Symptom burden in stable COPD patients with moderate or severe airflow limitation.

OBJECTIVES: To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations. BACKGROUND: Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation. METHODS: A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations. RESULTS: The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups. CONCLUSIONS: Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke.

PURPOSE: The purpose of this study was to explore the effect of modified constraint-induced movement therapy (CIMT) in a real-world clinical setting on spasticity and functional use of the affected arm and hand in patients with spastic chronic hemiplegia. METHOD: A prospective consecutive quasi-experimental study design was used. Twenty patients with spastic hemiplegia (aged 22-67 years) were tested before and after 2-week modified CIMT in an outpatient rehabilitation clinic and at 6 months. The Modified Ashworth Scale (MAS), active range of motion (AROM), grip strength, Motor Activity Log (MAL), Sollerman hand function test, and Box and Block Test (BBT) were used as outcome measures. RESULTS: Reductions (p<0.05-0.001) in spasticity (MAS) were seen both after the 2-week training period and at 6-month follow-up. Improvements were also seen in AROM (median change of elbow extension 5°, dorsiflexion of hand 10°), grip strength (20 Newton), and functional use after the 2-week training period (MAL: 1 point; Sollerman test: 8 points; BBT: 4 blocks). The improvements persisted at 6-month follow-up, except for scores on the Sollerman hand function test, which improved further. CONCLUSION: Our study suggests that modified CIMT in an outpatient clinic may reduce spasticity and increase functional use of the affected arm in spastic chronic hemiplegia, with improvements persisting at 6 months.

Comparison between women and men with recent onset rheumatoid arthritis of disease activity and functional ability over two years (the TIRA project).

OBJECTIVE: To describe the course of recent onset rheumatoid arthritis (RA) and to compare consequences of the disease in men and women. METHODS: 284 patients with recent onset RA were followed up prospectively for two years from the time of diagnosis. Measures of disease activity (for example, 28 joint disease activity score (DAS28), C reactive protein, morning stiffness, physician's global assessment) and function outcome (for example, range of movement, hand function, walking time) were determined. The patients' self reported assessment of functional capacity (Health Assessment Questionnaire (HAQ)) and grading of wellbeing and pain (visual analogue scale) were registered. Changes over time and differences between men and women were evaluated. RESULTS: Improvements were seen for all variables within the first three months. Disease activity then remained unchanged. Function variables followed the same pattern during the first year, but then tended to worsen. HAQ scores were similar at baseline, but significantly worse in women than in men at the one and two year follow ups. CONCLUSIONS: Disease activity was well managed and had improved substantially after two years, whereas function seemed slowly to deteriorate. Although disease variables were similar for men and women, functional ability (HAQ) had a less favourable course in women.

Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain.

PURPOSE: To identify prognostic factors for perceived pain and function with focus at one-year follow-up in primary care patients treated for non-specific neck pain. METHODS: A prospective study was performed including 193 neck pain patients. Before and after treatment period, and 12 months after the start date for treatment, patients completed a questionnaire including background data and aspects of pain, function and general health. Linear multiple regression analysis was used to identify prognostic factors with the dependent variables Oswestry score and pain intensity at 12-month follow-up. Response rate 81%. RESULTS: At 12-month follow-up, Oswestry score identified four prognostic factors: pain intensity; well-being; expectations of treatment; and duration of current episode. Adjusted R2 for the model was 0.32, and 20% of the patients had three of the four prognostic factors at entry, indicating risk of poor outcome. The dependent variable pain intensity revealed three prognostic factors: Oswestry score; duration of current episode; and similar problem during the previous five years. Adjusted R2 was 0.24, and 60% of the patients had two of the three prognostic factors at entry, indicating risk of poor outcome. CONCLUSIONS: Different prognostic factors (with the exception of duration of current episode) were identified by the two outcome variables. Thus the results suggest that it should be taken into account whether an impairment or disability outcome is used.

A critical analysis of randomised clinical trials on neck pain and treatment efficacy. A review of the literature.

The efficacy of physiotherapy or chiropractic treatment for patients with neck pain was analysed by reviewing 27 randomised clinical trials published 196-1995. Three different methods were employed: systematic analyses of; methodological quality; comparison of effect size; analysis of inclusion criteria, intervention and outcome according to The Disablement Process model. The quality of most of the studies was low; only one-third scored 50 or more of a possible 100 points. Positive outcomes were noted for 18 of the investigations, and the methodological quality was high in studies using electromagnetic therapy, manipulation, or active physiotherapy. High methodological quality was also noted in studies with traction and acupuncture, however, the interventions had either no effect or a negative effect on outcome. Pooling data and calculation of effect size showed that treatments used in the studies were effective for pain, range of motion, and activities of daily living. Inclusion criteria, intervention, and outcome were based on impairment in most of the analysed investigations. Broader outcome assessments probably would have revealed relationships between treatment effect and impairment, functional limitation and disability.

Effects of an exercise programme on organizational/psychosocial and physical work conditions, and psychosomatic symptoms.

