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PubMed2003

Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities.

BACKGROUND: in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs. OBJECTIVE: to examine whether tiredness in daily activities is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women. DESIGN: a prospective study with 1 1/2-year follow-up. SETTING: 34 communities in four counties in Denmark. SUBJECTS: 1396 older non-disabled adults (74-75 and 80 years old) living in 17 of the participating communities. METHODS: questionnaire surveys at baseline and at 1 1/2-year follow-up. Tiredness in daily activities was measured by questions about tiredness in six mobility activities. Onset of mobility disability was measured as onset of need for help in one to six mobility activities. RESULTS: men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up, when adjusted by the covariates. In addition, low social participation, poor psychological function, and physical inactivity were independent risk factors of onset of mobility disability among men, and home help, low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women. CONCLUSION: older people who complain about tiredness are at higher risk of becoming disabled than others. This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective.

Activities of Daily Living↗

PubMed2002

Waist circumference and weight change are associated with disability among elderly Hispanics.

BACKGROUND: Studies have suggested that both high and low body mass index (BMI) and weight change are related to functional disability in elderly populations. Elderly Hispanics have a high prevalence of both obesity and disability, yet few studies have examined their interrelationship in this population. Therefore, we examined these relationships in a mostly Puerto Rican group of Hispanic elders. METHODS: We investigated associations between a three-level disability score created from responses to a questionnaire on activities of daily living and BMI, waist circumference (WC), and weight change since age 50, using the proportional odds model in a cross-sectional study of 763 elderly Hispanics, aged 60 to 92 years, residing in Massachusetts. RESULTS: After adjusting for potential confounders, men with a WC > or =109.3 cm (vs <90 cm), or with a reported weight loss of -0.32 to -0.01 kg/year, or a weight gain > or =0.55 kg/year since age 50 (vs relatively stable weight, -0.01 to +0.21 kg/year [y]) were each significantly associated with an approximately threefold higher risk for greater disability. Women with a BMI > or =35 kg/m(2) were almost four times as likely to have higher disability as those with a BMI of 20 to 25 kg/m(2). Compared with women with a WC < or =85.2 cm, those with a WC of 91.5 to 106.6 cm were two times more likely, and those with a WC > or =106.6 cm were five times more likely, to have higher disability scores. Compared with relatively stable weight (-0.05 to +0.23 kg/y), weight gain > or =0.23 kg/year was associated with a twofold higher risk of greater disability among women. When BMI and WC were included in the same model, WC, but not BMI, remained significantly associated with disability. CONCLUSIONS: Abdominal obesity (WC > or =109.3 cm for men, or WC > or =91.5 cm for women) and weight gain > or =0.55 kg/year after age 50 in men or > or =0.23 kg/year in women may increase the risk of disability among elderly Hispanics.

Aged↗

PubMed2005

Diseases and impairments as risk factors for onset of disability in the older population in England and Wales: findings from the Medical Research Council Cognitive Function and Ageing Study.

BACKGROUND: This paper reports the association between self-reported diseases and impairments and 2-year onset of disability in a prospective study of people aged 65 years or older in five urban and rural centers in England and Wales (Medical Research Council Cognitive Function and Ageing Study; MRC-CFAS). METHODS: We initially reviewed risk factors for onset of disability in 35 prospective studies of functional decline in older people published in 1998-2001. In the present study, disability was defined as requiring help from another person at least several times a week and was assessed by dependency in activities of daily living. Polytomous and bivariate logistic regression models were fitted for onset of disability and mortality among those nondisabled at baseline (n=7913), adjusting for age, sex, and sociodemography. RESULTS: Among prevalent conditions, arthritis (population-attributable risk 11.4%) and cognitive impairment indicated by a Mini-Mental State Examination score of <or=21 (population-attributable risk 6.8%) were powerful predictors of incident disability. Baseline cognitive impairment, stroke, treated diabetes, chronic airways obstruction, coronary heart disease, and treated hypertension were significantly associated with both incident disability and mortality, whereas Parkinson's disease, eyesight problems, and arthritis were statistically significant disabling conditions not associated with mortality. Stroke, heart attack, cognitive impairment, eyesight problems, and hearing problems were newly occurring conditions significantly associated with onset of disability. CONCLUSIONS: Cognitive impairment, arthritis, followed by stroke, and problems with vision have major impact on population disability at older ages. Both prevalent and incident conditions must be considered as risk factors to accurately assess potential benefits from prevention.

