Biomedical subjects

A Cohen de Lara

Publications and source records attributed to A Cohen de Lara.

14 recordsLinked to original sources

PubMed1994

Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.

OBJECTIVE: To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes. DESIGN: Inception cohort study. SETTING: Primary care. PATIENTS: 103 patients with acute localised non-specific back pain lasting less than 72 hours. MAIN OUTCOME MEASURES: Complete recovery (disappearance of both pain and disability) and return to work. RESULTS: 90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery. These factors were also related to absenteeism from work. Absenteeism from work was also influenced by job satisfaction and gender. CONCLUSIONS: The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences.

Absenteeism↗

PubMed1994

Inter- and intraobserver variability in the interpretation of computed tomography of the lumbar spine.

In order to assess the variability in interpreting lumbar CT-scans, two radiologists and two rheumatologists examined the same set of 40 CT-scans and evaluated the presence of primary abnormalities using pre-established criteria. Inter- and intraobserver concordance was assessed using kappa statistics. Interpretation of herniated nucleus pulposus appeared reliable in this study (interobserver and intraobserver kappa statistics approximately 0.7 and 0.9, respectively). Conversely, significant variability of interpretation was seen in many findings often considered important in benign low-back pain or sciatica. Particularly low levels of agreement (interobserver kappa statistics lower to 0.20) were found for facet joint osteoarthritis and spinal stenosis. Since herniated nucleus pulposus appeared as the only reliable CT finding, lumbar CT ordering should therefore be currently restricted to confirmation and localization of herniated nucleus pulposus, especially when surgery or any other invasive intervention is planned to treat prolonged sciatica.

Adolescent↗

PubMed1988

Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients).

The treatment of polymyalgia rheumatica (PMR) and temporal arteritis (TA) is still controversial. To assess the influence on the course of these diseases of the clinical symptoms at initial presentation and of the starting dosage of corticosteroid (CS) treatment the data for 210 patients, who were diagnosed as having PMR or TA from 1976 to 1986 and were followed up closely, were reviewed. One hundred and thirty two patients were diagnosed as having 'clinically pure' PMR; prednisone starting doses of over 15 mg daily provided more CS related adverse effects without any advantage. The mean duration of treatment was 25.7 months. Nine patients later developed symptoms of TA, and there were no predictive features for this. None experienced visual or neurological complications. Seventy eight patients were diagnosed as having clinical TA. Twenty five patients treated with low starting doses of prednisone, ranging from 10 to 20 mg/d (mean 16.2 mg/d), developed less CS related adverse effects and did not have more visual or neurological complications than 53 patients treated with higher doses. The mean duration of treatment was 30.9 months. Fifteen patients experienced visual or neurological complications and men (10/30) developed these complications more frequently than women (5/48) (p less than 0.02). These results suggest that (a) clinically pure PMR is a benign disease requiring low doses of CS treatment; (b) low doses of CS seem an adequate treatment for most cases of TA; (c) a worse prognosis seems attached to the male sex in TA.

Aged↗

PubMed1987