The aim of this study was to evaluate the effect of a weekly exercise programme among nursing staff on organizational/psychosocial and physical work conditions, and psychosomatic symptoms. Out of 106 nurses and nursing aides from four geriatric wards who were invited to participate in a cross-over study, 86 accepted. For the exercise periods the staff were invited to participate in an exercise programme twice a week for 8 weeks during work time. Fifty subjects participated > or = 8 times regularly during the exercise periods (participants). During the control periods, 78 subjects attended without intervention. The effect was followed-up with questionnaires before and after the intervention periods. The exercise programme did not affect perceived organizational/psychosocial or physical work conditions, with one exception. A higher change for the worse was seen in the factor "work planning" during the exercise periods compared with during the control periods. The result suggests that the organization of the training is important in order not to add extra stress.

One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.

STUDY DESIGN: A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy. OBJECTIVES: To compare outcome and costs of chiropractic and physiotherapy as primary treatment for patients with back and neck pain, with special reference to subgroups, recurrence rate, and additional health care use at follow-up evaluation 12 months after treatment. SUMMARY OF BACKGROUND DATA: Earlier studies on the effect of spinal manipulation have shown inconsistent results. Mostly they include only short-term follow-up periods, and few cost-effectiveness analyses have been made. METHODS: A group of 323 patients aged 18-60 years who had no contraindications to manipulation and who had not been treated within the previous month were included. Outcome measures were changes in Oswestry scores, pain intensity, and general health; recurrence rate; and direct and indirect costs. RESULTS: No differences were detected in health improvement, costs, or recurrence rate between the two groups. According to Oswestry score, chiropractic was more favorable for patients with a current pain episode of less than 1 week (5%) and physiotherapy for patients with a current pain episode of greater than 1 month (6.8%). Nearly 60% of the patients reported two or more recurrences. More patients in the chiropractic group (59%) than in the physiotherapy group (41%) sought additional health care. Costs varied considerably among individuals and subgroups; the direct costs were lower for physiotherapy in a few subgroups. CONCLUSIONS: Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.

Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Six-month follow-up.

STUDY DESIGN: A randomized, clinical trial was conducted in which patients with back/neck problems, visiting a general practitioner, were allocated to chiropractic or physiotherapy as primary management. OBJECTIVES: To compare outcome and costs of chiropractic and physiotherapy in managing patients with low back or neck pain. SUMMARY OF BACKGROUND DATA: Earlier studies on the treatment of back pain by spinal manipulation have shown inconsistent results. When a "new" strategy--chiropractic--in the treatment of back pain was introduced in public health care in Sweden, there was a need to compare the effects and costs of chiropractic with the established physiotherapy. METHODS: Three hundred twenty-three patients aged 18 to 60 years who had no contraindications to manipulation and who had not been treated within the previous month were included in the study. Treatment was carried out at the discretion of the therapist. Outcome measures were primarily changes in pain intensity and general health, both assessed with visual analog scale and Oswestry pain disability questionnaire. Direct and indirect costs were measured. RESULTS: For patients with low back or neck pain visiting the general practitioner in primary care, both chiropractic and physiotherapy as primary treatment reduced the symptoms. No difference in outcome or direct or indirect costs between the two groups could be seen, nor in subgroups defined as duration, history, or severity. CONCLUSIONS: The effectiveness and total costs of chiropractic or physiotherapy as primary treatment were similar to reach the same result after treatment and after 6 months.

Effects of an exercise program on musculoskeletal symptoms and physical capacity among nursing staff.

Musculoskeletal disorders are a major health problem, and nursing staff are often seen as a risk group. The purpose of this study was to evaluate the effect of a weekly exercise program among nursing staff on musculoskeletal symptoms and to study the relation to changes in physical capacity. A total of 106 nurses and nursing aides from four geriatric wards were invited to participate; 86 accepted. A cross-over design was used. The staff from two wards were assigned to an exercise period and the staff from the other wards to a control period for the first intervention period. After a wash-out period, the intervention changed. For the exercise periods the staff were invited to participate in an exercise program twice a week for 8 weeks. In total 50 subjects participated more than 8 times regularly during the exercise periods (participants = > or = 8 times regular participation, nonparticipants = < 8). During the control periods 78 subjects attended without intervention. Assessments were made with a standardized questionnaire for analysis of musculoskeletal and psychosomatic symptoms, testing of muscle strength in m. quadriceps with a Cybex dynamometer, and testing of cardiovascular capacity with a Dynavite computerized exercise bicycle before and after the exercise periods. The muscle strength in m. quadriceps increased more during the exercise periods compared with the control periods, explained primarily by the subgroup of nonregular exercisers and those > or = 40 years of age. The number of musculoskeletal symptoms tended to decrease more in the subgroup of nonregular exercisers (those who exercised less than once a week in their spare time) during the exercise periods compared with the nonregular exercisers during the control periods. Comparisons within groups showed a decrease in the number of musculoskeletal symptoms within the exercise periods, explained primarily by a decrease among the participants rather than among the nonparticipants. The decrease within the participants was explained primarily by the subgroup of nonregular exercisers and those > or = 40 years of age. An increase in cardiovascular capacity and a tendency to increase in muscle strength in m. quadriceps were seen among the participants, explained primarily by the effect in the subgroup of nonregular exercisers. The study suggests that a moderate weekly exercise program, performed in a group, among nursing staff affects physical capacity and the number of musculoskeletal symptoms for subjects who are nonregular exercisers and probably subjects > or = 40 years of age.