. The aim of this small pilot study was to identify the feasibility of a larger randomized controlled trial of occupational therapy and to report preliminary data on the impact of occupational therapy on disability, mood, and health-related quality of life in patients with MSA. Patient groups were comparable for age, gender distribution, type of MSA, and severity. The active occupational therapy intervention group experienced a significant reduction of Unified Parkinson's Disease Rating Scale (total score and Activities of Daily Living [ADL] section), and PDQ-39 scores (total scores and ADL subsection). An occupational therapy program may improve functional abilities in patients with mild to moderate MSA. A larger multicenter study is needed.

Activities of Daily Living↗

PubMed2004

Comparing alternative Rasch-based methods vs raw scores in measuring change in health.

OBJECTIVES: To compare alternative Rasch-based approaches to the assessment of change over time through the example of an outcome measure used in total hip replacement surgery. SUBJECTS: Preoperative data were collected on 1424 patients receiving total hip replacement surgery; 1221 (86%) were sent follow-up questionnaires 1 year after surgery. MEASURES: The 12-item Oxford Hip Score (OHS) questionnaire administered preoperatively and 1-year postoperatively. METHODS: Subscales of the OHS for pain and functional impairment were examined for unidimensionality and item invariance. Two criteria were used to examine Rasch-based measurement of the 2 subscales. Advantages of Rasch measurement were examined in terms of whether it produced improved discrimination of outcomes of patients (1) undergoing different levels of complexity of surgery; and (2) reporting different retrospective judgments of the success of their surgery. Using the method of relative precision in relation to groups of patients distinguished in these 2 ways, change scores using Likert scoring methods were compared with 2 Rasch scoring methods: (1) separate analyses of the 2 time points; and (2) a common scale analysis obtained by stacking patients from the 2 time points. RESULTS: Less evidence for item invariance over time was found for the pain subscale. Other evidence supported treating subscales as unidimensional. Whichever Rasch scoring method was used, some gains in precision over standard Likert scoring were obtained in discriminating between groups of patients. CONCLUSIONS: The evidence from the current study suggests that there may be some gains in sensitivity to change of outcome measures from different Rasch-based scoring approaches.

Aged↗

PubMed2004

The use of probabilistic decision models in technology assessment : the case of total hip replacement.

There is increasing recognition that decision modelling is central to health technology assessment and, in particular, to analyses to support formal decision making regarding the funding of the use of new technologies. In part, the key role of decision analysis stems from the need to handle multiple sources of uncertainty in the available evidence. The use of probabilistic decision analysis is a means of reflecting the parameter uncertainty in models and presenting this in a comprehensible manner to decision makers. In this article, we demonstrate the potential role of probabilistic models using the case study of total hip replacement surgery.A cost-effectiveness model was constructed to compare the Charnley and Spectron hip prostheses in terms of lifetime costs and quality-adjusted life-years (QALYs). Revision rates were estimated from the Swedish National Total Hip Arthroplasty Register (1992-2000); the risk of revision with the Spectron prosthesis relative to the Charnley prosthesis was 0.67 (95% confidence interval [CI] 0.32, 1.02) for early revisions and 0.26 (95% CI 0.07, 0.46) for late revisions. This lower revision risk resulted in the Spectron generating more QALYs than the Charnley prosthesis. Based on mean costs and QALYs, the Spectron results in cost savings in younger patients, and generates incremental cost-effectiveness ratios of between pound1000 and pound16 000 in older patient groups. The probabilistic results from the model indicated that, if it is assumed that decision makers are willing to pay up to pound20 000 per additional QALY, the probability of the Spectron being the more cost-effective prosthesis ranged between 70% and 100%, depending on the age and sex of the patient.This article looks at the application of probabilistic decision modelling using total hip replacement as a case study to emphasis the need for decision models to quantify all sources of parameter uncertainty and to clearly distinguish parameter uncertainty from subgroup heterogeneity.

Adult↗

PubMed2003

Rasch scoring of outcomes of total hip replacement.

We examined whether there are advantages in terms of outcome assessment of using Rasch methods of scoring the 12-item Oxford Hip Score questionnaire over conventionally summed scores. Data were collected on patients receiving total hip replacement surgery. Three patient groups were created according to surgery type: primary, revision, and re-revision; two groups were created according to satisfaction with surgery: very satisfied and dissatisfied. Analyses were performed to test the relative precision (RP) of Rasch scoring versus conventionally summed scores in discriminating the groups experiencing different types of surgery and level of satisfaction. At the 1-year follow-up, RP ratios favored the Rasch scoring method in both tests of discrimination. Considerable gains in precision were achieved with Rasch scoring methods when groups were compared in a cross-sectional way. Alternative approaches to scoring questionnaires should be investigated to better assess comparisons over time.

