Biomedical subjects

Kelvin Jordan

Publications and source records attributed to Kelvin Jordan.

At least 19 recordsLinked to original sources

PubMed2006

Disabling knee pain--another consequence of obesity: results from a prospective cohort study.

BACKGROUND: Obesity is linked to knee osteoarthritis (OA) and knee pain. These are disabling problems that are more prevalent in older adults. No prospective study has estimated the impact of excess weight avoidance on the occurrence of knee pain in the general older population. The aim of this study was to investigate the influence of overweight and obesity on the onset and progression of knee pain and disability in older adults living in the community. METHODS: A prospective cohort study of people aged 50 and over registered with three general practices in North Staffordshire, UK. 5784 people who had responded to a survey in March 2000 were mailed a follow-up questionnaire in March 2003. The main outcome measures were self-reported knee pain and severe knee pain and disability at 3 years measured by the Western Ontario and McMaster Universities Osteoarthritis index. RESULTS: Adjusted response to follow-up was 75%. Among responders with no knee pain at baseline, obesity predicted onset of severe knee pain (relative risk 2.8; 95% CI 1.8, 4.5 compared to normal body mass index (BMI) category). Considering overweight and obese categories together, 19% of new cases of severe knee pain over a 3-year period could potentially be avoided by a one-category shift downwards in BMI; this includes almost half of the new cases that arose in the obese group. CONCLUSION: Obesity accounts for a substantial proportion of severe disabling knee pain. As knee pain is a common disabling condition in older adults living in the community, effective public health interventions about avoidance of excess weight could have a major impact on future lower limb disability in older adults.

Aged↗

PubMed2006

The influence of completing a health-related questionnaire on primary care consultation behaviour.

BACKGROUND: Surveys of the population are commonly used to obtain information on health status. Increasingly, researchers are linking self-reported health status information to primary care consultation data. However, it is not known how participating in a health-related survey affects consultation behaviour. The objective of this study was to assess whether completion of a health-related questionnaire changes primary care consultation behaviour. METHODS: Participants were 3402 adults aged 50 and over from the general population in North Staffordshire, UK, who completed a health-related postal survey received in April 2003. The survey was predominantly about occurrence and severity of knee pain in the last year. Primary care attendance for the three months following response was compared to three control periods: i) the three months prior to the survey, ii) the same time period in the previous year and iii) the same time period in the following year. Comparisons were made on consultations for any problem, consultations for musculoskeletal disorders and consultations for knee problems. RESULTS: The percentage of subjects consulting for any condition was marginally higher for the three months directly after receipt of the questionnaire but the difference was only statistically significant in comparison to the three months before the survey (64% v. 62%, p = 0.05). There was little difference in consultation prevalence for musculoskeletal problems immediately after the survey compared to the three control periods. There was an increase of 37% in knee disorder consultations for the three months after the survey compared to the three months directly before the survey (p = 0.02). However, consultation prevalence for knee problems was identical for the three months after the survey to the same time periods in the years prior to and following the survey (both p = 0.94). CONCLUSION: The results from this study suggests that questionnaires related to physical health do not affect the standard consulting behaviour of patients, even for the symptom under investigation. This should reassure researchers who wish to link self-reported health status and medical care utilisation and clinicians whose patients are involved in such research.

Aged↗

PubMed2006

A comparison of two consensus methods for classifying morbidities in a single professional group showed the same outcomes.

OBJECTIVE: To investigate whether consensus differs when reached by the Nominal or the Delphi method. STUDY DESIGN AND SETTING: Seventeen general practices from North Staffordshire, England were randomly allocated to Delphi (postal feedback only) or Nominal group (also had group discussion). General practitioners classified 56 morbidities according to four scales of severity (chronicity, time course, health care use, patient impact) in two consensus rounds. Consensus outcomes were assessed by between-group comparison of severity scores at baseline and follow-up rounds, and consensus process by within-group change in the variance of severity scores between the two rounds. RESULTS: Consensus rounds were completed by 21 out of 35 Nominal GPs and 23 out of 43 Delphi GPs. Baseline scores for three of the four severity scales were significantly higher for Nominal compared to Delphi GPs, but there were no differences at follow-up. Between the two rounds, variance reduced within the Nominal and Delphi group, respectively, by 61% and 35% (chronicity), 40% and 62% (time course), 42% and 36% (health care use), and 19% and 38% (patient impact). CONCLUSION: The Nominal and Delphi methods did not result in different outcomes and we conclude that either method can be used in health services research.

