Biomedical subjects

S E Lamb

Publications and source records attributed to S E Lamb.

15 recordsLinked to original sources

PubMed2005

Clinical and cost effectiveness of mechanical support for severe ankle sprains: design of a randomised controlled trial in the emergency department [ISRCTN 37807450].

BACKGROUND: The optimal management for severe sprains (Grades II and III) of the lateral ligament complex of the ankle is unclear. The aims of this randomised controlled trial are to estimate (1) the clinical effectiveness of three methods of providing mechanical support to the ankle (below knee cast, Aircast brace and Bledsoe boot) in comparison to Tubigrip, and (2) to compare the cost of each strategy, including subsequent health care costs. METHODS/DESIGN: Six hundred and fifty people with a diagnosis of severe sprain are being identified through emergency departments. The study has been designed to complement routine practice in the emergency setting. Outcomes are recovery of mobility (primary outcome) and usual activity, residual symptoms and need for further medical, rehabilitation or surgical treatment. Parallel economic and qualitative studies are being conducted to aid interpretation of the results and to evaluate the cost-effectiveness of the interventions. DISCUSSION: This paper highlights the design, methods and operational aspects of a clinical trial of acute injury management in the emergency department.

Ankle Injuries↗

PubMed2004

Reviewing measures of outcome: reliability of data extraction.

RATIONALE, AIMS AND OBJECTIVES: Although there is wide acceptance of the necessary domains for the evaluation of measures of health outcome, there has been little development or evaluation of methods of data extraction, such as checklists. This study aimed to assess the inter-rater reliability of data extraction from published articles using a new electronic database developed for structured reviews of health outcome measures. METHODS: Domains considered important in the evaluation of measures of health outcome provided the foundation for a checklist for data extraction using a new electronic database. The database utilized Microsoft Access 2000 software (Microsoft Corporation, 2000). Following training, three independent reviewers extracted data from seven selected articles using the electronic database, and assessed article and measure quality against pre-defined criteria. Data extraction was compared for consistency and item content. Inter-reviewer agreement for categorical data was assessed by multiple kappa correlation. RESULTS: Analysis demonstrated strong agreement between reviewers for all aspects of data extraction. However, lack of clarity in published articles affected the ability to clearly identify measures of outcome. CONCLUSIONS: The high level of inter-reviewer agreement supports the use of multiple trained reviewers in data extraction for reviews of measures of outcome using the checklist and Access software described. The electronic database supports standardized data extraction from published articles, benefiting from the combination of data extraction and data entry in a single step. Adaptation of the database to support structured reviews of measures of outcome adopted in the evaluation of other health states is proposed.

Ankle Injuries↗

PubMed2004

Multi-item outcome measures for lateral ligament injury of the ankle: a structured review.

OBJECTIVE: To identify and review evidence relating to the measurement properties of published multi-item outcome measures for the conservative management of lateral ligament injuries of the ankle. METHODS: Systematic literature searches were used to identify measures, which were then assessed against pre-defined criteria relating to development, item content, reliability, validity and responsiveness. RESULTS: Seven disease-specific measures of ankle status [Ankle Joint Functional Assessment Tool, Clinical Trauma Severity Score, Composite Inversion Injury Scale, Kaikkonen Functional Scale (KFS), Karlsson Ankle Function Score (KAFS), Olerud and Molander Ankle Score (OMAS), and the Point System] and two generic measures of health (McGill Pain Questionnaire, Sickness Impact Profile) met the review inclusion criteria. While all measures had been used in acute injuries, only two had also been applied during later stages of recovery (>6 months). The studies covered a comprehensive range of graded ligament injuries. Expert opinion dominated item generation for all measures. All measures lack evidence of test-retest or internal consistency reliability in patients with ankle sprain. Several measures were assessed for validity through comparison with other measures, but there was limited evidence of construct validity and no formal assessment of responsiveness for any measure. CONCLUSION: The disappointing lack of evidence for measurement properties suggests that any measure should be used with caution until appropriate evidence is provided. On the basis of limited evidence, the KFS offers the most promising approach to a combined clinician- and patient-assessment of ankle function, and the KAFS or OMAS if a patient-assessed evaluation of function is required.

