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Biomedical subjects

Andrew J Haig

Publications and source records attributed to Andrew J Haig.

28 records · Page 2Linked to original sources
PubMed2002

The Spurling test and cervical radiculopathy.

STUDY DESIGN: A cross-sectional study design was used. OBJECTIVE: To determine the sensitivity and specificity of the Spurling test for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: The Spurling test is an accepted physical examination test, but there is little data on its sensitivity or specificity. METHODS: From 1988 to 1993, 255 consecutive patients were referred for electrodiagnosis of upper extremity nerve disorders. A Spurling test administered before other testing was performed. The Spurling test was scored as positive if it caused pain or tingling that started in the shoulder and radiated distally to the elbow. After the electrodiagnostic examination, a score was given to each diagnosis in the differential diagnosis according to the likelihood of its presence. To determine the odds ratio, sensitivity, and specificity, chi2 analysis was used. Also, the percentage of subjects with positive results from the Spurling test was calculated for several nerve disease diagnoses. RESULTS: The Spurling test had a sensitivity of 6/20 (30%) and a specificity of 160/172 (93%). The results were positive in 16.6% of the normal group, in 3.4% of the group with nerve disorders other than a radiculopathy, in 25% of the group with an abnormality not consistent with any specific diagnosis group, in 37.5% of the group with possible radiculopathy, and in 40% of the group with certain radiculopathy. CONCLUSIONS: The Spurling test is not very sensitive, but it is specific for cervical radiculopathy diagnosed by electromyography. Therefore, it is not useful as a screening test, but it is clinically useful in helping to confirm a cervical radiculopathy.

Arm↗
PubMed2002

Physical functioning in female caregivers of children with physical disabilities compared with female caregivers of children with a chronic medical condition.

OBJECTIVES: To evaluate if physical functioning is different in female caregivers of children with physical disabilities compared with female caregivers of children with nondisabling medical illnesses, and to investigate the factors associated with functioning level. DESIGN: Cross-sectional survey. SETTING: University-based clinics. PATIENTS: Ninety consecutive female caregivers of children presenting to a pediatric physical medicine and rehabilitation (PM&R) clinic, and 23 presenting to a pediatric endocrine clinic. INTERVENTION: Fifteen-minute self-administered survey. MAIN OUTCOME MEASURES: The dependent variable measured was physical functioning (physical functioning subscale of the Short Form-36). Independent variables measured were the average back pain severity over the last week (100-mm visual analog scale), mood (using the Center for Epidemiologic Studies-Depression Scale), work status, amount of lifting at work, caregiver demographics, child demographics, and the physical functioning ability of the child (measured using the WeeFIM scale). RESULTS: The mean (SD) physical functioning score of caregivers of children in the pediatric PM&R clinic was 80.6 (21.9), which was less than the score of 90.2 (17.6) for caregivers in the pediatric endocrine clinic (mean difference, 9.6; 95% confidence interval, -0.9 to -18.4). The physical functioning score of 77.7 (22.9) in caregivers of PM&R clinic children with a WeeFIM scale score of 1 to 4 was significantly worse than the 90.5 (14.8) in female caregivers of children with a WeeFIM score of 5 to 7 (mean difference, 12.8; 95% confidence interval, -2.0 to -23.6). This decrease is associated with the average pain severity, mood, and total length of time of back pain in the previous 12 months. Regression analysis shows that pain severity and caregiver mood are significantly related to the physical functioning status of the caregiver. CONCLUSIONS: Physical functioning is decreased in female caregivers of children with a physical disability. This decrease is associated with caregiver pain severity and mood.

Adult↗
PubMed2002

Lumbosacral radiculopathies: conservative approaches to management.

The prevalence of sciatica in Western society and its economic and functional impact make it an important problem to understand for treatment. Such understanding will impact greatly both medical management and decisions regarding activity, which could affect the perceived disability and financial dependence of a patient. This knowledge could be used to direct primary prevention, patient education, and future research efforts in back pain. The article also discusses that such strategies could improve health, decrease disability, and rein in costs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

Concordance between rating of perceived exertion and function in persons with chronic, disabling back pain.

Rating of perceived exertion (RPE), or the Borg scale, has been shown to be positively associated with physiologic effort in individuals undergoing cardiovascular assessment. This study examined the correlations between cardiovascular performance, psychosocial factors, and the RPE scale among 50 persons with chronic pain undergoing multidisciplinary assessment. The results indicated a significant negative association between fitness outcome measures (maximum VO2 and endurance on bicycle), psychosocial measures, and age. With a mean maximum heart rate achieved on the exercise bicycle of 79.2% (SD = 8.3), there was no significant association between the highest rating of perceived exertion on the exercise bicycle test and percent of maximum heart rate. Percent of maximum heart rate was significantly related to self-reported pain and disability as well as age. These findings suggest that perceived exertion in this population is not highly correlated with physiologic effort, as other factors such as pain may influence effort ratings.