Consensus↗

PubMed2006

Health care utilization: measurement using primary care records and patient recall both showed bias.

OBJECTIVE: To assess reasons for discrepancies between primary care consultation measured from patient self-report and that based on medical records. METHODS: Retrospective comparison of recalled consultation in previous 12 months among 2,414 subjects aged 50+ who reported knee pain in a population survey vs. primary care medical records. Record review included (1) all knee morbidity codes and (2) knee problems mentioned in consultation text. It was then extended to: (3) more than 12 months before survey, and (4) consultations for leg or widespread problems (e.g., generalized osteoarthritis). RESULTS: In those who reported knee pain, recalled consultation prevalence for knee problems "in past year" was 33% compared with 15% based on medical records. Forty percent of those with a recalled consultation had a recorded knee problem in the same time period (kappa = 0.43). Expanding record search to include leg and widespread problems, and knee problems up to 40 months prior to survey, increased "verified" self-reported consulters to 80%. CONCLUSIONS: Disparity in estimates of consultation prevalence arose from inaccuracy of: (1) recall in survey responders and (2) recording by general practitioners of specific problems and repeat consultations. Perceived importance of problem in a multiproblem contact and whether it leads to an outcome (e.g., prescription) may influence recording. Implications exist for service provision projections and research.

Aged↗

PubMed2006

Is frequent attendance in primary care disease-specific?

BACKGROUND: Sociodemographic characteristics of frequent attenders in general practice are known. It is not known whether frequent attendance is linked to specific diseases. OBJECTIVE: To investigate whether frequent consultation in primary care is related to specific morbidities and whether this relationship is influenced by the general practice which the patient attends. DESIGN: One-year survey of consultation data. SETTING: Nine general practices in North Staffordshire, UK. PARTICIPANTS: 1000 adults aged 18 years and over who had consulted primary care at least once during the study year were randomly selected from each practice and grouped into frequent (high and very high), medium and low frequency consulters. MAIN OUTCOME MEASURES: Type of morbidity coded at each consultation and number of repeat consultations for each morbidity (based on Read Code Chapters). RESULTS: All morbidity Chapters were associated with frequent consultation. Frequent consultation was also associated with repeated consultation within most morbidities. Stronger associations were seen with mental disorders, blood disorders, circulatory disorders, digestive disorders, endocrine diseases and with causes of injury and poisoning. Some variation between practices in the morbidities associated with frequent consultation were apparent; particularly for skin diseases and unspecified conditions. CONCLUSIONS: Frequent consulters in primary care are not restricted to particular groups of morbidities. There is some aspect of frequent consultation that is a characteristic of individuals regardless of the symptoms with which they consult. Some morbidities are more prominent than others in this group of consulters, and this may help guide practice policies and future research into frequent consulters.

Adolescent↗

PubMed2006

Characterizing the course of low back pain: a latent class analysis.

Understanding the course of back pain is important for clinicians and researchers, but analyses of longitudinal data from multiple time points are lacking. A prospective cohort study of consecutive back pain consulters from five general practices in the United Kingdom was carried out between 2001 and 2003 to identify groups defined by their pain pathways. Patients were sent monthly questionnaires for a year. Longitudinal latent class analysis was performed by using pain intensity scores for 342 consulters. Analysis yielded four clusters representing different pathways of back pain. Cluster 1 ("persistent mild"; n = 122) patients had stable, low levels of pain. Patients in cluster 2 ("recovering"; n = 104) started with mild pain, progressing quickly to no pain. Cluster 3 ("severe chronic"; n = 71) patients had permanently high pain. For patients in cluster 4 ("fluctuating"; n = 45), pain varied between mild and high levels. Distinctive patterns for each cluster were maintained throughout follow-up. Clusters showed statistically significant differences in disability, psychological status, and work absence (p < 0.001). This is the first time, to the authors' knowledge, that latent class analysis has been applied to longitudinal data on back pain patients. Identification of four distinct groups of patients improves understanding of the course of back pain and may provide a basis of classification for intervention.