Adult↗

PubMed2004

Functional recovery in patients with nonunion treated with the Ilizarov technique.

There are few reports on function after limb salvage surgery using the Ilizarov technique, and none that document the pattern of recovery or predict when maximum function returns. This prospective, longitudinal study documents the baseline functional abilities of 40 consecutive patients with nonunion of a fracture in the lower limb. Patients were studied for at least two and a half years following the completion of surgery. Function was measured by timed tests of functional performance and by the Toronto Extremity Salvage Score self-reported patient questionnaire. Recovery was slowest in the early stages after removal of the frame and greatest between six months and one year. Statistically significant improvement continued up to, but not beyond two years. This observation has important implications for the length of follow-up incorporated into the rehabilitation programmes for patients, predictions of patient status in regard to compensation and for the design of future studies to evaluate functional outcome.

Adolescent↗

PubMed2003

A survey of current consultant practice of treatment of severe ankle sprains in emergency departments in the United Kingdom.

OBJECTIVE: To determine current consultant practice in larger UK emergency departments in the management of severe ankle sprains. DESIGN: Questionnaire study to all UK emergency departments seeing more than 50 000 new patients per year. RESULTS: 70% response rate. Most popular treatment was ice, elevation, Tubigrip, and exercise, each of which was reported as used in most cases by over 70% of respondents. Crutches, early weight bearing, and non-steroidal anti-inflammatory drugs were each reported as used in most cases at over half of responding departments. Physiotherapy was usually only used in selected cases. Rest was usually advised for one to three days (35%). Follow up was only recommended for selected patients. CONCLUSIONS: The results of this survey suggest that there is considerable variation in some aspects of the clinical approach (including drug treatment, walking aids, periods of rest) taken to the management of severe ankle sprains in the UK, although in some areas (for example, not routinely immobilising, early weight bearing as pain permits, use of physiotherapy, use of rest, ice, and elevation) there was concordance.

Ankle Injuries↗

PubMed2003

Risk factors for falling in home-dwelling older women with stroke: the Women's Health and Aging Study.

BACKGROUND AND PURPOSE: Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population. METHODS: This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments. RESULTS: Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling. CONCLUSIONS: Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients.

Accidental Falls↗

PubMed2002

Can lay-led walking programmes increase physical activity in middle aged adults? A randomised controlled trial.

STUDY OBJECTIVE: To compare health walks, a community based lay-led walking scheme versus advice only on physical activity and cardiovascular health status in middle aged adults. DESIGN: Randomised controlled trial with one year follow up. Physical activity was measured by questionnaire. Other measures included attitudes to exercise, body mass index, cholesterol, aerobic capacity, and blood pressure. SETTING: Primary care and community. PARTICIPANTS: 260 men and women aged 40-70 years, taking less than 120 minutes of moderate intensity activity per week. MAIN RESULTS: Seventy three per cent of people completed the trial. Of these, the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6% in the advice only and 35.7% in the health walks group at 12 months (between group difference =13% (95% CI 0.003% to 25.9%) p=0.05). Intention to treat analysis, using the last known value for missing cases, demonstrated smaller differences between the groups (between group difference =6% (95% CI -5% to 16.4%)) with the trend in favour of health walks. There were improvements in the total time spent and number of occasions of moderate intensity activity, and aerobic capacity, but no statistically significant differences between the groups. Other cardiovascular risk factors remained unchanged. CONCLUSIONS: There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat. In people who completed the trial, health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week.

Adult↗

PubMed2002

A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties.