Aged↗

PubMed2001

Should disability items in the census be used for planning services for elders?

PURPOSE: The main goal of this study was to determine how well the disability questions of both the 1990 and 2000 Census correlated with a standard measure of disability. If the census questions were to correlate moderately well with a standard measure of disability, then Area Agencies on Aging (AAA) and other organizations would be able to use census information in estimating service needs for their catchment (service) area. DESIGN AND METHODS: Questionnaires containing both the census disability questions and a standard measure of disability were mailed to 4,508 older adults; 1,514 completed surveys were returned. In order to assess reliability, 472 of the respondents who completed the mail survey were reinterviewed by phone. All three disability measures were collapsed into the following three categories: no needs, instrumental activities of daily living (IADL) needs only, and activities of daily living (ADL) needs. RESULTS: All three disability measures exhibited moderate to good test-retest reliability. Using a standard measure of disability as the criterion, validity for the 1990 Census measure was quite low (Kappas of approximately 0.35). Validity for the 2000 Census measure was moderate to good (Kappas of approximately 0.60). IMPLICATIONS: These results suggest that the 2000 Census disability questions may be sufficiently valid for planning purposes. However, additional research with more representative samples of older adults is needed.

Activities of Daily Living↗

PubMed1992

Disadvantage as a measure of handicap: a paired sibling study of disabled adults in Lebanon.

In 1980 WHO defined disability as a functional limitation due to impairment, and handicap as the psychosocial disadvantage consequent to disability. This study was designed to investigate the advent of handicap in a group of adults physically disabled by poliomyelitis in childhood by comparing them to their age- and sex-matched siblings. An area survey was conducted in West Beirut and its Southern Suburb and 240 such disabled people and their siblings were identified and interviewed. Handicap was defined as disadvantage in six areas, namely, education, work, income, marital status, housing, and mental well-being. The differences between each disabled person and his/her sex-matched sibling were assessed. Significant differences were noted in employment (Odds ratio (OR) = 4.20, confidence interval (CI): 1.38-15.26), social class (OR = 2.67, CI: 1.11-6.79), income (OR = 2.88, CI: 5.57-113.3) and marital status for both the disabled people compared with their elder siblings (OR = 20.00, CI: 5.57-113.30) and for those disabled compared with their younger siblings (OR = 4.60, CI: 1.53-16.55). Multivariate analyses of the explanatory factors for each of these six areas of disadvantage among the disabled group showed that educational discrepancies cut across social class differences (OR = 1.90, CI: 1.00-3.61), income differences (OR = 1.44, CI: 0.97-2.14), and symptoms of depression (OR = 2.33, CI: 1.42-3.84). Marital-status disadvantage was related to lower income groups and disabled women (OR = 1.66, CI: 1.10-2.49; OR = 1.60, CI: 1.07-2.39).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2002

Satisfaction with quality and access to health care among people with disabling conditions.

OBJECTIVE: To compare satisfaction with health care between persons with and without disabling conditions. DESIGN: Responses to 1996 Medicare Current Beneficiary Survey. SETTING: Nationally representative of the United States population. STUDY PARTICIPANTS: Community-dwelling Medicare beneficiaries, older and younger than 65 years (n = 16 403). MAIN OUTCOME MEASURE: Adjusted odds of being dissatisfied or very dissatisfied with five general quality measures and five access-to-care measures by five disabling conditions (blind or low vision, deaf or hard of hearing, difficulty walking, difficulty reaching, manual dexterity difficulties). Multivariable logistic regressions on dissatisfaction adjusted for age group, sex, disabling condition, race, ethnicity, urban versus rural residence, education, household income < $25 000 versus > or = $25 000, having a usual source of care, proxy respondent, and managed care. RESULTS: Of an estimated 33.58 million non-institutionalized Medicare beneficiaries, 64.1% (estimated 21.51 million) reported at least one disabling condition. Among younger beneficiaries, 10.4% with any major disability were dissatisfied with their care overall, as were 4.6% without disabilities. Nevertheless, persons with disabilities generally had significantly higher adjusted odds of dissatisfaction. For elderly persons with any major disability, the adjusted odds ratios (95% confidence interval) of dissatisfaction were: 3.2 (2.4-4.3) for overall quality; 3.2 (2.2-4.6) for access to specialists; 4.4 (3.1-6.4) for follow-up; and 4.2 (3.1-5.7) for ease of getting to doctors. Elderly managed care enrollees were less satisfied with access to specialists, but more satisfied with costs. CONCLUSION: The quality domains generating the greatest dissatisfaction were anticipated, given the nature of disabling conditions. Improving these areas requires attention inside and outside the health care system. Redesigning practice settings and procedures, and changing payment policies offer the only solutions to some problems.