Adult↗

PubMed2006

A prospective study of the consulting behaviour of older people with knee pain.

BACKGROUND: Knee pain is common among older adults but only a minority consult their doctor about it. AIM: To determine predictors of new episodes of consultation in primary care among older people with knee pain. DESIGN OF STUDY: Population-based prospective cohort study linking baseline survey to primary care medical records. SETTING: Three general practices in North Staffordshire, UK. METHOD: Subjects were 1797 people aged > or =50 years who responded to a general population survey, reported knee pain in the previous 12 months and had no record of a knee disorder consultation in the 18 months prior to the survey. The main outcome measure was a record of a knee disorder consultation in the 18 months following the survey. RESULTS: The incidence of a new episode of general practice care was approximately 10% per year. Apart from chronicity (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.1 to 2.1), measures of pain severity were not strong influences on future consultation. No social support (measured by having no partner) increased likelihood of future consultation (OR = 1.3; 95% CI = 1.0 to 1.8). Among those with chronic and severe pain, main predictors were previous experiences of health care (use of non-GP services OR = 1.8; previous knee injury OR = 1.7). Current depression reduced likelihood of consulting about the knee problem (OR = 0.6; 95% CI = 0.3 to 0.9). CONCLUSIONS: Knee pain is common in the older population but a minority consult their doctor about it. Severity of pain and disability is not a strong influence on consultation. For those more severely affected, depression may act as a barrier to healthcare use.

Aged↗

PubMed2005

A minimal clinically important difference was derived for the Roland-Morris Disability Questionnaire for low back pain.

OBJECTIVE: To compare methods commonly used to derive minimal important differences and recommend a rule for defining patients as clinically improved on the low back pain-specific Roland-Morris Disability Questionnaire (RMDQ). METHODS: 447 primary care low back pain consulters completed a questionnaire at consultation and 6 months. Patients were classified as having achieved an important change based on methods with the best theoretical qualities, that is, the standard error of measurement, reliability change index (RCI), and modified RCI (RC(indiv)), and using a 30% reduction in score from baseline. To assess clinical importance, improvements based on these methods were compared with improvements on other back pain-related measures. RESULTS: The percentage of patients rated as improved ranged from 14 to 51% by method. Using a simple rule it was possible to identify patients who had clinically important improvement (36%), patients not improved (53%), and a group of possible improvers (11%). Clinical improvement is shown if RMDQ score is reduced by 30% from baseline and back pain is rated as better on a global rating scale. CONCLUSION: A minimal clinically important difference is derived that is clinically relevant, incorporates the measurement error of the RMDQ, and allows subjects with different grades of severity to improve.

Adult↗

PubMed2005

Interrater reliability of scoring of pain drawings in a self-report health survey.

STUDY DESIGN: Study of interrater reliability. OBJECTIVE: To assess the interrater reliability of data from pain drawings scored by multiple raters and the consistency of the subsequent classification of cases of widespread pain. SUMMARY OF BACKGROUND DATA: In large health surveys, pain drawings used to capture self-reported pain, and to classify cases of widespread pain, are often scored by several raters. The reliability of multiple rater scoring of pain drawings has not been investigated. METHODS: As part of a postal survey sent to adults 50 years and older, subjects were asked to shade their pain on a blank body manikin. The first 50 pain drawings in which respondents had shaded pain were selected for this study. Eight nonclinical staff were trained to score pain drawings using transparent templates divided into 50 body areas. Interrater reliability was assessed by comparing the scoring of "pain" or "no pain" for all 50 areas of each pain drawing. RESULTS: Complete scoring agreement among all raters was observed for at least 78% of pain drawings across all body areas (kappa > 0.60). The raters had complete agreement in 42 of 50 areas in 90% or more of pain drawings. From the raters' scoring of pain areas, there was complete agreement on the presence or absence of widespread pain for 49 of 50 pain drawings (98% agreement, Kappa = 0.98). CONCLUSIONS: This study shows that multiple raters, with training and guidelines, can reliably score pain drawings, and high consistency in the subsequent classification of cases of widespread pain can be obtained from such data.

Art↗

PubMed2005

The prevalence and history of knee osteoarthritis in general practice: a case-control study.