Adult↗
PubMedDate not supplied

Paraspinal denervation and the spinal degenerative cascade.

BACKGROUND CONTEXT: The aging of the spine has been reported to follow a degenerative cascade described by Kirkaldy-Willis. This cascade does not take into account the paraspinal muscles. Substantial recent knowledge of the anatomy, physiology and pathophysiology of the paraspinal muscles suggests that they should play a role in the degenerative cascade. Pain relates to paraspinal denervation in a number of disorders. Using new needle electromyographic technique, MiniPM, we may be able to quantify the extent of paraspinal muscle denervation. PURPOSE: To explore the potential interactions between paraspinal muscle denervation and the degenerative cascade. STUDY DESIGN: Literature review, reanalysis of a blinded electromyographic study and case reports. PATIENT SAMPLE: A previously reported group of 35 asymptomatic paid volunteers, ages 18 to 58 years. Two elderly volunteers with moderate to severe spinal stenosis on magnetic resonance imaging (MRI), one significantly disabled, one asymptomatic. OUTCOME MEASURES: Blinded electromyographic testing, including MiniPM, a codified, quantified needle electromyography technique for the paraspinal muscles. In the two case reports, magnetic resonance imaging and 15-minute timed ambulation. METHODS: The 35 volunteers were tested by a blinded electromyographer using the MiniPM technique. The two older subjects underwent MRI, MiniPM and extensive electrodiagnostic evaluations, functional testing, complete history and physical examination. RESULTS: The patient with symptomatic stenosis had a MiniPM score of 6 on each side, and the asymptomatic volunteer had a score of 0. In the asymptomatic subject group, reproducible evidence for denervation was found in 20 subjects (57%), sparsely distributed, but more caudal than cranial (p<.0001). Based on conservative estimates of nerve regeneration rates, the population averaged a detected axonotemesis denervating event approximately once every 120 days. CONCLUSIONS: Paraspinal denervation may be proven to be a better marker than MRI findings for symptomatic spinal stenosis. Subtle paraspinal muscle denervation occurs frequently in asymptomatic persons. Whether a cause or an effect, paraspinal denervation might lead to hypermobility and thus progression along the degenerative cascade.

Adolescent↗
PubMedDate not supplied

Predicting outcomes of transforaminal epidural injections for sciatica.

BACKGROUND CONTEXT: Previous studies on epidural injections have focused on efficacy and have not evaluated factors predicting outcomes of epidural injections. PURPOSE: To determine which patient factors are associated with transforaminal epidural injection outcomes for sciatica. STUDY DESIGN: Cross-sectional study design at a university spine center. PATIENT SAMPLE: Consecutive patients with sciatica who have had an electromyography study and a transforaminal epidural injection between January 1999 and July 2001. OUTCOME VARIABLE: The outcome variable was a composite score of the patients' pain severity and medication use compared with their initial visit. Independent variables included demographics, previous back surgery, pain severity at initial presentation, pain medication use at initial presentation, litigation, having Social Security Disability Insurance (SSDI) or workers' compensation, electromyography results. METHODS: Medical information was gathered on the variables listed above. RESULTS: Seventy-six patients, mean age 50.4 years and 49% female, participated. At a mean follow-up of 122 days (SD 146.3), 35 (47%) were improved, 21 (28% were unchanged) and 12 (16%) were worse. Initial correlation analysis showed some relationship between outcomes and having SSDI or workers' compensation (R=.43, p<.001), lifting requirements at work (R=.44, p=.002), working status (R=-.31, p=.02), and electromyogram evidence of radiculopathy (R=-.25, p=.04). Regression analysis showed that having SSDI or workers' compensation was the primary factor associated with worse outcomes. CONCLUSIONS: When controlled for SSDI/workers' compensation, lifting requirements at work, but not working status and radiculopathy, also were associated with outcomes but the association was not as strong. This paper brings into question the utility of offering epidural injections to patients who are on SSDI/workers' compensation and require heavy lifting at work.

Adult↗
PubMedDate not supplied

Impairment, activity, participation, life satisfaction, and survival in persons with locked-in syndrome for over a decade: follow-up on a previously reported cohort.

