Neck pain and disability: a cross-sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinic.

This hospital-based cross-sectional cohort study examines the clinical and demographic features of neck pain, disability (using the Northwick Park neck pain questionnaire) and relationships to handicap in employment. Of 173 consecutive referrals to a rheumatology clinic with neck pain, 70% had neck/arm pain without neurological involvement, 13% other conditions, 11% nerve involvement and 5% other spinal pain. 141 patients (mean age 50 years) had mechanical or degenerative neck pain, of which 13% was probably work-related and 13% was trauma-related. 44 had taken sickness absence for an average of 30 weeks. Comorbidities were frequent (lumbar pain 51%). Those in work were significantly less disabled than those not working (p = 0.001) and those off sick (p < 0.01). Those reporting sleep disturbance, tearfulness and crying were significantly more disabled (p = 0.0001) than those who did not. Neck pain in secondary care is complicated by physical and emotional comorbidities. Comprehensive management requires a biopsychosocial model of care.

Changes in the quality of life in severely disabled people following provision of powered indoor/outdoor chairs.

PURPOSE: To determine the benefits for patients who received an electric powered inoor/outdoor chair (EPIOC) and to quantify their perceived changes to their quality of life. METHOD: Community-based cohort study of all patients provided with an EPIOC over 4 months; and followed up about 3 months later in a community served by a regional wheelchair service in North West London (population about 3.1 million) using the EuroQol EQ-5D with visual analogue scales for each of the five dimensions of the EQ-5D. RESULTS: Sixty-four wheelchair users were assessed initially and 51 completed follow up. Chair users showed no significant improvement in health state as measured by the EQ-5D after EPIOC provision. The visual analogue scales (VASs) indicated that, although perceived overall health state, independence and social life did not appear to improve, the dimensions of mobility, quality of life and pain/discomfort improved significantly on provision of an EPIOC. CONCLUSION: EPIOC users reported significant improvements in several important aspects of their lives; not just in mobility (as expected) but also in reduction of pain and discomfort. The use of VASs provided a more holistic set of outcome measures that demonstrate quality of life benefits beyond that of health state alone.

Using geographical information systems for management of back-pain data.

In the medical world, statistical visualisation has largely been confined to the realm of relatively simple geographical applications. This remains the case, even though hospitals have been collecting spatial data relating to patients. In particular, hospitals have a wealth of back pain information, which includes pain drawings, usually detailing the spatial distribution and type of pain suffered by back-pain patients. Proposes several technological solutions, which permit data within back-pain datasets to be digitally linked to the pain drawings in order to provide methods of computer-based data management and analysis. In particular, proposes the use of geographical information systems (GIS), up till now a tool used mainly in the geographic and cartographic domains, to provide novel and powerful ways of visualising and managing back-pain data. A comparative evaluation of the proposed solutions shows that, although adding complexity and cost, the GIS-based solution is the one most appropriate for visualisation and analysis of back-pain datasets.

Conservative management of low back pain.

Back pain is prevalent worldwide, but back pain disability has reached epidemic proportions in many industrialised societies. Few patients have serious medical pathology or direct neurological involvement requiring surgery. Although the causes remain unclear, physical stress and its consequences on discs, facet joints and supporting soft tissues at work or leisure are important, sometimes aggravated by adverse psychosocial factors. Modern management emphasises the role of self-care, beginning in primary care with the first episode. Without root compression, bed rest should not exceed 48 hours. Emphasis is on encouraging a rapid return to physical fitness and other activities, including employment, acknowledging that returning to a normal life may require working through pain. Medication facilitates this. No one should remain in pain beyond six weeks without being referred to a specialist service for a physical and psychosocial assessment by appropriately trained professionals and with consultant support for investigation, pain management and rehabilitation when needed.

Subjective pain experience of people with chronic back pain.