BACKGROUND: There is no clear published estimate of the prevalence of diagnosed knee osteoarthritis based on consultation in primary care. Further, little is known about the clinical history of patients who are subsequently diagnosed with knee osteoarthritis. OBJECTIVES: Our aims were (i) to determine the prevalence of knee osteoarthritis diagnosed in primary care; (ii) to compare the medical history of patients currently diagnosed with knee osteoarthritis with that of controls; and (iii) to determine factors associated with X-ray at the time of first diagnosis. METHODS: A case-control study was carried out in one general practice in North Staffordshire. Cases aged > or =45 years were identified from computer searches for knee osteoarthritis between 1 January 1998 and 31 January 2000. Matched controls had no diagnosis of knee osteoarthritis during that same period. The medical records for both groups were examined to identify recorded knee-related symptoms, X-rays and secondary care referrals. RESULTS: A total of 146 cases and controls were reviewed; 49% of cases and 15% of controls had a previous (pre-1998) diagnosis of knee osteoarthritis. This gives an estimated prevalence of diagnosed knee osteoarthritis in the general population aged > or =45 years of 12.5%. Cases were more likely to have had a prior history of knee-related disorders, X-rays and referral to secondary care than controls. There was no association between an X-ray at first diagnosis and previous knee symptoms (odds ratio 0.98; 95% confidence interval 0.49-1.97) and only weak associations of X-ray with gender (male), age (under 60) of patient and time of diagnosis (pre-1998). CONCLUSIONS: Diagnosed knee osteoarthritis is common in general practice and diagnosed patients often have a long history of knee symptoms prior to diagnosis. Further research might usefully consider what influences GPs' diagnosis of knee osteoarthritis and how diagnosis relates to management and outcome.

Aged↗

PubMed2005

"Pain elsewhere" and the impact of knee pain in older people.

OBJECTIVE: To investigate how often knee pain is accompanied by pain elsewhere and to determine whether the presence of "pain elsewhere" than the knee influences either knee-related disability or the impact of knee pain on health and psychological status. METHODS: A survey was mailed to 8,995 individuals (age > or =50 years) registered with 3 general practices in North Staffordshire in the UK. Patients recorded pain on a manikin and completed the Short-Form 36 health survey, the Hospital Anxiety and Depression Scale, and the Western Ontario and McMaster Universities Osteoarthritis Index. Responders were categorized as having no pain, knee pain with or without pain elsewhere, or other pain (no knee pain, but pain elsewhere). Those with knee pain or other pain were subdivided by the extent of pain elsewhere. RESULTS: The adjusted survey response rate was 70%. Fifty-seven percent of responders with knee pain had pain in at least 2 other joint areas. Pain elsewhere was associated with lower physical function and with anxiety and depression both in the knee-pain group and in the other-pain group (associations were stronger in the knee-pain group). Knee pain and disability were less severe in those with knee pain alone than in those with knee pain and pain elsewhere, even after adjusting for age, sex, obesity, laterality of pain, and depression. CONCLUSION: Most people with knee pain have multiple joint site pain. The importance of this to clinicians and researchers is that the severity of knee pain and related disability is worse in the presence of pain elsewhere. This finding has implications for the management and treatment of older people with knee pain.

Aged↗

PubMed2005

Clinical comorbidity was specific to disease pathology, psychologic distress, and somatic symptom amplification.

OBJECTIVE: To test the hypothesis that disease pathology, psychologic distress, and somatic symptom amplification separately influence health care use by investigating the patterns of comorbidity in patients with diabetes, anxiety, and upper respiratory tract infection (URTI), respectively. METHODS: Adult diabetes (n=4,365), anxiety (13,421), and URTI (9,854) cases, and 15,000 randomly selected controls were identified from a 1-year national survey of general practice consultations. Comorbidity was based on a standard clinical morbidity classification used by general practitioners in actual consultations. RESULTS: In case-control analyses of 122 morbidities, the number of significant comorbid associations (P<.01) for diabetes was 30, anxiety was 72, and URTI was 49. These associations showed significant heterogeneity in the odds ratios estimated using Cochran's Q and I2 statistic, both between case groups and within each case group. Diabetes associations were stronger with peripheral vascular disease (odds ratio 2.7), candidiasis (2.5), cataract (2.4), obesity (2.2), and hypertension (1.7); anxiety with depressive disorder (4.1), affective psychosis (4.0), adjustment reaction (3.2), functional gastrointestinal disorders (2.5) and general symptoms (2.5); and URTI with nonspecific blood findings (5.5), bronchitis (5.2), and injury (3.5). CONCLUSION: Our study shows patterns of clinical comorbidity specific to the case conditions that supports the hypothesis that different mechanisms (disease pathology, psychologic distress, and somatic symptom amplification) operate to influence consultation behavior and comorbidity.