Adolescent↗

PubMed2002

A comparison of five low back disability questionnaires: reliability and responsiveness.

BACKGROUND AND PURPOSE: The aim of this study was to examine 5 commonly used questionnaires for assessing disability in people with low back pain. The modified Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire, the Waddell Disability Index, and the physical health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were compared in patients undergoing physical therapy for low back pain. SUBJECTS AND METHODS: Patients with low back pain completed the questionnaires during initial consultation with a physical therapist and again 6 weeks later (n=106). Test-retest reliability was examined for a group of 47 subjects who were classified as "unchanged" and a subgroup of 16 subjects who were self-rated as "about the same." Responsiveness was compared using standardized response means, receiver operating characteristic curves, and the proportions of subjects who changed by at least as much as the minimum detectable change (MDC) (90% confidence interval [CI] of the standard error for repeated measures). Scale width was judged as adequate if no more than 15% of the subjects had initial scores at the upper or lower end of the scale that were insufficient to allow change to be reliably detected. RESULTS: Intraclass correlation coefficients (2,1) calculated to measure reliability for the subjects who were classified as "unchanged" and those who were self-rated as "about the same" were greater than.80 for the Oswestry and Quebec questionnaires and the SF-36 Physical Functioning scale and less than.80 for the Waddell and Roland-Morris questionnaires and the SF-36 Role Limitations-Physical and Bodily Pain scales. None of the scales were more responsive than any other. DISCUSSION AND CONCLUSION: Measurements obtained with the modified Oswestry Disability Questionnaire, the SF-36 Physical Functioning scale, and the Quebec Back Pain Disability Scale were the most reliable and had sufficient width scale to reliably detect improvement or worsening in most subjects. The reliability of measurements obtained with the Waddell Disability Index was moderate, but the scale appeared to be insufficient to recommend it for clinical application. The Roland-Morris Disability Questionnaire and the Role Limitations-Physical and Bodily Pain scales of the SF-36 appeared to lack sufficient reliability and scale width for clinical application.

Adult↗

PubMed2000

The links between joint damage and disability in rheumatoid arthritis.

OBJECTIVE: The characteristic joint damage and disability of rheumatoid arthritis (RA) increase slowly over 10-20 yr. Although it is generally believed that persisting inflammatory synovitis causes joint damage and subsequent disability, the strength of their relationship has not been systematically evaluated. This review describes their progression and interrelationship in treated RA. METHODS: MEDLINE and Current Contents databases were searched for the combined terms of rheumatoid arthritis AND X-rays, Health Assessment Questionnaire, slow-acting anti-rheumatic drugs and all identifiable synonyms. This search identified 1303 articles and from these we evaluated in detail 23 reports on the progression of joint damage, 12 reports on the progression of disability and 25 reports dealing with their interrelationship. Additional information was obtained from four data sets comprising 725 RA patients studied cross-sectionally and 33-126 cases followed prospectively for 1-5 yr. X-ray damage was primarily assessed by Larsen and Sharp indices, and disability by the Health Assessment Questionnaire (HAQ). RESULTS: Joint damage and disability both increase throughout the duration of RA. Although disability (HAQ score) is correlated with disease duration (correlation coefficients between 0.27 and 0.30), the link between X-ray damage and disability is stronger (correlation coefficients between 0.30 and 0.70). In the earliest phases of RA, X-ray damage and HAQ scores are not related. By 5-8 yr, there are significant correlations with correlation coefficients between 0.30 and 0.50. In late RA (>8 yr), most studies show highly significant correlations between 0.30 and 0.70. CONCLUSIONS: Joint damage progresses constantly over the first 20 yr of RA. It accounts for approximately 25% of disability in established RA. The link between damage and disability is strongest in late (>8 yr) RA. However, avoiding or reducing joint damage in both early and established/late RA is likely to maintain function.

