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Biomedical subjects

M A Chamberlain

Publications and source records attributed to M A Chamberlain.

At least 55 records · Page 3Linked to original sources
PubMed1996

Are we making the most of the Stanford Health Assessment Questionnaire?

For many years, the Stanford Health Assessment Questionnaire (HAQ) has provided an effective measure of disability. Recently, some debate has emerged about whether or not the HAQ is an "ordinal' or "interval' scale. The opportunity to test its level of measurement arose when the scale was applied in a community survey which undertook a two-stage random sample using postal questionnaires to ascertain the health care needs of those with arthritis. The HAQ data are fitted to the Rasch model which tests for the presence of certain desirable characteristics of measurement, e.g. unidimensionality. The fit of the data to the model for those self-reporting rheumatoid arthritis (RA) was adequate. The transformed HAQ score, derived from the Rasch analysis, is compared with the ordinary HAQ (raw) score. This shows that, for those with RA, incremental units of the raw score at the margins of the scale reflect an increasing level of (dis)ability compared to similar units in the centre of the scale. Thus, the traditional HAQ score (range 0-3) is an ordinal score. The findings also indicate that scoring all 20 items may lead to greater sensitivity. Questions are also raised about the construct validity for those with other types of arthritis. For osteoarthrosis, the grip item does not appear to belong to the same underlying construct as the other items.

Activities of Daily Living↗
PubMed1996

Prevalence of self reported stroke in a population in northern England.

STUDY OBJECTIVE: The aim of this study was to determine the prevalence of stroke survivors in a health district population aged 55 years and over. DESIGN: This was a point prevalence study using two-stage postal questionnaires sent to an age stratified random sample of the population. SETTING: A district health authority in northern England with a resident population of 723,000. SUBJECTS: Altogether 18,827 residents aged 55 years or over. MAIN RESULTS: Prevalence was found to increase with age and, apart from the very elderly, males had a higher prevalence than females. Overall prevalence was found to be 46.8/1,000 (95% CI 42.5, 51.6). 23% of respondents reported full recovery from stroke. Cognitive impairments (33%), problems with lower limbs (33% for right leg; 27% for left leg) and speech difficulties (27%) were the most common residual impairments. CONCLUSIONS: Current guidelines to purchasers on the provision of services to those who have had a stroke may under-estimate prevalence rates by as much as 50%. This could lead to a shortfall in provision of services designed to support people in the months and years following their stroke.

Age Distribution↗
PubMed1996

Prevalence of low back pain in the community: implications for service provision in Bradford, UK.

STUDY OBJECTIVE: To assist a purchasing district in the planning of services for low back pain by assessing the prevalence of symptoms and the current involvement of primary, secondary, and complementary care in the treatment of low back pain. In the light of these findings, to assess further the potential impact of a new system of open access to physical therapy, as recommended by the British Clinical Standards Advisory Group (CSAG). DESIGN: A two-stage cross sectional survey approach using postal questionnaires. SUBJECTS: Altogether 1437 men and 1747 women aged 25-64 years, randomly selected from the family health services association register in Bradford. MAIN RESULTS: An annual incidence of 4.7% for low back pain was found, with lifetime, 12 month period, and point prevalences of 59%, 39%, and 19% respectively. Over a one year period, 50.3% of episodes were acute (< 2 weeks), 21% were subacute (2 weeks-3 months), and 26% were chronic (over 3 months) in duration. Altogether 17.8% of the population in this age range experienced referred pain, numbness, or tingling, and 6.4% took time off work as a result of low back pain. In the same year, 20% of the population in the same age range consulted no-one about their pain, 13.7% were treated at the primary care level, 4% received secondary care, and 3% visited a complementary therapist. One fifth of those who did not consult a professional experienced severe pain during episodes. Prevalence estimates indicate that an emphasis on early intervention and primary care management of simple low back pain as recommended by the CSAG could generate a 131% surge in demand for physical therapy. CONCLUSIONS: Local prevalence estimates may allow purchasers to estimate the potential effects of a shift in management policy for low back pain and to highlight areas of unmet need in terms of resources and patient education.