OBJECTIVE: To assess the feasibility of comparing two types of exercise regime aiming to improve mobility and function following knee arthroplasty. DESIGN: A single-blind randomized controlled trial. SUBJECTS: Patients with primary, unilateral knee osteoarthritis undergoing elective knee joint replacement. INTERVENTION: Home-based traditional exercise group (TEG) or home-based functional exercise group (FEG) following discharge from hospital. OUTCOME MEASURES: These included goniometry; a knee-specific pain score, leg extensor power and a walking test. Patients were followed up at three, six and 12 months after surgery. RESULTS: Forty-seven patients met the study criteria, 24 were randomized to the TEG and 23 to the FEG. There were marked improvements in mobility, leg extensor power and pain in the year after surgery (MANOVA p < 0.001). There were no statistically significant differences between the two exercise groups. Knee flexion decreased during the follow-up period and had not recovered by 12 months. Retention of patients was a problem, with nearly 50% lost to follow-up at 12 months. These patients were assessed as having low motivation during inpatient rehabilitation (p < 0.05). CONCLUSIONS: There were trends in favour of the FEG that were of clinical relevance. A definitive study would need a sample size of at least 100 patients in each arm. It is essential to develop strategies to combat loss to follow-up.

Aged↗

PubMed2001

Loss of knee range of motion in leg lengthening.

STUDY DESIGN: Prospective longitudinal study. OBJECTIVE: To determine factors predictive of loss of movement in a cohort of patients undergoing femoral lengthening. BACKGROUND: Loss of joint movement due to poor adaptation of the muscle is a major problem during limb lengthening but remains poorly documented in the literature. METHODS AND MATERIALS: A validated technique using a modified goniometer was used to measure knee motion. Measurements were taken before surgery, prelengthening, during lengthening, and at 6 and 12 months post frame removal. The subjects were 35 patients with a mean age of 22 years (+/-12.8 years), 23 men and 12 women, undergoing femoral lengthening by the Ilizarov method. RESULTS: The pattern of recovery of knee range of movement that was observed showed that 88% of knee flexion was regained by 6 months, 92% of patients regained their knee flexion by 12 months, and 97% by 18 months. Significant loss of knee flexion occurred in the latent period prior to lengthening, mean loss 79 degrees (+/-22.8 degrees). All patients regained full knee extension by the end of lengthening, but 2 patients who had fixed flexion deformities of > 40 degrees developed posterior subluxation of the knee. CONCLUSIONS: The unexpected loss of movement observed in the prelengthening period indicates that physical therapy efforts must be directed to this phase in order to accelerate the recovery of joint range and reduce the muscle-related complications that can occur during limb lengthening.

Adolescent↗

PubMed2000

Interventions for preventing falls in the elderly.

BACKGROUND: Fractures in the elderly often result from a simple fall. OBJECTIVES: To assess the effects of programmes designed to reduce the incidence of falls in community dwelling, institutionalised, or hospitalised elderly people. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CINAHL, PsycLIT, Social Science Citation Index, Dissertation Abstracts, Index to UK Theses, the Cochrane Register of Controlled Trials, and bibliographies of identified studies. We contacted known workers in the field. Trials were also obtained from the Cochrane Musculoskeletal Injuries Group trials register. Date of the most recent search: May 1997. SELECTION CRITERIA: Randomised trials of interventions designed to minimise the effect of, or prevent exposure to, any putative risk factor for falling in elderly individuals living in the community, in institutional care, or in hospital. The main outcomes of interest were number of fallers or falls, or the number sustaining a fall resulting in injury. Trials that focused on intermediate outcomes such as improved balance or did not report fall outcomes, were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers selected trials for inclusion. For each included trial, quality assessment and data extraction was carried out independently by two reviewers. Results of trials of similar design were pooled. MAIN RESULTS: Eighteen trials and one pre-planned meta-analysis were included. The analysis of four trials which studied the effect of exercise alone did not establish protection against falling (Peto odds ratio 1.05; 95% confidence interval 0.74 to 1.48). Based on one trial, there was no evidence to support exercise in conjunction with health education classes (Peto odds ratio 1.72; 95% confidence interval 0.78 to 3.75), or of health education classes alone (Peto odds ratio 1.25; 95% confidence interval 0.51 to 3.03) for the prevention of falls. However, significant protection against falling was apparent from interventions which targeted multiple, identified, risk factors in individual patients (Peto odds ratio 0.77; 95% confidence interval 0. 64 to 0.91), and from interventions which focused on behavioural interventions targeting environmental hazards plus other risk factors (Peto odds ratio 0.81; 95% confidence interval 0.71 to 0.93). REVIEWER'S CONCLUSIONS: Health care purchasers and providers contemplating fall prevention programmes should consider health screening of at risk elderly people, followed by interventions which are targeted at both intrinsic and environmental risk factors of individual patients. There is inadequate evidence for the effectiveness of single interventions such as exercise alone or health education classes for the prevention of falls.