Arthritis, Rheumatoid↗

PubMed2005

Considering the culture of disability in cultural competence education.

Cultural competence extends beyond understanding those values, beliefs, and needs that are associated with patients' age or gender or with their racial, ethnic, or religious backgrounds. People hold many simultaneous cultural associations, and each have implications for the care process. The "culture of disability" is a pan-ethnic culture for which a set of physician competencies are required to ensure appropriate, culturally sensitive care to persons with congenital or acquired disabilities. Such competencies include communicating with patients who have deficits in verbal communication and avoidance of infantilizing speech; understanding the values and needs of persons with disabilities; the ability to encourage self-advocacy skills of patients and families; acknowledging the core values of disability culture including the emphasis on interdependence rather than independence; and feeling comfortable with patients with complex disabilities. Medical schools have developed programs to increase students' exposure to persons with disabilities and it is suggested that such programs are most effective when they are the result of collaboration with community-based facilities or organizations that serve persons with disabilities in the natural environment. Combining lecture-based instruction and structured experiences with the opportunity for students to interact with patients in their natural environments may facilitate development of competencies with respect to patients with disabilities. The culture of disability should be included as one of the many cultures addressed in cultural competence initiatives in medical school and residency curricula.

Attitude to Health↗

PubMedDate not supplied

Physical disability among American medical students.

The present survey aimed to assess the prevalence and nature of physical disabilities among medical school graduates and to investigate the academic performance of these new physicians with disabilities. A questionnaire was sent to the deans of student affairs of each of the then existing 128 United States and Puerto Rican medical schools, addressing the profiles of students with physical disabilities in the 1987 through 1990 graduating classes. Seventy-seven (60%) United States and Puerto Rican medical schools responded to the questionnaire, of which 67 were able to complete it. A total of 67 students with physical disabilities (40 males and 27 females) were reported. Three of the 67 students were excluded from the study because their conditions did not match our definition of physical disability. The remaining 64 students (38 males and 26 females), ranging from 0 to 10 per school, comprised 0.19% of the 33,138 students who graduated from the 67 medical schools during these 4 academic yr. The disabilities represented by the 64 students encompassed a wide spectrum of etiologies, including neurologic (39%), musculoskeletal (20%), medical-surgical (13%), visual (13%), and auditory (9%) problems. The majority of students with disabilities had above average (36%) to average (48%) academic standings. The actual prevalence of medical students with disabilities might be higher than reported because of the underreporting of the less noticeable types of disabilities.

Achievement↗

PubMedDate not supplied

Endogenous opioids and chronic pain intensity: interactions with level of disability.