Adult↗
PubMed1996

Use of botulinum toxin in stroke patients with severe upper limb spasticity.

OBJECTIVES: Spasticity can contribute to poor recovery of upper limb function after stroke. This is a preliminary evaluation of the impact of botulinum toxin treatment on disability caused by upper limb spasticity after stroke. METHODS: Seventeen patients with severe spasticity and a non-functioning arm were treated with intramuscular botulinum A neurotoxin (median age at treatment 54.5 years; median time between onset of stroke and treatment 1.5 years). Baseline and assessments two weeks after treatment were compared to assess efficacy. The duration of improvement in disability was documented. Outcome measures used were; passive range of movement at the shoulder, elbow, wrist, and fingers; modified Ashworth scale to assess spasticity of biceps and forearm finger flexors; an eight point scale to assess the degree of difficulty experienced by the patient or carer for each functional problem defined before treatment; the presence of upper limb pain. The biceps, forearm finger flexors, and flexor carpiulnaris were treated with intramuscular botulinum toxin. Up to a total dose of 400-1000 mouse units (MU) of Dysport (Speywood) or 100-200 MU of BOTOX (Allergan) was used in each patient. RESULTS: Functional problems reported by the patients before treatment were difficulty with cleaning the palm, cutting fingernails, putting the arm through a sleeve, standing and walking balance, putting on gloves, and rolling over in bed. Hand hygiene improved in 14 of 17 patients; difficulty with sleeves improved in four of 16; standing and walking balance improved in one of four; shoulder pain improved in six of nine; wrist pain improved in five of six. Passive range of movement at shoulder, elbow, and wrist improved after treatment. Benefit was noted within two weeks and lasted one to 11 months. No adverse effects occurred. CONCLUSION: This preliminary study suggests that intramuscular botulinum toxin is a safe and effective treatment for reducing disability in patients with severe upper limb spasticity.

Adolescent↗
PubMed1995

Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty.

OBJECTIVE: To determine the prevalence of knee problems in people aged 55 years and over and identify those who should be considered for knee arthroplasty. DESIGN: Postal survey; questionnaires were sent to a multistage stratified probability sample of residents of North Yorkshire Health Authority aged 55 and over. SETTING: A health district with a population of 210,000 aged 55 and over. RESULTS: An initial four page postal questionnaire produced an 86% response rate among 18,827 eligible patients. A subsequent detailed questionnaire sent to 1277 patients with knee problems (with a response rate of 78%) then determined the prevalence of severe pain and severe disability. Pain and disability consistent with the need to consider arthroplasty was found in 20.4/1000 (95% confidence interval 18.0 to 23.1); of these, 4.1 (2.7 to 5.8)/1000 had extreme disability. Age and sex specific rates in men who might benefit from arthroplasty were, in those aged 55-64, 12.9 (8.4 to 19.0)/1000; aged 65-74, 12.1 (7.4 to 18.4)/1000; aged 75 and over, 20.3 (12.9 to 30.5)/1000. In women aged 55-64 the rates were 12.9 (8.6 to 18.7)/1000; aged 65-74, 19.6 (13.9 to 26.7)/1000; aged 75 years and over, 42.6 (34.3 to 52.4)/1000. CONCLUSIONS: Total knee replacement has until recently been considered unreliable and often seen as a last resort for many with severe knee problems. Advances in prosthesis design and surgical and anaesthetic techniques have transformed this procedure into a reliable option with a potential for reducing disability and dependency in a large number of people in the community. Understandably, the prevalence pool of those who may benefit is large; health authorities and, increasingly, general practitioners should consider purchasing more total knee replacement surgery to offer real choice to those in need.

Aged↗
PubMed1995

Behçet's disease.

