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Biomedical subjects

Martin R Underwood

Publications and source records attributed to Martin R Underwood.

7 recordsLinked to original sources
PubMed2006

Asking older people about fear of falling did not have a negative effect.

BACKGROUND AND OBJECTIVE: To assess whether completing a questionnaire on risk of falling could affect outcome measures: fear of falling, reported falls, and health service contacts in older people (panel conditioning). METHODS: We used a postal questionnaire to assess the effect on falls risk of implementing falls injury prevention guidelines within a single locality in outer London, UK. We compared responses for the baseline and 6-month follow-up surveys with those for a fresh survey. The latter was sent to a new pool of subjects drawn from the same population, and was sent only once; timing coincided with the follow-up survey. RESULTS: At baseline, we received 498 responses for 1,000 (50%) surveys sent; of these, 358 (72%) subsequently returned the follow-up survey. For the fresh survey, we received 1,261 out of 2,000 (61%) responses to the fresh survey. The odds ratio for the effect of panel conditioning on fear of falling was 0.92 (95% confidence interval CI = 0.64-1.33), within our predefined limit for equivalence. Odds ratios for the effect on reported falls and health service contacts were 0.87 (95% CI = 0.59-1.29) and 0.75 (95% CI = 0.55-1.02), respectively. CONCLUSION: The proportions of subjects who feared falling in the follow-up survey and in the fresh survey were equivalent. Reduced reporting of falls and health service use in the follow-up survey suggest that the potential for panel effects cannot be ignored.

Accidental Falls↗
PubMed2004

Back pain and health policy research: the what, why, how, who, and when.

STUDY DESIGN: A background literature, supported by discussion and outcomes on the subject of Health Policy and Back Pain, from the Fifth International Forum on Low Back Pain Research in Primary Care, in Montreal in May 2002. SUMMARY OF BACKGROUND DATA: A multitude of randomized controlled trials and systematic reviews have been completed in the field of back pain research. There has been limited health policy research in the field of back pain but a greater amount of health policy research in other medical fields. METHODS: The focus of the workshop was on the contribution health policy could make in the area of back pain, the methodologies that are appropriate to research in back pain, and the barriers to back pain health policy research. The workshop was supported by the workshop coordinators' literature review. RESULTS: There was consensus about the lack of improved outcomes from randomized controlled trials and individual treatments and general agreement on the importance supporting current research initiatives with health policy research. That policy-makers were developing policy in this area was agreed, and study methodology to support evidence based policy development was explored. CONCLUSIONS: Health policy research is a relatively underdeveloped area of research in back pain. Back pain as a public health problem may be supported by a broader research approach and a collaborative association with policy-makers in this area.

Back Pain↗
PubMed2004

Important determinants of self-efficacy in patients with chronic musculoskeletal pain.

OBJECTIVE: To define the presenting characteristics of a population of patients with chronic musculoskeletal pain seen in a tertiary rheumatology clinic, and to investigate which factors are associated with self-efficacy in these patients. METHODS: Data were collected prospectively for 196 patients who attended the clinic for the first time between October 2000 and August 2002. The primary outcome measure was self-efficacy, measured using the Pain Self-Efficacy Questionnaire. Secondary outcome measures were pain intensity and disability due to pain. The data were analyzed using both univariate and multiple regression methods. RESULTS: These patients had typically undergone extensive investigations and tried various therapies but were left with persisting pain and poor self-efficacy. Multiple regression analysis showed that after adjustment for other factors, the presence of depressive symptoms and employment status were associated with self-efficacy. Patients who reported depressive symptoms had mean self-efficacy scores 7.0 units lower (95% confidence interval, CI: 2.2-11.9) than those who did not. Being employed was associated with higher self-efficacy. The retired had scores 8.3 units lower than employed people (95% CI: 2.4-14.2), whereas housewives and the unemployed had scores approximately 14 units lower (95% CI: 8.0-20.9 and 7.5-19.0, respectively) than employed people. There was also some evidence that distribution of painful sites was associated with self-efficacy. Patients with extensive pain had scores 4.1 units (95% CI: -0.4-8.6) lower than those with limited pain. CONCLUSION: Depressive symptoms, occupational status, and possibly distribution of pain are associated with the reported confidence of these patients with chronic pain in their ability to carry out everyday activities. Possible links to the idea of legitimacy of pain are discussed.

Activities of Daily Living↗
PubMed2003

An evaluation of personal medical services: the times they are a changin'.

The Personal Medical Services (PMS) pilot sites, launched in England in 1997 by the Secretary of State for the then Conservative government, introduced a local contract for primary care, aimed at promoting flexibility, innovation and policy participation. As part of the National Evaluation of PMS, this paper considers the professional and organisational relationships established between service providers working in those PMS sites which specifically set out to address inequalities in access to primary care for vulnerable populations. The introduction of PMS enabled a change of cultural values in primary care, particularly regarding GPs' relationships with nurses and practice staff. However, PMS has not necessarily led to equal partnerships within primary care teams. Rather,in the selected sites evaluated new interprofessional relationships emerged. There was evidence of intra and interprofessional partnerships being forged, providing the basis for further improved intersectoral collaboration. There was also evidence that the GP based medical model made way for a community oriented/public health model with emphasis on health maintenance for the vulnerable.

Cooperative Behavior↗
PubMed2003

Homelessness: a problem for primary care?

Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness.

Adolescent↗
PubMed2002

Disseminating and implementing the results of back pain research in primary care.

STUDY DESIGN: Description of a workshop entitled "Implementation and Dissemination: Getting Research into Practice," that was held at the Fourth International Forum on Low Back Pain Research in Primary Care, in Israel in March 2000. SUMMARY OF BACKGROUND DATA: A gap exists between research endeavors and the dissemination and implementation of new research findings. OBJECTIVES: To describe the outcomes of a workshop on implementation and dissemination of research findings. METHODS: The Fourth International Forum on Low Back Pain Research in Primary Care aimed to encourage open discussion and consensus building among leading experts in the field, and to develop a research agenda. The workshop on implementation and dissemination focused on issues surrounding the gap between research results and actual practice. These issues were introduced by several presentations. The broad conclusions of the subsequent debate are summarized in this paper as a series of responses to key questions: 1) who should do the implementation?, 2) what should researchers do to help implementation?, 3) what are the key outcomes?, and 4) what are important ingredients for successful implementation? RESULTS: There was consensus about the importance of implementation of research findings, about the ineffectiveness of merely publishing or disseminating research findings, and about the need for prospective randomized trials evaluating the cost-effectiveness of different implementation strategies. The majority view is that the health provider professions and the professional bodies are the central organizations to implement guidelines, rather than the researchers themselves. Success in getting guidelines or research results into practice is dependent on involving local health service groups, experts, and opinion leaders (both local and national). Patient-centered outcomes and cost-effectiveness of guideline implementation were considered important. It was acknowledged that there are many potentially effective ingredients for successful implementation, but a clear indication of the contents of an effective implementation strategy is still lacking. CONCLUSIONS: The plenary and workshops focused on closing the gap between research results and actual practice. As long as we do not fully understand how best to influence and change physician behavior, the choice of implementation strategies should be based on the present knowledge of potentially effective interventions and should include considerations of available resources for, and potential barriers to, implementation.

Back Pain↗