Activities of Daily Living↗

PubMed2003

Distant past exercise in women: measures may be reliable, but are they valid?

INTRODUCTION/PURPOSE: Methods to measure lifetime physical activity have been described together with evidence suggesting that they are reliable. We present study findings that challenge the validity of such measures. METHODS: One hundred twenty-seven women aged 50-70 interviewed (31 cases, 96 controls) during a pilot case-control study about risk factors for osteoarthritis of the knee. Interviews used a life course approach with visual cues. Information obtained on past physical activity: (i) Total METs for a large range of activities within each decade between age 10 and age 50, (ii) 10-point rating scales representing level of physical activity during each decade between age 10 and age 50, and (iii) lifetime hours' participation in competitive sports. RESULTS: Any statistical correspondence between METs and activity rating scales was best in relation to women's activity when in their teens (Spearman rank correlation r = 0.40). The highest correlation thereafter related to the most recent decade (r = 0.25), which was low, but there was little or no linear association between MET values and the activity ratings when women were in their 20s or 30s. Around one fifth (20.4%) of women who reported no competitive sports participation during their teens and 18.5% who reported none during their 20s also reported total METs corresponding to the top quartile of physical activity during those periods of their lives. CONCLUSION: Retrospective reports from women of distant past activity levels will likely yield different information depending on the form of questioning. It is unclear which method, if any, is accurate and unbiased. The validity of each method is therefore also questionable.

Age Distribution↗

PubMed2002

Comparison of clinical and patient-based measures to assess medium-term outcomes following shoulder surgery for disorders of the rotator cuff.

OBJECTIVE: To compare different assessments following shoulder surgery for impingement syndrome with or without rotator cuff tear or repair. METHODS: A prospective study of 93 patients was conducted. Standard assessments were performed before, at 6 months, and at 4 years following shoulder surgery using the patient-based Oxford Shoulder Score (OSS), the Medical Outcomes Study Short Form-36 (SF-36) questionnaire, and a surgeon-assessed Constant Shoulder Score. Patients were categorized according to the surgery received in relation to the presence of cuff tears: full repair, partial repair, cuff tear/no repair, no tear/no repair. RESULTS: Most patients (57%) received subacromial decompression for impingement with no cuff tear. This group had the fewest pre- and postoperative symptoms. The category of patients who received only partial repair of a cuff tear had worse scores on all outcome assessments compared with other groups. Patient-based measures were more stable over time than the Constant. CONCLUSION: The shoulder-specific measures had greater sensitivity than the SF-36 in registering significant differences in outcomes between comparison groups at 6 months and 4 years.

Adult↗

PubMed2002

The prevalence of foot problems in older women: a cause for concern.

BACKGROUND: Painful feet are an extremely common problem amongst older women. Such problems increase the risk of falls and hamper mobility. The aetiology of painful and deformed feet is poorly understood. METHODS: Data were obtained during a pilot case-control study about past high heel usage in women, in relation to osteoarthritis of the knee. A total of 127 women aged 50-70 were interviewed (31 cases, 96 controls); case-control sets were matched for age. The following information was obtained about footwear: (1) age when first wore shoes with heels 1, 2 and 3 inches high; (2) height of heels worn for work; (3) maximum height of heels worn regularly for work, going out socially and for dancing, in 10-year age bands. Information about work-related activities and lifetime occupational history was gathered using a Life-Grid. The interview included a foot inspection. RESULTS: Foot problems, particularly foot arthritis, affected considerably more cases than controls (45 per cent versus 16 per cent, p = 0.001) and was considered a confounder. Cases were therefore excluded from subsequent analyses. Amongst controls, the prevalence of any foot problems was very high (83 per cent). All women had regularly worn one inch heels and few (8 per cent) had never worn 2 inch heels. Foot problems were significantly associated with a history of wearing relatively lower heels. Few work activities were related to foot problems; regular lifting was associated with foot pain (p = 0.03). CONCLUSION: Most women in this age-group have been exposed to high-heeled shoes over many years, making aetiological research difficult in this area. Foot pain and deformities are widespread. The relationship between footwear, occupational activities and foot problems is a complex one that deserves considerably more research.

Age Factors↗