OBJECTIVE: To test whether endogenous opioid antinociceptive system dysfunction evidenced in response to acute pain stimuli is associated with increased clinical pain intensity in chronic pain sufferers, and to determine whether this association is moderated by disability level. DESIGN: A double-blind, placebo-controlled, randomized crossover design. Subjects underwent laboratory acute finger pressure pain stimulation and ischemic pain stimulation under placebo and under opioid blockade with naloxone. The primary independent measures, reflecting degree of endogenous opioid antinociception, were opioid Blockade Effects derived to reflect the change elicited by naloxone in pain intensity ratings for the acute pain tasks. High and Low Disability groups were derived based on Pain Disability Index scores to allow examination of the influence of disability level on the relationship between Blockade Effects and chronic pain intensity. SUBJECTS: Twenty-eight chronic low back pain sufferers. OUTCOME MEASURE: Seven-day diary ratings of overall chronic pain intensity based on McGill Pain Questionnaire-Short Form total scores. RESULTS: Greater daily chronic pain intensity was associated with greater placebo acute pain sensitivity in the laboratory (P < 0.05). Positive Blockade Effects (ie, presence of opioid analgesia) were associated as expected with lower placebo-condition acute pain sensitivity in the laboratory (P < 0.05). In main effects analyses, Blockade Effects were not associated significantly with daily chronic pain intensity. This absence of overall main effects was accounted for by significant opposing interactions between disability level and Blockade Effects (P < 0.05). Negative Blockade Effects (ie, absence of endogenous opioid analgesia to acute pain) in the High Disability group were associated with greater daily chronic pain intensity, consistent with the hypothesized effects of chronic pain-related opioid dysfunction. In contrast, Positive Blockade Effects (ie, effective opioid analgesia to acute pain) were associated with higher daily chronic pain intensity in the Low Disability group. CONCLUSIONS: These results suggest that endogenous opioid antinociceptive system dysfunction may contribute to elevated acute and chronic pain sensitivity among more disabled chronic pain patients. Among less disabled patients, chronic pain may serve as a primer producing up-regulated opioid antinociceptive responses to acute pain

Adult↗

PubMed1991

Disability exaggeration as a predictor of functional restoration outcomes for patients with chronic low-back pain.

Many of the individual biological, psychological, and social factors attributed to low-back disability have been tested previously for their ability to predict treatment outcomes. To test the assumption that disability exaggeration affects treatment outcomes, models were developed to quantify this complex characteristic and to test its predictive value. Two hundred fifty-eight patients with chronic back disability entering a program of functional restoration were initially evaluated with a battery of tests, including measurements of trunk flexibility, lifting capacity, cycling endurance, self-assessments of pain and disability, and psychological attributes. On the basis of these measurements, patients were characterized as disability exaggerators if by peer comparison their self-assessments of pain and disability were in the most severe range despite high levels of physical capacity. Program completion and work status 1 and 2 years after treatment were compared between disability exaggerators and their peers. Individual initial attributes associated with program completion included pain intensity and Million Visual Analogue scores, lifting capacity, trunk flexibility, some Minnesota Multiphasic Personality Inventory and Million Behavioral Health Inventory scales, and cigarette smoking. One-year re-employment was associated with Minnesota Multiphasic Personality Inventory Scale 8, Wechsler Adult Intelligence Score-Revised, and cycling endurance. There were no significant associations between any individual factor and 2-year work status. Only two of the 12 disability exaggeration models distinguished between program graduates and dropouts, and none of the models accurately predicted return to work following treatment. Prescription of intensive multidisciplinary treatment should not be denied on the basis of any individual patient attribute or of disability exaggeration, as measured in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

The relation between pain intensity, disability, and the episodic nature of chronic and recurrent low back pain.

STUDY DESIGN: An observational study on the course of chronic and recurrent low back pain and its relation to disability and medication use performed on the basis of daily diary recording. OBJECTIVES: To provide a description of daily pain reporting by individuals with self-reported chronic and recurrent low back pain, to study how the intensity and episodic nature of low back pain is related to disability and medication use, and to classify subjects according to Von Korff's categories of chronic low back pain. SUMMARY OF BACKGROUND DATA: The natural history of low back pain has been described, and some classification schemes have been proposed, but little has been reported on pain characteristics and their relation to self-report of disability. METHODS: Daily self-reports of pain intensity, social and work disability, and medication use were collected from 94 participants with self-reported chronic or recurrent low back pain over a 6-month period. A metric for describing the episodic nature of chronic low back pain was developed. RESULTS: A significant effect of pain intensity on disability was found. During an episode, participants had significantly greater disability and medication use. Work-related disability and medication use was significantly greater in the latter half of an episode. CONCLUSIONS: Pain intensity can affect disability, but the episodic nature of low back pain also affects the ability to function in both work and personal life. Intermittent increases in pain can markedly alter disability. Chronic low back pain should not be treated as a static phenomenon.

Activities of Daily Living↗

PubMed2001

Active therapy for chronic low back pain: part 3. Factors influencing self-rated disability and its change following therapy.