The reliability and ease of use of any activity form has to be balanced against the content validity of the questions being asked. Clinical experience over several years suggests that presence of a high disease activity score is consistent both with the clinician's and patient's overall impression of disease activity. If the onset of the more serious manifestations can be predicted by more readily measured symptoms such as oral and genital ulceration, skin lesions, arthritis and superficial thrombophlebitis, then these organ system subscores could be expanded to provide a more accurate representation of activity. Other organ systems such as auditory system may also provide a measure of disease activity. For the purpose of clinical trials it is likely that if treatment is targeted at a specific organ system then a more comprehensive measure of activity within that organ system would have to be used (e.g. the role of thalidomide in oral ulceration) (Revuz et al, 1990). This would require the use of a form which measured many facets of oral ulceration (duration of ulcers, number of ulcers, size of ulcers, number of crops of ulcers, site of ulcers, etc). However it is recommended that such a form should be used in conjunction with a validated general disease activity form to alert the clinician conducting any trials of the advantageous or deleterious effects of the trial drug on other organ systems.

Behcet Syndrome↗
PubMed1995

Rehabilitation medicine.

The nature of rehabilitation medicine is outlined in terms of its objectives, its methods, the patient groups which it seeks to help and its relationships to other specialties. Some major advances of recent years are discussed, such as the development of the impairment/disability/handicap framework. With particular emphasis upon neurological rehabilitation, the breadth of the specialty is then illustrated with examples of current preoccupations. These include recovery patterns of the damaged nervous system, testing the efficacy of existing therapies, applying new treatment techniques and developing quantitative measures of disability and handicap. Looking to the future, some key areas are identified where further advances might be sought.

Central Nervous System Diseases↗
PubMed1994

Functional assessment in ankylosing spondylitis: evaluation of a new self-administered questionnaire and correlation with anthropometric variables.

We describe the development of a new self-administered questionnaire for assessment of specific disability in ankylosing spondylitis (AS). The questionnaire was derived both from discussion with patients and from previous published material and covered four main areas of function: mobility, bending down, reaching up and neck movements, and posture. Four categories of response were available similar to the Stanford Health Assessment Questionnaire and the questionnaire was similarly scored providing a range of scores from 0-3. The questionnaire was found to be acceptable, understandable, easy to complete and fulfilled recognized criteria for reproducibility and validity. A significant improvement in functional score as a result of treatment was found in a longitudinal study of physiotherapy in 42 subjects with AS (pre-treatment score 1.23 +/- 0.79, post-treatment 1.07 +/- 0.75 P < 0.01). The areas which showed the most improvement were mobility, bending and posture. Functional scores correlated well with some anthropometric variables, particularly cervical movements, finger to floor distance and chest expansion. Both spinal and peripheral joint impairment contributed to functional disability.

Anthropometry↗
PubMed1993

Autoreactivity in patients with Behçet's disease.

Behçet's disease (BD) has features consistent with an immunopathogenic mechanism. We tested 23 patients with BD and 139 normal controls for autoantibodies to nuclear, cardiolipin and smooth muscle antigens using indirect immunofluorescence, immunodiffusion, Western blots and an enzyme immunosorbent assay. Serum immunoglobulin G, M and A levels were measured by standard radial immunodiffusion techniques. The prevalence of the following autoantibodies was raised in patients with BD compared with the control group: ANA on rodent (P < 0.05) and human (P < 0.01) substrates and smooth muscle antibody (P < 0.001). Anticardiolipin antibody was detected in one patient (GPL 23.1 U). Antibodies to the ribonucleoproteins Ro, La, Sm and RNP were not found. Levels of serum immunoglobulins G, M and A were elevated in BD compared with the controls and this was significant for immunoglobulin M (P < 0.05) and A (P < 0.001). These findings support the concept of a polyclonal B cell activation in BD.

Adult↗
PubMed1993

A controlled study of sacroiliitis in Behçet's disease.

Radiographs of the sacroiliac joints of 34 patients with Behçet's disease were read blind by a senior radiologist. They were compared with those from 25 controls, 14 of whom were healthy. The remainder (11) had other rheumatological disorders including six who had AS. One patient with Behçet's disease had radiologically proven sacroiliitis only but her history was atypical and she was B27 positive. All patients with AS had definite sacroiliitis. Five out of 34 patients with Behçet's disease and four of 25 controls (three healthy, one with SLE) had equivocal sacroiliitis. Whilst appreciating that the numbers in this study are not large, we find no evidence of an increased prevalence of sacroiliitis in Behçet's disease.