BACKGROUND AND PURPOSE: Studies into the effect of pain experience on those who have it have largely focused on the views and interpretations of researchers gained by the use of assessment tools aimed at measuring pain. The purpose of this study was to explore and describe pain, as experienced by those with chronic back pain, and to document 'insider' accounts of how pain is perceived and understood by those who have it. METHOD: Unstructured interviews using the framework approach. Subjects were sampled for age, sex, ethnicity and occupation, from new referrals with back pain to a rheumatology outpatient clinic. Eleven subjects (5 M; 6 F) agreed to be interviewed. Interviews were unstructured, but followed a topic guide. Subjects were interviewed in English (nine) or their preferred language (two). Tape-recordings of interviews were transcribed verbatim and read in depth twice to identify the topics or concepts. Data were extracted in the form of words and phrases by use of thematic content analysis. The themes were pain description and amount of pain. An independent researcher reviewed the data and confirmed or contended the analysis. RESULTS: All subjects, except one, provided descriptors of the quality of their pain. The use of simile was common to emphasize both what the pain was, and what it was not. Five subjects expressed a loss of words in trying to describe their pain. Only 13 of 29 different pain descriptors used were commensurate with those in the McGill Pain Questionnaire (Melzack, 1983). Subjects had great difficulty quantifying their pain intensity. Several explained how the pain fluctuated, thus, quantifying pain at one point in time was problematic. Only one subject offered a numerical description of pain intensity. CONCLUSIONS: Subjects provided graphic and in-depth descriptions of their pain experience, but these bore little resemblance to commonly used assessment tools. The findings challenge the appropriateness of such formal instruments.

A Delphi study of self-care in a community population of people with multiple sclerosis.

OBJECTIVE: The aim of the study was to obtain the views and priorities of people with multiple sclerosis (MS) to inform the design of a professionally guided self-care programme. DESIGN: A three-round postal Delphi survey was used as a research tool. SETTING: The study was conducted at the Centre for Research in Rehabilitation at Brunel University in London. SUBJECTS: The respondent panel consisted of 200 volunteers with MS of whom 136 responded to the survey (68%). Respondents were recruited through voluntary organizations throughout the UK. The only selection criterion was that the diagnosis of MS was confirmed by the general practitioner. MAIN OUTCOME MEASURES: The results from each of the three rounds of the Delphi survey were the outcome measures. RESULTS: One hundred and one people used ten or more self-care strategies (74%). Round 1 data revealed the diversity of practices reported, crossing many domains of life such as daily chores, leisure, relationships and physical and mental health. The top five priorities identified in rounds 2 and 3 concerned coping strategies, social support, independence in daily living, rest and mobility. Complete consensus about priorities was not achieved. However, agreement about priorities approached stability across rounds 2 and 3 and a highly significant Kendall's coefficient of concordance indicated there was good agreement within round 3 group rankings (W= 0.46, chi-squared = 499.37, df = 9, p<0.001, N= 122). CONCLUSION: Self-care practices were widespread, and those most commonly used could be identified. This survey method allows the views and priorities of this consumer group to be revealed. The information obtained can be used to develop services where the professional guides and encourages appropriate self-management based upon the issues that people with MS consider to be most important.

A cross-sectional survey of the clinical and psychological features of low back pain and consequent work handicap: use of the Quebec Task Force classification.

A hospital-based cross-sectional study examined 657 consecutive referrals with low back pain over two years to a district rheumatology service serving a population of about 250,000 people. Five hundred and thirty-eight had mechanical/degenerative low back pain. The mean age was 48.6 (range 18-80 SD 15.3) years; 64% were women. Patients with radiating pain or neurological deficit (Quebec Task Force classification) were significantly more disabled (Roland disability score p < 0.001) and depressed (Modified Zung score p < 0.05) than those without radiating pain. Women were more impaired (p = 0.02) than men but had similar disabilities (mean Roland score 11.7, range 0-24 SD 6.5). Fifty-three per cent of patients were receiving benefits and were significantly more likely to have musculoskeletal comorbidities than those in work (p < 0.025). It is concluded that the Quebec Task Force classification of low back pain impairment is a helpful descriptor and related to both physical and psychological disability and handicap in employment.

The development of a scale of the Guttman type for the assessment of mobility disability in multiple sclerosis.