Adolescent↗

PubMed2004

Patterns of consent in epidemiologic research: evidence from over 25,000 responders.

Ethical guidelines in the United Kingdom require written consent from participants in epidemiologic studies for follow-up or review of medical records. This may cause bias in samples used for follow-up or medical record review. The authors analyzed data from seven general population surveys conducted in the United Kingdom (1996-2002), to which over 25,000 people responded. Associations of age, gender, and symptom under investigation with consent to follow-up and consent to review of medical records were examined. Consent to follow-up was approximately 75-95% among survey responders under age 50 years but fell among older people, particularly females. Consent to follow-up was also higher among responders who had the symptom under investigation (pooled odds ratio = 1.61, 95% confidence interval: 1.36, 1.92). Consent to review of medical records followed a similar pattern. Patterns of consent were relatively consistent and represented a high proportion of responders. Males, younger people, and subjects reporting the symptom under investigation were more likely to give consent, and these groups may be overrepresented in follow-up samples or reviews of medical records. Although consent is high among responders, the additive effect of nonresponse and nonconsent can substantially reduce sample size and should be taken into account in epidemiologic study planning.

Adolescent↗

PubMed2004

Quality of morbidity coding in general practice computerized medical records: a systematic review.

BACKGROUND: Increased use of computers and morbidity coding in primary care delivery and research brings a need for evidence of the quality of general practice medical records. OBJECTIVE: Our aim was to assess the quality, in terms of completeness and correctness, of morbidity coding in computerized general practice records through a systematic review. METHODS: Published studies were identified by searches of electronic databases and citations of collected papers. Assessment of each article was made by two independent observers and discrepancies resolved by consensus. Studies were reviewed qualitatively due to their heterogeneity. RESULTS: Twenty-four studies met the inclusion criteria for the review. There was variation in the methodology and quality of studies, and problems in generalizability. Studies have attempted to assess the completeness and correctness of morbidity registers by reference to a gold standard such as paper notes, prescribing information or diagnostic tests and procedures, each of which has problems. A consistent finding was that quality of recording varied between morbidities. One reason for this may be in distinctiveness of diagnosis (e.g. coding of diabetes tended to be of higher quality than coding of asthma). CONCLUSIONS: This review highlights the problems faced in assessing the completeness and correctness of computerized general practice medical records. However, it also suggests that a high quality of coding can be achieved. The focus should now be on methods to encourage and help practices improve the quality of their coding.

Disease↗

PubMed2004

An epidemiological survey of symptoms of menstrual loss in the community.

BACKGROUND: For the early detection of gynaecological malignancy, guidance based on presenting symptoms exists to aid a general practitioner (GP) in determining who to investigate or refer. The evidence for this advice is based on the prevalence of symptoms in women with gynaecological malignancy or within specialist clinics. There are no studies on the incidence of symptoms within the community. AIM: To provide an estimate of the incidence of self-reported symptoms of menstrual loss in the community population of a single general practice. DESIGN OF STUDY: A prospective population-based cohort study of women identified through a baseline postal survey and followed 6 and 12 months later. SETTING: An urban general practice with four partners and 10,000 registered patients. METHOD: A postal baseline survey was undertaken on all women aged 18-54 years on the practice age-sex register. Responders who consented to follow-up were sent further questionnaires at 6 and 12 months. All questionnaires enquired about the presence or absence of symptoms related to vaginal bleeding. Twelve-month cumulative incidence rates were calculated using responders to the baseline, 6-month and 12-month questionnaires. RESULTS: A total of 2435 questionnaires were initially sent out at baseline and 1513 (62%) women replied to all three questionnaires. The 12-month cumulative incidence of symptoms in menstruating women was: menorrhagia 25% (95% confidence interval [CI] = 22 to 29); periods heavier than usual, 21% (95% CI = 18 to 23); change in pattern of cycle, 29% (95% CI = 26 to 32); short cycle 21% (95% CI = 19 to 24); long cycle 15% (95% CI = 13 to 18); intermenstrual bleeding 17% (95% CI = 14 to 19); postcoital bleeding 6% (95% CI = 5 to 8); prolonged period 9% (95% CI = 7 to 11). CONCLUSION: The development of symptoms of menstrual loss among women in the community is common, in contrast to the rarity of gynaecological malignancy. This raises concern about the usefulness of current guidelines, based on symptoms, advising women when to consult, and for the early detection of gynaecological malignancy in the community and primary care.