OBJECTIVE: To determine the long-term outcome of patients with stable locked-in syndrome. SETTING: The community. DESIGN: Retrospective phone survey. This study was further follow-up on a previously reported cohort. PARTICIPANTS: Twenty-nine persons with locked-in syndrome were included in an initial cohort 11 years prior to the current study. Records or contact with family showed that 16 were deceased. Telephone interviews were made with 1 living patient and the caregivers of 11 others. Public records documented survival of 1 nonrespondent. OUTCOME MEASURES: Survival, codified responses regarding functional activities, social activities, and satisfaction with life. RESULTS: Five-, 10-, and 20-year survival were 83%, 83%, and 40%, respectively. Ten subjects had not been hospitalized in the previous year. Eight lived with family. Little change in impairment occurred, but care was simplified. Improvements in communication related to technology, including computer and Internet access. Eleven left home at least monthly. Caregivers reported seven expressed satisfaction with life; five were occasionally depressed. No deaths could be attributed to euthanasia and no survivor had a "no code" status. One patient wished to die, seven had never considered euthanasia, six had considered and rejected it. CONCLUSIONS: Persons with initially stable locked-in syndrome can have prolonged survival, can live in the community if there is enough support, and have some measure of quality of life.

Adolescent↗
PubMedDate not supplied

Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain.

OBJECTIVES: The purpose of this study was to examine the relationship between pain-related fear, lumbar flexion, and dynamic EMG activity among persons with chronic musculoskeletal low back pain. It was hypothesized that pain-related fear would be significantly related to decreased lumbar flexion and specific patterns of EMG activity during flexion and extension. STUDY DESIGN: Data was obtained from subjects who, on a single day, completed self-report measures of pain and pain-related fear, and were interviewed to determine demographic and pain information. Subjects then underwent a dynamic EMG evaluation for which they were asked to stand, then bend forward as far as possible, stay fully flexed, and return to standing. Lumbar EMG and angle of flexion were recorded during this time. A flexion-relaxation ratio (FRR) was computed by comparing maximal EMG while flexing to the average EMG in full flexion. SUBJECTS: Seventy-six persons with chronic musculoskeletal low back pain. RESULTS: Zero-order correlations indicated that pain-related fear was significantly related to reduced lumber flexion (r = -0.55), maximum EMG during flexion (r = -0.38) and extension (r = -0.51), and the FRR (r = -0.40). When controlling for pain and demographic factors, pain-related fear continued to be related to reduced lumbar flexion. Using a path-analytic model to examine whether angle of flexion mediated the relationship between fear and EMG activity, the models examining maximal EMG during flexion and extension supported the notion that pain-related fear influences these measures indirectly through its association with decreased range of motion. Conversely, pain-related fear was independently related to higher average EMG in full flexion, while angle of flexion was not significantly related. Pain-related fear was directly related to a smaller FRR, as well as indirectly through angle of flexion. CONCLUSIONS: Pain-related fear is significantly associated with reduced lumbar flexion, greater EMG in full flexion, and a smaller FRR. The relationship between pain-related fear and EMG during flexion and extension appears to be mediated by reduced lumbar flexion. These results suggest that pain-related fear is directly associated with musculoskeletal abnormalities observed among persons with chronic low back pain, as well as indirectly through limited lumbar flexion. These musculoskeletal abnormalities as well as limited movement may be involved in the development and maintenance of chronic low back pain. In addition, changes in musculoskeletal functioning and flexion associated with pain-related fear may warrant greater attention as part of treatment.

Adult↗
PubMedDate not supplied

A randomized, controlled trial of manual therapy and specific adjuvant exercise for chronic low back pain.

OBJECTIVE: This article examines the effectiveness of manual therapy with specific adjuvant exercise for treating chronic low back pain and disability. METHODS: A single blind, randomized, controlled trial was employed. Patients were prescribed an exercise program that was tailored to treat their musculoskeletal dysfunctions or given a nonspecific program of general stretching and aerobic conditioning. In addition, patients received manual therapy or sham manual therapy. Participants were seen for 6 weekly sessions and were asked to perform their exercise program twice daily. RESULTS: Seventy-two out of 100 patients completed the study. Multivariate tests conducted for measures of pain and disability revealed a significant group by time interaction (P = 0.04 and P = 0.05, respectively), indicating differential change in these measures pretreatment to posttreatment as a function of the treatment received. When controlling for pretreatment scores, patients receiving manual therapy with specific adjuvant exercise reported significant reductions in pain. No change in perceived disability was observed, with the exception that patients receiving sham manual therapy with specific adjuvant exercise reported significantly greater disability at posttreatment. DISCUSSION: Manual therapy with specific adjuvant exercise appears to be beneficial in treating chronic low back pain. Despite changes in pain, perceived function did not improve. It is possible that impacting chronic low back pain alone does not address psychosocial or other factors that may contribute to disability. Further studies are needed to examine the long-term effects of these interventions and to address what adjuncts are beneficial in improving function in this population.

Adult↗