OBJECTIVE: To develop a valid and reliable scale of the Guttman type for the assessment of mobility disability in multiple sclerosis (MS). SUBJECTS: Sixty-eight subjects with a definite diagnosis of MS participated. They were living in the community and attending as outpatients at a MS unit at a District General Hospital. Thirty had the primary progressive pattern of disease, and 38 had the relapsing-remitting pattern. METHODS: Formal assessments used for neurological disability were inspected, and 14 test items of gross motor function were extracted and ordered according to criteria. These were that tests required trunk control and did not require isolated movement at a single limb or body segment, that actions progressed from lying, to sitting, to standing and walking tasks, proceeding from broader to narrower bases of support. All subjects carried out all test items which were scored as 'pass' or 'fail'. ANALYSIS: Data were tested for internal consistency, reliability, inter-item correlation, reproducibility and scalability. On the basis of the results, the items were reordered in rank, and reduced to 11 tests. The 11-item scale was reanalysed. RESULTS: Results showed that the scale had an internal consistency of 0.88 (alpha coefficient) and a coefficient of reproducibility (CR) of 0.95 and above for both MS subject groups. The coefficient of scalability (CS) for items was 0.78 for primary progressive subjects and 0.74 for the relapsing-remitting group. Reliability ranged from moderate (kappa = 0.49) for one item, to perfect for six items. CONCLUSION: The scale was demonstrated to be a hierarchical scale of the Guttman type exhibiting homogeneity and good reliability. The high CR indicated that scores may be summed, and the very acceptable levels of CS indicated that the cumulative scores are meaningful within the defined concept of hierarchy used in this study.

Assessment of motor function in people with multiple sclerosis.

Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system (CNS) which predominantly affects young adults. In order to provide physiotherapy appropriate to the needs of individuals with MS, it is necessary to assess and evaluate the nature and degree of motor and functional deficits. The aim of this research was to develop a physiotherapy assessment which would consistently and objectively evaluate motor function in people with MS. The Motor Club Assessment (MCA), originally developed for use in stroke patients, was identified as exhibiting several features which were consonant with the required criteria. It was therefore modified for use in MS. The Amended MCA (AMCA) was tested for inter-rater agreement, which was found to be good for the lower limb motor section (weighted kappa = 0.80), the upper limb motor section (weighted kappa = 0.90), and the functional activities section (weighted kappa = 0.92). The internal consistency was high for the lower limb section (alpha = 0.97) and the functional activities section (alpha = 0.92), but could not be determined for the upper limb section due to a clear ceiling effect. The study demonstrated that the AMCA is a valid tool for assessment use by physiotherapists in MS patients, and that it has an acceptable level of reliability when used in a clinic setting by physiotherapists suitably experienced in the treatment of neurological patients.

A study of magnetic properties of magnetotactic bacteria.

The first direct measurements of magnetic properties of magnetotactic bacteria from natural samples are presented. Measurements were made at 4.2 K, using a Superconducting Quantum Interfering Device (SQUID) magnetometer. From the magnetization results an anisotropy is obtained that is typical of magnetized ferro- or ferri-magnetic materials. The average magnetic moment of the bacteria determined from the results is in good agreement with the estimated moment from electron microscopy.

Assessment of recovery of arm control in hemiplegic stroke patients. 2. Comparison of arm function tests and pursuit tracking in relation to clinical recovery.

In a preliminary study, return of arm function in hemiplegic patients has been assessed for periods up to 64 weeks after stroke using two methods of testing. The first method concerns the performance of simple motor tasks involving the arm and hand. The second method is a pursuit tracking task using elbow movements. Patients were divided into two groups depending on whether they scored above 80% (Group I) or below 80% (Group II) on the first method at 16 weeks after stroke. When the two arm assessment methods were compared with clinical assessments for all the patients, general agreement was shown. Among Group I patients there was also significant agreement between the assessments; among Group II patients the agreement was poor. The two arm assessment methods, however, showed mutual agreement. In conclusion, both arm assessments provide a general prediction of the recovery of movement control of patients following stroke.

Assessment of recovery of arm control in hemiplegic stroke patients. 1. Arm function tests.

In a preliminary study a group of hemiplegic patients have been assessed for return of arm function for periods up to 64 weeks after stroke. The assessment procedure employs a few simple and easily performed tests which take into account principles of the central nervous control of movement. The tests are highly repeatable and can be carried out by staff untrained in medicine or any form of physical therapy. Patients have been divided into two groups on the basis of the scores obtained in the tests at 16 weeks after stroke. The group scoring 80% or more are very likely subsequently to recover useful function of the arm and hand. The group of patients scoring less than 80% at 16 weeks after stroke are likely subsequently to recover limited arm movements and little hand movement. The preliminary results would suggest that the tasks provide a guide to prognosis and an indiction of the most suitable type of general physical therapy.