Adolescent↗

PubMed2004

Assessment of the 3-dimensional Fastrak measurement system in measuring range of motion in ankylosing spondylitis.

OBJECTIVE: To assess the repeatability and validity of the electromagnetic 3-dimensional tracking system, Fastrak, in measuring cervical spine and shoulder movement in patients with ankylosing spondylitis (AS). METHODS: Fifty patients with AS had their cervical spine and shoulder movements measured on up to 3 occasions with the Fastrak. Patients also completed disease-specific and generic patient assessed health instruments, and their spinal mobility was assessed by tape measure methods. Repeatability over 2 weeks was assessed using intraclass correlation coefficients (ICC). Fastrak measurements were compared between patients with different self-ratings of AS related health. Comparisons between the Fastrak measurements and patient assessed health instruments and tape measurements were made using Spearman correlations and multilevel modeling. RESULTS: Patients with AS tended to be limited in both cervical spine and shoulder movements. ICC were all > 0.80 (except shoulder extension, 0.75), indicating substantial reliability. Fastrak was able to differentiate between patients with a high self-rating of AS related health and those with a poorer rating. Cervical spine flexion and shoulder flexion and abduction were most strongly related to the patient assessed health instruments, although the shoulder movements had limited relationships with the tape measurements of spinal mobility. CONCLUSION: The Fastrak appears to be reliable and valid in an AS population. Shoulder movements tended to have a stronger relationship with the patient assessed health instruments than cervical spine movements. Shoulder movement may be more related to everyday function measured by these instruments, which indicates the importance of this joint in assessment of AS.

Adult↗

PubMed2003

Data quality of general practice electronic health records: the impact of a program of assessments, feedback, and training.

OBJECTIVE: The aim of this study was to investigate the impact of a program of repeated assessments, feedback, and training on the quality of coded clinical data in general practice. DESIGN: A prospective uncontrolled intervention study was conducted in a general practice research network. MEASUREMENTS: Percentage of recorded consultations with a coded problem title and percentage of patients receiving a specific drug (e.g., tamoxifen) who had the relevant morbidity code (e.g., breast cancer) were calculated. Annual period prevalence of 12 selected morbidities was compared with parallel data derived from the fourth National Study of Morbidity Statistics from General Practice (MSGP4). RESULTS: The first two measures showed variation between practices at baseline, but on repeat assessments all practices improved or maintained their levels of coding. The period prevalence figures also were variable, but over time rates increased to levels comparable with, or above, MSGP4 rates. Practices were able to provide time and resources for feedback and training sessions. CONCLUSION: A program of repeated assessments, feedback, and training appears to improve data quality in a range of practices. The program is likely to be generalizable to other practices but needs a trained support team to implement it that has implications for cost and resources.

Computer User Training↗

PubMed2003

Evaluation of a computer-assisted data entry procedure (including Teleform) for large-scale mailed surveys.

Computer-assisted data entry procedures for self-completion population surveys are previously unreported. We used Teleform for a questionnaire to registrants (aged 50+) with general practices in North Staffordshire, UK (n=8995). The survey achieved a 77% response rate. 98% (n=6647) of returned questionnaires were scannable. These questionnaires were checked (and corrected) before scanning for entries that may be inaccurately read by the software. Three percent of 1020 scanned questionnaires checked (0.041% of all questionnaire items) had a data entry error. Systematic processes enable accurate survey data transfer to be achieved with Teleform. However, many administrative and technical issues need addressing.

Data Collection↗