Adult↗
PubMed1993

Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip.

Hydrotherapy for OA of the hip has rarely been evaluated in controlled studies. Forty-seven patients with OA of the hip were followed for 18 weeks. Patients were randomly allocated either to a regimen of home exercises or to twice weekly hydrotherapy for 6 weeks in addition to home exercises. There was an improvement seen in both subjective and objective measures in both groups with treatment. There was no significant difference between the two groups. Response to treatment appeared independent of age, sex and radiological severity. We conclude that for most patients, a carefully graded and supervised regimen of home exercises is beneficial and there is little benefit in adding hydrotherapy to this regimen.

Aged↗
PubMed1993

How do communication aid centres provide services to their clients?

A survey of the functioning of the six communication aid centres (CACs) in England and Wales was undertaken. All CACs are specialist units drawing clients from a wide area of the country which means that referrals are more likely to come from outside, rather than from within the districts in which the CACs are located. All CACs have developed individual assessment procedures, with some CACs undertaking continuous assessment of clients, and others recommending an aid after a single session. Funding of aids was often a problem because CACs were only able to recommend aid provision and did not supply them; their stocks of aids were used in assessment sessions or for interim loan to clients until a definitive aid had been acquired. CAC staff engaged in a variety of other functions including the organisation of courses, acting as an advice and information service, and undertaking research.

Communication Devices for People with Disabilities↗
PubMed1992

Clinical differentiation of oral ulceration in Behçet's disease.

Behçet oral ulceration (BOU) is described as being indistinguishable from conventional recurrent oral ulceration (ROU). A clinical comparison between 38 Behçet patients and 38 control ROU cases was effected by completion of a standard questionnaire. Behçet patients reported an increased number of concurrent ulcers and involvement of the soft palate and oropharynx. No differences were detected with respect to duration, frequency, age of onset or family history. In addition, photographs of BOU in 15 patients revealed the concurrence of atypical aphthous and herpetiform varieties. Number, site and appearance of oral ulceration may therefore provide diagnostic features for the development of Behçet's disease.

Behcet Syndrome↗
PubMed1991

Coagulation and fibrinolytic activity in Behçet's disease.

Coagulation and fibrinolytic activities were studied in 18 subjects with Behçet's disease and compared with results from 14 matched control patients suffering from sero-negative arthritis. Significantly higher plasma concentrations (median and range) were found in Behçet's patients for the following variables: fibrinogen 3.7 (1.7-6.9) vs 3.0 (2.0-5.1) g/l, p less than 0.05; von Willebrand factor antigen, 115 (72-344) vs 74 (60-119)%, p less than 0.002; plasminogen activator activity (10(6)/ECLT2) 219 (94-329) vs 137 (78-197) units, p less than 0.002; tissue plasminogen activator inhibitor (t-PA-I) activity, 9.1 (5.5-19.3) vs 5.1 (1.8-12.0) IU/ml, p less than 0.002; and PAI-1 antigen, 13.9 (4.5-20.9) vs 6.4 (2.4-11.1) ng/ml, p less than 0.002. Protein C antigen was significiantly lower: 97 (70-183) vs 126 (96-220)%, p less than 0.02. No differences were observed in antithrombin III activity or antigen, factor VIII coagulant activity, fibrinopeptides A and B beta 15-42, plasminogen, alpha-2-antiplasmin, functional and immunological tissue-plasminogen activator, thrombin-antithrombin complexes and D-dimer. Levels of tissue plasminogen activator inhibitor (activity and antigen) correlated with disease activity while fibrinogen and von Willebrand factor concentrations did not. Seven of the 18 subjects with Behçet's disease had suffered thrombotic events but it was not possible to distinguish these from the 11 patients without thrombosis using the assays performed. The results suggest the abnormal fibrinolytic activity in Behçet's disease is due to increased inhibition of tissue plasminogen activator. No abnormality of coagulation or fibrinolytic activity specific to Behçet's disease was detected.

Adult↗