PubMed · 8680251
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S Rose, G Sharpe. Revised mobility allowance: double disadvantage.. https://doi.org/10.12968/bjon.1996.5.2.90
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AIMS: To examine the characteristics of patients admitted to Auckland Hospital with chronic obstructive pulmonary disease (COPD) and to assess their management prior to hospitalisation. METHODS: Prospective survey of 99 patients admitted with COPD over an 8 week period. Of these, 80 patients were interviewed about their social circumstances, physical functioning, smoking habits and medical treatment. They also had their inhaler technique checked and FEV1 measured. RESULTS: Subjects had a mean age of 70.6 years with a mean FEV1 of 29% of predicted. 45% lived alone and a third still smoked. The mean value for their usual physical functioning was 15.4 (possible 10-30) on the SF-36 health status questionnaire. 84% of all subjects used a beta-agonist, 50% an anticholinergic bronchodilator, 69% inhaled steroids, 18% oral steroids, and 19% theophylline. 40% used nebulised medication and only 6% had domiciliary oxygen. 40% reported having an influenza vaccination in the preceding year and 27% had participated in some form of pulmonary rehabilitation. The mean length of stay was 7.5 days. CONCLUSIONS: Patients hospitalized for COPD report marked impairment in physical functioning, despite which many live alone. They frequently use inhaled and oral steroids, and nebulised medication, but only a minority had received an influenza vaccination or attended pulmonary rehabilitation.
STUDY DESIGN: In this article, the authors review the three broad categories of measures that have been used to objectify functional improvement after nonoperative care of painful spinal disorder patients-physical, psychological, and socioeconomic. For each of the three categories, the major measures used are discussed, as well as research relating to the efficacy of the measures. OBJECTIVE: To point out the many differences that still exist among research studies regarding which functional outcome measures to use and when to use them. SUMMARY OF BACKGROUND DATA: During the past few decades, it has been made abundantly clear that painful spinal disorders, particularly when associated with work disability and/or financial benefits, result from a complex interaction of medical, psychological, and social factors. This has resulted in frequent confusion regarding what constitutes the primary roots of the disabling process. Currently, a more comprehensive biopsychosocial perspective of chronic pain and disability has emerged that has significant implications for diagnostic and treatment philosophies of practitioners. METHODS: Identifying the measures frequently used to address the important biopsychosocial factors, and evaluating their relative benefits and drawbacks. RESULTS AND CONCLUSIONS: It is demonstrated that there has been an overall trend in recent years toward using more objective, quantifiable instruments, encompassing the physical, psychological, and socioeconomic parameters of outcomes research in painful spinal disorders. These changes will certainly improve the ability of researchers to tease out which factors tap more directly into such tissue as physical impairment, as well as create greater uniformity of measures that will permit direct comparisons between studies.
BACKGROUND: Specific concerns and expectations may be a key reason that people with common physical complaints seek health care for their symptoms. OBJECTIVES: To determine the frequency of symptom-related patient concerns and expectations, physician perceptions and actions, and the relationship of these factors to patient satisfaction and symptom outcome. METHODS: This was a prospective cohort study of 328 adult outpatients presenting for evaluation of a physical complaint. The setting was a general medicine clinic in a teaching hospital. Measures included previsit patient questionnaire to identify symptom-related concerns and expectations; a postvisit physician questionnaire to determine physician perceptions and actions; and a 2-week follow-up patient questionnaire to assess symptom outcome and satisfaction with care. RESULTS: Pain of some type accounted for 55% of common symptoms, upper respiratory tract illnesses for 22%, and other physical complaints for 23%. Two thirds of patients were worried their symptom might represent a serious illness, 62% reported impairment in their usual activities, and 78%, 46%, and 41% hoped the physician would prescribe a medication, order a test, or provide a referral. Physicians often perceived symptoms as less serious or disabling and frequently did not order anticipated tests or referrals. While symptoms improved 78% of the time at 2-week follow-up, only 56% of patients were fully satisfied. Residual concerns and expectations were the strongest correlates of patient satisfaction. CONCLUSIONS: Improved recognition of symptom-related concerns and expectations might improve satisfaction with care in patients presenting with common physical complaints.