Accidental Falls↗

PubMed2000

Factors that modify the association between knee pain and mobility limitation in older women: the Women's Health and Aging Study.

OBJECTIVE: To investigate the influence of pain severity, knee extensor muscle weakness, obesity, depression, and activity on the association between recent knee pain and limitation of usual and fast paced walking, and ability to rise from a chair. METHODS: A cross sectional analysis of 769 older women (mean age 77.8, range 65-101) with physical disability, but no severe cognitive impairment. Severity of knee pain in the past month was classified as none, moderate, or severe. Mobility was measured using timed performance tests. RESULTS: The prevalence of recent knee pain was 53% (408/769). One third of the women with pain reported it to be severe. In general, knee pain was only significantly associated with limited mobility if severe. Obesity, activity and, to a lesser extent, depression intensified the effects of pain. Knee extensor weakness did not. Obesity was a distinctive risk factor in that it substantially increased the risk of mobility limitation, but only in women with pain. In women who had severe pain, activity (walking more than three city blocks in the past week) increased the risk of walking disability more than inactivity. Depression had a minor, but statistically significant effect on walking ability, but not the ability to rise from a chair. CONCLUSION: In older women with recent knee pain, a high pain severity score, obesity, and activity are important factors that increase the risk of mobility limitation.

Aged↗

PubMed1999

Repeatability of goniometer measurements of the knee in patients wearing an Ilizarov external fixator: a clinic-based study.

OBJECTIVE: To examine the intra-tester and inter-tester reliability of three different methods of measurement of knee range of motion in patients undergoing limb reconstruction with the Ilizarov external fixator. DESIGN: Twenty-five patients had the passive range of motion of their knee measured by 13 physiotherapists who were experienced in the use of goniometry. The testers were assigned into random pairs, each tester measured three or four patients who were allocated to them using the three different methods. These were: (1) a universal goniometer aligned against anatomical landmarks, (2) a universal goniometer aligned against the Ilizarov frame and (3) a modified universal goniometer. SETTING: Orthopaedic limb reconstruction outpatient clinics. SUBJECTS: Twenty-five patients undergoing limb reconstruction using an Ilizarov external fixator on both the femur and tibia. RESULTS: Comparison of the three different goniometry methods showed that using a modified goniometer there was enhanced reliability compared with other methods. This method demonstrated good repeatability for both intra-tester and inter-tester measurements. CONCLUSIONS: When serial measurements of knee range of motion are taken in patients wearing an Ilizarov external fixator the modified model of goniometer should be used.

Adult↗

PubMed1998

A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial.

