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Biomedical subjects

Stephen May

Publications and source records attributed to Stephen May.

10 recordsLinked to original sources
PubMed2006

Classification by McKenzie mechanical syndromes: a survey of McKenzie-trained faculty.

OBJECTIVE: The purpose of this survey was to identify the percentage of patients with spine pain who can be classified by McKenzie-trained faculty as having one of either derangement, dysfunction, or postural syndromes. METHODS: McKenzie Institute International faculty members in 20 countries, who are highly trained and are experienced users of the classification system, recorded details on 15 consecutively discharged patients. RESULTS: Responses were received from 57 therapists in 18 countries (89% of potential sample), and details were collected on 607 patients with spine pain. Eighty-three percent were classified in one of the mechanical syndromes; derangement was the most common syndrome. Therapists recorded a mechanical classification in a mean of 82% (SD, 15.1; range, 44%-100%) of their patients with spine pain. CONCLUSIONS: For this study, the McKenzie mechanical syndromes were commonly diagnosed in a large consecutive group of patients at multiple sites by experienced therapists. This classification system may have valuable clinical use in managing patients with spine pain.

Adult↗
PubMed2006

Reliability of procedures used in the physical examination of non-specific low back pain: a systematic review.

The purpose of this systematic review was to determine the quality of the research and to assess the reliability of different types of physical examination procedures used in the assessment of patients with non-specific low back pain. A search of electronic databases (MEDLINE, PEDro, AMED, EMBASE, Cochrane, and CINAHL) up to August 2005 identified 48 relevant studies which were analysed for quality and reliability. Pre-established criteria were used to judge the quality of the studies and satisfactory reliability, and conclusions emphasised high quality studies (> or = 60% methods score). The mean quality score of the studies was 52% (range 0 to 88%), indicating weak to moderate methodology. Based on the upper threshold used (kappa/ICC > 0.85) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability. When the lower threshold was used (kappa/ICC > 0.70) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability. Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability.

Humans↗
PubMed2005

Centralization: its prognostic value in patients with referred symptoms and sciatica.

STUDY DESIGN: Prospective, comparative cohort study. OBJECTIVE: To investigate the prognostic significance of centralization in patients with subacute sciatica and referred symptoms. SUMMARY OF BACKGROUND DATA: Previous studies have shown that centralization occurs commonly in the nonspecific low back population, and its occurrence is associated with a good prognosis. The phenomenon has never been evaluated in a population with sciatica and referred symptoms. METHODS: The sample pool was 104 consecutive patients referred for investigation of possible disc herniation. Of these patients, 60 were recruited into the study and underwent a standardized mechanical evaluation using repeated end-range movements, while symptom response was monitored to expose 2 groups: centralization group (CG) and noncentralization group (NCG). All patients were treated in the same way and were followed for one year. If patients did not have improvement surgery was considered. Outcomes included back and leg pain, disability, Nottingham Health Profile, and surgical outcome. RESULTS: There were 25 patients who were classified in the CG, 35 in the NCG, and other baseline characteristics were similar between groups. At 1, 2, and 3 months, the CG had significantly better outcomes than the NCG. At 2 months, the CG had more improvements in leg pain (P = 0.007), disability (P = <0.001), and Nottingham Health Profile (P = 0.001). After 1 year, disability was less in the CG (P = 0.029). In the CG, 3 patients underwent surgery, in the NCG, 16 (P = 0.01). The odds ratio for surgery in the NCG was 6.2. CONCLUSION: Patients with sciatica and suspected disc herniation who have a centralization response to a mechanical evaluation will have significantly better outcomes. Patients who do not have centralization will be 6 times more likely to undergo surgery.

Adolescent↗
PubMed2004

The centralization phenomenon of spinal symptoms--a systematic review.

The centralization phenomenon was first described 20 years ago. It refers to the abolition of distal pain emanating from the spine in response to therapeutic exercises. Since then a number of papers on the subject have been published. A review of current knowledge is appropriate. Selection criteria were established prior to a computer-aided search for published papers. Two reviewers independently extracted data and checked quality; a third reviewer resolved any disagreements. A narrative review was conducted based on the findings. The review primarily considered prevalence, reliability of assessment, and prognostic significance. These have been most commonly reported, and are important to establish the clinical worth of this symptom response. Fourteen studies were identified. Quality of studies varied; prognostic studies were given a mean score of 3.3 out of 6 by using established quality criteria. The prevalence rate of pure or partial centralization was 70% in 731 sub-acute back patients, and 52% in 325 chronic back patients. It is a symptom response that can be reliably assessed during examination (kappa values 0.51-1.0). Centralization was consistently associated with a range of good outcomes, and failure to centralize with a poor outcome. Centralization appears to identify a substantial sub-group of spinal patients; it is a clinical phenomenon that can be reliably detected, and is associated with a good prognosis. Centralization should be monitored in the examination of spinal patients.

Back Pain↗
PubMedDate not supplied

Sitting posture of subjects with postural backache.

OBJECTIVE: To test the construct validity of postural backache. To identify if individuals with backache sit for longer periods of sustained sitting and have more flexed relaxed sitting posture than individuals in a no backache group. METHODS: Following an initial questionnaire, student volunteers without a history of 'serious' back pain were classified as either postural backache group or no backache group. With the use of an activity diary that plotted activity every 5 minutes over a 3-day period, the average time spent in different postures was established. Relaxed sitting posture was evaluated using Dartfish software to analyze videotape after 10 minutes of sitting. RESULTS: The most common daytime activity of both groups was sitting, with average sitting time not significantly different between groups. Periods of uninterrupted sustained sitting and uninterrupted sustained studying were significantly longer, and the degree of flexion in relaxed sitting was significantly greater in the postural backache group (all P < .024). CONCLUSION: In a group of student volunteers, half reported postural backache. The group with backache sat for longer periods without interruption and had a more flexed relaxed sitting posture than the no backache group. These findings appear to validate McKenzie's concept of a postural syndrome.

Adult↗