DESIGN: Cross-sectional analysis of the factors influencing self-rated disability associated with chronic low back pain and prospective study of the relationship between changes in each of these factors and in disability following active therapy. OBJECTIVES: To examine the relative influences of pain, psychological factors, and physiological factors on self-rated disability. SUMMARY OF BACKGROUND DATA: In chronic LBP, the interrelationship between physical impairment, pain, and disability is particularly complicated, due to the influence of various psychological factors and the lack of unequivocal methods for assessing impairment. Investigations using new "belief" questionnaires and "sophisticated" performance tests, which have shown promise as discriminating measures of impairment, may assist in clarifying the situation. Previous studies have rarely investigated all these factors simultaneously. METHODS: One hundred forty-eight patients with cLBP completed questionnaires and underwent tests of mobility, strength, muscle activation, and fatigability, and (in a subgroup) erector spinae size and fiber size/type distribution. All measures were repeated after 3 months active therapy. Relationships between each factor and self-rated disability (Roland and Morris questionnaire) at baseline, and between the changes in each factor and changes in disability following therapy, were examined. RESULTS: Stepwise linear regression showed that the most significant predictors of disability at baseline were, in decreasing order of importance: pain; psychological distress; fear-avoidance beliefs; muscle activation levels; lumbar range of motion; gender. Only changes in pain, psychological distress, and fear-avoidance beliefs significantly accounted for the changes in disability following therapy. CONCLUSION: A combination of pain, psychological and physiological factors was best able to predict baseline disability, although its decrease following therapy was determined only by reductions in pain and psychological variables. The active therapy program-in addition to improving physical function-appeared capable of modifying important psychological factors, possibly as a result of the positive experience of completing the prescribed exercises without undue harm.

Adaptation, Psychological↗

PubMed2003

Rasch analysis of the Roland disability questionnaire.

STUDY DESIGN: A cross-sectional survey using patient questionnaires was conducted. OBJECTIVE To assess whether the Roland Disability Questionnaire satisfies the Rasch model including unidimensionality and item separation. SUMMARY OF BACKGROUND DATA: The Roland Disability Questionnaire, the most widely used patient-assessed measure of health outcome for back pain, has undergone several evaluations for its measurement properties including reliability, validity, and responsiveness. However, there is no published work relating to the underlying dimensionality of the instrument and the extent to which individual items contribute to the construct of physical disability resulting from low back pain. METHODS: Patients entering a randomized controlled trial of exercise, manipulation, and usual management for back pain completed a questionnaire that included the Roland Disability Questionnaire. The Winsteps program was used to assess whether the Roland Disability Questionnaire fits the Rasch model. Item fit was assessed using the Infit and Outfit statistics. RESULTS: The Roland Disability Questionnaire was completed by 1008 (90%) of the patients taking part in the trial. Most of the items in the Roland Disability Questionnaire contribute to a single underlying construct. However, four items had poor Outfit statistics, suggesting that they do not contribute sufficiently to the scale hierarchy. Several items positioned around the middle of the hierarchy are not sufficiently distinct in terms of difficulty. There were very few items positioned at the extremes of the hierarchy. CONCLUSIONS: The Roland Disability Questionnaire largely satisfies the Rasch model for unidimensionality. However, the instrument could be improved through the removal of poorly fitting items and the addition of items at the upper and lower points of the scale hierarchy. The distribution of Roland Disability Questionnaire scores should be carefully considered before statistical testing is undertaken. Rasch transformed scores can be used to deal with deficiencies in the scale hierarchy.

Adolescent↗

PubMed2003

A cross-sectional study correlating degeneration of the cervical spine with disability and pain in United kingdom patients.