The aim of this study was to assess the long-term effect of a supervised fitness programme on patients with chronic low back pain. The design of the study was a single blind randomised controlled trial with follow-up, by postal questionnaire, 2 years after intervention. The Oswestry Low Back Pain Disability Index was used as the outcome measure to assess daily activity affected by back pain. Eighty-one patients with chronic low back pain, who were referred to the physiotherapy department of a National Health Service orthopaedic hospital, were randomised to either a supervised fitness programme or a control group. Patients in the intervention group and control group were taught specific exercises to be continued at home and referred to a backschool for back care education. In addition, the intervention group attended eight sessions of a supervised fitness programme. Sixty-two patients (76%) with a mean age of 37 years, returned the Oswestry Low Back Pain Disability Index questionnaire. Of these, 29 were in the intervention group and 31 in the control group. Patients in the intervention group demonstrated a mean reduction of 7.7% in the Oswestry Low Back Pain Disability Index score (95% confidence interval of mean paired difference 3.9, 11.6 P < 0.001), compared with only 2.4% in the control group (95% confidence interval of mean paired difference -2.0, 6.9 P > 0.05). Between group comparisons demonstrated a statistically significant difference in disability scores between the treatment and control group (mean difference 5.8, 95% confidence interval 0.3, 11.4 P < 0.04). This study supports the current trend towards a more active treatment approach to low back pain. We have demonstrated clinical effectiveness of a fitness programme 2 years after treatment but this needs to be replicated in a larger study which should include a cost effectiveness analysis, further analysis of objective functional status and a placebo intervention group.

Adolescent↗

PubMed1997

Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the Women's Health and Aging Study.

BACKGROUND: Sarcopenia, an age-related reduction in muscular mass and strength, may cause a decline in physical functioning and subsequent loss of autonomy. It has been suggested that strength is associated with lower extremity function mainly in the lower portion of the range of strength. Identifying the threshold under which strength is most critical to function may help in targeting groups who may benefit most from exercise interventions. METHODS: The study uses data from the Women's Health and Aging Study. The study population, recruited by screening a population-based sample aged 65 years and older, comprised 1,002 women who represent the one-third most disabled women without severe cognitive impairment living in the community. Knee extensor and hip flexor strength were assessed using a hand-held dynamometer. Lower extremity performance was evaluated using tests of walking, standing balance, and rising from a chair. RESULTS: Among women tested for strength (n = 892), those who could walk (97%), do the side-by-side stand (87%), or complete 5 chair stands (74%) had significantly greater strength. Walking speed was linearly associated with knee extensor strength over the entire range of strength, but its association with hip strength was limited to values below 15 kg. Time for five chair stands was associated with knee extensor and hip flexor strength below 10 and 15 kg, respectively, and no significant association was detected above these values. Stronger women were more likely to hold balance for 10 sec in the side-by-side, semi-tandem, and tandem positions. The percentage of the variance in performance explained by strength alone was always lower than 20%. CONCLUSIONS: In this population, which does not include the strongest older women, there is a departure from linearity in the relationship between muscular strength and some measures of lower extremity performance.

Aged↗

PubMed1995

Mobility after proximal femoral fracture: the relevance of leg extensor power, postural sway and other factors.

We studied 40 previously healthy women (median age 83 years 90% central range 77-90) 1 week after surgical fixation of their proximal femoral fracture to establish the significance of leg extensor power, postural sway, age, pre-injury mobility and fracture type in recovery of walking and stair-climbing ability. Subjects demonstrated a range of walking and stair-climbing abilities. Those not mobile all had sway greater than 40.9 cm/1 min and were more likely to have suffered a trochanteric fracture (p < 0.05). These subjects were not the oldest or those with the worst pre-injury mobility, but did report much greater pain (p < 0.05). Multiple linear regression revealed leg extensor power in the fractured leg (LEPf) to be the most important determinant of walking speed (R2 0.40, p < 0.001) and stair climbing time (R2 0.33, p < 0.002). LEPf was less than in the uninjured leg (p < 0.001), and accounted for only 30% of the total power output. LEPf was determined by pain, and not pre-injury mobility or fracture pattern. These findings have implications for the development of rehabilitation programmes.

Activities of Daily Living↗