The association of the involvement of financial compensation with the outcome of cervicobrachial pain that is treated conservatively.

OBJECTIVES: To examine the influence of the involvement of financial compensation on the results of physiotherapeutic McKenzie treatment on cervicobrachial pain. METHODS: A prospective study was carried out with a cohort of 60 patients referred to two spine clinics after they had experienced at least 5 weeks of neck pain radiating to the arm. Follow-up was performed 1 yr later using a validated questionnaire to measure the outcomes of neck and arm pain, disability, the use of analgesics and the perceived effect of the treatment as reported by the patient. RESULTS: At follow-up, there was no improvement in the group of patients for whom financial compensation was involved, whereas the group for whom compensation was involved showed highly significant improvement. CONCLUSIONS: Despite uniform selection criteria and similarity of complaints and treatment protocols, the involvement of financial compensation seemed to be associated with an adverse effect on treatment results for patients with cervicobrachial pain who were treated conservatively.

[Significance of unresolved financial compensation for the course of cervical root compression]. / Betydningen af uafklaret økonomisk kompensation for forløbet af nerverodstryk i nakken.

The aim of this study was to examine the influence of claims for financial compensation on the results of physiotherapeutic McKenzie treatment for cervical nerve root compression. This study was based on prospectively collected data for quality assurance purpose with baseline classification and included a follow-up postal questionnaire to measure the outcomes: Neck and arm pain, disability, use of analgesics and the perceived effect of the treatment registered by the patient. At baseline, patients with or without compensation issues were identical in regard to their neurological and clinical signs. The study showed that 6-12 months later there was no improvement in six out of seven patients with claims for compensation involvement, in contrast to the 21 patients without claims for financial compensation who all showed significant improvement. The results applied to all five outcome measures. In conclusion, compensation involvement seems to act as a negative factor on treatment results for patients with cervical nerve root compression who were treated conservatively.

Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study.

OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general practice in Denmark. The patients were those aged 18-60 years consulting their GP due to an episode of LBP lasting less than 2 weeks. The GPs collected data regarding 34 exposure variables, including their global assessment of the likelihood of chronic LBP. Outcome variables were collected from the patients after 1, 6 and 12 months. The outcome measures were days on sick leave, and functional or complete recovery from LBP. RESULTS: In total, 503 (96%) patients were followed during the whole study period. Fifty per cent of the patients on sick leave returned to work within 8 days; after 1 year, only 2% remained on sick leave. At the 1-year follow-up, 45% of the patients continued to complain of LBP. Logistic regression analyses showed that the factors most significantly associated with poor long-term LBP outcome were (i) severity of LBP at inclusion, (ii) assessments by the GP of susceptibility to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict the prognosis of the individual LBP patient. The overall assessment by the GPs seems to be the most important predictor associated with the long-term outcome.

Staphylococcus lugdunensis: an important cause of endocarditis. A case report.

Staphylococcus lugdunensis endocarditis was diagnosed in a 55-year-old woman maintained on chronic haemodialysis. S. lugdunensis was isolated from blood and a Gore-Tex graft fistula at admission, and vegetations with Gram-positive cocci were found on the mitral cusps at autopsy.

Functional testing in lumbar nerve root compression syndromes. An evaluation in patients with normal neurological findings.

A functional test using downhill walking was evaluated in relation to the myelographical examination in 33 patients with a suspected lumbar nerve root compression syndrome despite normal neurological findings. Any changes of motor or reflex signs or of straight leg raising were accepted as test results. They were noted in a decision matrix and the positive and negative predictive value (PPV and NPV, respectively) calculated. The PPV of any deterioration of the neurological status resulting from the test as a sign of abnormal myelographical findings was calculated to be approximately 85 per cent, the corresponding NPVs being approximately 50 per cent. In its present form, this functional test is inadequate as a screening procedure in these patients.