STUDY DESIGN: A prospective cross-sectional study was conducted. OBJECTIVE: To determine the relation between degeneration of all the joints in the cervical spine, and to identify the effects of litigation on pain and disability levels in trauma and nontrauma patients. SUMMARY OF BACKGROUND DATA: The link between spinal degeneration and patient symptoms remains controversial. Two recent similar studies present conflicting results concerning the association between spinal degeneration and symptomatology. These two studies, performed in different countries, did not consider the impact of impending litigation on self-reported pain and disability levels. The role of the uncovertebral and facet articulations has hitherto not been investigated. METHODS: Radiographic and questionnaire data from 180 consecutive patients with neck pain were collected. Neck pain severity was measured using two time-dependent scales. All patients completed the Neck Disability Index (NDI) and questions about chronicity, etiology, and associated litigation. The radiographs were evaluated for the number of levels of degeneration and the severity of degeneration in the discs as well as the uncovertebral and facet articulations. RESULTS: In this study, 71 patients (40.57%) reported neck pain as a result of injury. However, only 5.1% had associated litigation. There was no statistically significant difference in pain severity or disability levels between the patients with and those without cervical degeneration. According to the findings, the number of levels of cervical degeneration and the severity of degeneration in the discs, facets, and uncovertebral joints are not related to the levels of pain and disability. Patients reporting neck pain caused by injury had a tendency (P = 0.055) to more pain during the preceding week and significantly more disability (P < 0.001). Significant differences included pain intensity (P < 0.025), reading (P < 0.001), headaches (P < 0.025), ability to drive (P < 0.01), and concentration (P < 0.01). Women reported significantly more pain (P < 0.01) and disability (P < 0.001) than men, but did not have more degeneration in any of the joints. CONCLUSIONS: In patients with neck pain, there is no difference in reported pain and disability levels between those with and those without evidence of cervical spine degeneration. Patients whose neck pain is the result of trauma report significantly more pain and disability than nontrauma patients. This is not because of more spinal degeneration or overriding litigation issues.

Activities of Daily Living↗

PubMed1999

Predictors of occupational low back disability: implications for secondary prevention.

Over the past decade, studies have identified a combination of demographic, physical/medical, ergonomic, and psychosocial factors in the development of work disability related to occupational low back pain. Using such data on disability risk factors, investigators have begun to develop risk identification and disability prevention programs. As part of an ongoing effort to develop a secondary prevention program, the present case-control study identified the relative contribution of demographic, physical demand, physical fitness, as well as occupational and individual psychosocial variables to back-related work disability in the US Army. Soldiers (n = 174) diagnosed with a lumbosacral strain and medically discharged from the Army were compared with non-disabled controls (n = 173). Dependent measures were obtained from the US Army Health Risk Appraisal (HRA). For cases, these data pre-dated disability determination by 1 to 3 years. For controls, the HRA was completed during the same time period. Significant predictors of low back disability were: age (odds ratio [OR] = 1.13 per year), lower rank (E2/E3) (OR = 4.08/OR = 3.02), infrequent aerobic exercise (OR = 2.2), higher work stress (OR = 2.71), worries (OR = 2.17), and lower social support (OR = 5.07). The model correctly classified 73.13% of all subjects. These results highlight the importance of considering age, status level in the organization, frequency of aerobic exercise, occupational stress, general worries, and social support for the early detection of soldiers at increased risk for back-related disability. Additionally, the findings support past research indicating the multivariate nature of work disability and emphasize the importance of considering such factors in future secondary prevention efforts.

Adult↗

PubMed2003

Greek versions of the Oswestry and Roland-Morris Disability Questionnaires.

Disability questionnaires are increasingly used for clinical assessment, outcome measurement of treatment and research methodology of low back pain. Their use in different countries and cultural groups must follow certain guidelines for translation and cross-cultural adaptation. The translation of such an instrument must be tested for its reliability and validity to be applied and to allow comparability of data. The Oswestry Disability Index and the Roland-Morris Disability Questionnaire are two disability questionnaires most commonly used as outcome measures in patients with low back pain. The two questionnaires were translated for use with the Greek population, were back translated and tested, and became available in a final version. The Greek versions of the Oswestry Disability Index and the Roland-Morris Disability Questionnaire were tested in 697 patients with low back pain. Internal consistency reliability for the Greek translation of the Oswestry Disability Index and the Roland-Morris Disability Questionnaire reached a Cronbach's alpha coefficient of 0.833 and 0.885 respectively. Face validity and content validity were ensured. Concurrent validity was assessed using a six-point pain scale as a criterion. The correlation of both scales was significant. The Greek translation of these disability questionnaires provided reliable and valid instruments for the evaluation of Greek-speaking patients with low back pain.

Adolescent↗