Biomedical subjects

Martin Englund

Publications and source records attributed to Martin Englund.

4 recordsLinked to original sources

PubMed2005

The effect of patient characteristics on variability in pain and function over two years in early knee osteoarthritis.

BACKGROUND: Large variations in pain and function are seen over time in subjects at risk for and with radiographic knee osteoarthritis (OA). We hypothesized that this variation may be related not only to knee OA but also to patient characteristics. The objective of this study was to investigate the influence of age, gender, and body mass index (BMI) on clinically relevant change in pain and function over two years in subjects at high risk for or with knee OA. METHODS: We assessed 143 individuals (16% women, mean age 50 years [range 27-83]) twice; 14 and 16 years after isolated meniscectomy. Subjects completed one disease-specific questionnaire, the Knee injury and Osteoarthritis Outcome Score (KOOS) and one generic measure, the SF-36. Individuals with a BMI between 25 and 29.9 were considered overweight, while individuals with a BMI of 30 or more were considered obese. RESULTS: Subjects aged 46-56 (the middle tertile) were more likely to change (> or =10 points on a 0-100 scale) in the KOOS subscale Activities of Daily Living (ADL) than younger subjects (odds ratio [OR] 4.5, 95% confidence interval [95% CI] 1.5-13.0). Essentially the same result was obtained after adjusting for baseline values. Overweight or obesity was a risk factor for clinically relevant change for knee pain (OR 2.4, 95% CI 1.0-5.8, OR 4.0, 95% CI 1.2-13.6) and obesity for change in ADL (OR 4.3, 95% CI 1.2-15.4). The results did not remain significant when adjusted for the respective baseline value. Being symptomatic was strongly associated with increased variation in pain and function while presence or absence of radiographic changes did not influence change over two years in this cohort. CONCLUSION: In a population highly enriched in early-stage and established knee OA, symptomatic, middle-aged, and overweight or obese subjects were more likely to vary in their knee function and pain over two years. The natural course of knee pain and function may be associated with subject characteristics such as age and BMI.

Age Factors↗

PubMed2004

Similar group mean scores, but large individual variations, in patient-relevant outcomes over 2 years in meniscectomized subjects with and without radiographic knee osteoarthritis.

BACKGROUND: Epidemiological studies have, so far, identified factors associated with increased risk for incident or progressive OA, such as age, sex, heredity, obesity, and joint injury. There is, however, a paucity of long-term data that provide information on the nature of disease progression on either group or individual levels. Such information is needed for identification of study cohorts and planning of clinical trials. The aim of the study was, thus, to assess the variation in pain and function on group and individual level over 2 years in previously meniscectomized individuals with and without radiographic knee osteoarthritis (OA). METHODS: 143 individuals (16% women, mean age at first assessment 50 years [range 27-83]) were assessed twice; approximately 14 and 16 years after isolated meniscectomy, with a median interval of 2.3 years (range 2.3-3.0). Radiographic OA (as assessed at the time of second evaluation) was present in the operated knee in 40%, and an additional 19% had a single osteophyte grade 1 in one or both of the tibiofemoral compartments. Subjects completed the self-administered and disease-specific Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: There were no significant changes in the group mean KOOS subscale scores over the 2-year period. However, a great variability over time was seen within individual subjects. Out of 143 subjects, 16% improved and 12% deteriorated in the subscale Pain, and 13% improved and 14% deteriorated in the subscale ADL > or = 10 points (the suggested threshold for minimal perceptible clinical change). Similar results were seen for remaining subscales. CONCLUSION: Group mean scores for this study cohort enriched in incipient and early-stage knee OA were similar over 2 years, but pain, function and quality of life changed considerably in individuals. These results may be valid also for other at risk groups with knee OA, and motivate further careful examination of the natural history of OA, as well as properties of the OA outcome instruments used. Longitudinal outcome data in OA studies need to be analyzed both on an individual and a group level.

Activities of Daily Living↗

PubMed2004

Meniscal tear--a feature of osteoarthritis.

Meniscectomy is recognized as an important risk factor for the development of knee osteoarthritis (OA), a disease that traditionally has been considered as a simple "wear and tear" phenomenon. However, despite numerous reports, little evidence has been presented that a limited meniscal resection, compared with a more extensive resection, reduces the risk of OA by preserving meniscal function. Why? This thesis provides one possible answer to that question. Patients, who had undergone isolated meniscal resection in 1973, 1978, or between 1983 and 1985 at Lund University Hospital, Sweden, were reviewed clinically and radiographically 15-22 years after the surgical procedure. Of the subjects (n = 317) almost 50% had developed radiographic OA in their operated knee, but just over half of these patients were symptomatic. An additional 20% of the patients had knee symptoms, but did not have radiographic knee OA. These results confirm a limited correlation between radiographic features of the disorder and symptoms. A degenerative type of meniscal tear and obesity were the factors most strongly associated with both radiographic knee OA and symptomatic radiographic knee OA. Partial meniscal resection induced less radiographic changes related to knee OA compared with total meniscectomy, but the patient-relevant outcomes remained essentially the same. If radiographic hand OA was present there was an increased likelihood of the patient also having knee OA following meniscectomy. This finding was independent of age, and therefore an inherited susceptibility to the disease contributes to the risk of knee OA after meniscal tear. Genetic and environmental risk factors interact in OA development. A degenerative meniscal lesion is often associated with early-stage knee OA, a disorder also involving the meniscal tissue. The tear may thus represent the first "signal" feature of OA. The challenge for the health professional is to discriminate between symptoms caused by a meniscal tear and those caused by OA. Meniscal resection may not benefit the patient with early-stage knee OA. The intervention merely removes evidence of the disorder, while the OA joint degradation proceeds.

Adult↗

PubMed2003

Self-reported headache during saturation diving.

INTRODUCTION: Some commercial divers have claimed that headache is a frequent symptom related to decompression following a saturation dive, but due to lack of systematic reporting there is limited knowledge of the incidence and clinical characteristics of such headaches. METHODS: During 2001, a questionnaire was distributed to divers participating in offshore saturation diving operations on the Norwegian continental shelf. Two major diving contractors participated. The survey allowed anonymous self-reporting of past and present problems with headache; pain intensity was indicated daily on a visual analog scale (VAS) from 0 to 10. Of 95 divers, 56 participated and 67 saturations were registered. RESULTS: The divers estimated a higher frequency of headaches in connection to saturation diving than in everyday life (p < 0.001). One third of the divers reported experiencing headache after they finished decompression. There was a significant increase in reports of headache on the last day of decompression (p = 0.03) and on the first day post-saturation (p < 0.001) compared with the start of decompression. Median headache duration was 6 h (range 1-84 h) and median pain score estimated on a VAS was 2.5 (range 0.1-7.8), equivalent to moderate intensity. CONCLUSIONS: Headache incidence is greater in divers during saturation diving than in everyday life. The increase is correlated to the last phase of decompression and the post-saturation period. No specific cause(s) of the headache could be identified, but we discuss possible explanations.

Adult↗