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Biomedical subjects

C Bombardier

Publications and source records attributed to C Bombardier.

At least 91 records · Page 5Linked to original sources
PubMed1995

The role of children in reporting their physical disability.

OBJECTIVE: To explore the contributions of children during the development of a disability scale, and their competence using the new scale. DESIGN: A new self-report measure of pediatric physical performance, the Activities Scale for Kids (ASK), was developed based on interviews and pilot testing with children. The ASK was then filled out by children on two occasions 2 weeks apart to assess the reliability of child self-report. Validity was assessed by comparison of interview data and ASK scores from children with similar data collected from their parents, and to clinician and family global ratings of disability. SETTING: The study was conducted at a pediatric tertiary care hospital and its affiliated rehabilitation center. PATIENTS: All subjects, 5 to 15 years of age, experienced activity limitations because of musculoskeletal disorders and were free of cognitive impairment. Thirty children (mean age, 11.5 years) participated in the development of the ASK, and 28 children (mean age, 11.4 years) participated in testing of reliability and validity. RESULTS: Children generated items similar to those generated by parents (85% agreement) and identified 10 items not obtained from parents or the literature. Children demonstrated excellent test-retest reliability (intraclass correlation coefficient [ICC] = .97) using the ASK, and their scores were highly concordant with parent-reported ASK scores (ICC = .96). Validity was ascertained by comparison of ASK scores across different levels of disability based on global ratings of families and clinicians (p = .0023). CONCLUSION: Children are able to play an important role in pediatric physical disability evaluation.

Adolescent↗
PubMed1995

Comparative costs of the various strategies of urinary stone disease management.

New technology is a major determinant of total healthcare costs. The assessment of alternative technologies from a cost-effectiveness perspective is important, although other considerations may finally determine which technology is used. The alternatives of extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrostolithotomy (PCNL) for the treatment of renal stone disease were compared by studying 1000 cases of ESWL and 133 cases of PCNL using a noncontemporaneous cohort study with PCNL representing the earlier cohort. The effectiveness, defined by success and stone-free rates, was higher with PCNL than with ESWL (96% success vs. 70%); PCNL was also accompanied by a lower burden of additional therapy, whereas ESWL had a higher retreatment rate. From the perspective of a third-party payer, total costs per case of ESWL ($2,746) were lower than those of PCNL ($4,087), but the figure varies with the annual volume. These represent the costs for complete treatment of a patient, including the costs of alternative technology such as PCNL or ureteroscopy that may ultimately be necessary in a patient initially managed by ESWL. The cost for a single ESWL treatment was $2,226 (at a volume of 1000 cases per year), but this increased to $2,746 when costs of retreatment and alternative treatment were prorated to each patient treated. The relative contribution of capital costs to the total cost of ESWL was always less than total professional fees and was only 12% at a volume of 2000 cases/year. Therefore ESWL is less expensive but it is also less effective in rendering patients stone-free.

Canada↗
PubMed1995

Comparison of a generic (SF-36) and a disease specific (WOMAC) (Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery.

OBJECTIVE: The discriminant validity of a generic, health related quality of life (HRQL) measure, the SF-36, was compared with that of a disease specific HRQL measure, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), in patients aged 67-99 years who had undergone knee replacement surgery 2 to 7 years previously. METHODS: A stratified random sample of 1750 Medicare beneficiaries was surveyed and 1193 usable responses were obtained (after adjustment for ineligible, incapacitated, and deceased individuals). Discriminant validity of scale scores common to both instruments (pain, physical functioning, and overall score) were compared. RESULTS: Examination of discriminant validity, using Spearman correlations, showed that the WOMAC discriminates better among individuals with knee problems, while the SF-36 discriminates better among individuals with varying levels of self reported general health status and comorbidities. CONCLUSION: These scales measure 2 distinct but important aspects of patients' health. These results support inclusion of both a generic and a disease specific HRQL measure in cross sectional studies.

Aged↗
PubMed1995

Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery.

Generic and disease-specific health status instruments are commonly used to assess patients' outcomes. The hypothesis that they measure distinct but complementary aspects of patients' quality of life was tested using a sample of patients aged 67 to 99 years who had undergone knee replacement surgery 2 to 7 years previously. Patients' scores on a generic health-related quality-of-life (HRQOL) measure, the SF-36, were compared to those of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index; the WOMAC was developed specifically for patients with lower extremity arthritis, whereas the SF-36 is aimed at all conditions. A stratified sample of 1,750 Medicare beneficiaries was surveyed and an overall response rate of 80.3% achieved, resulting in 1,193 usable surveys (after adjustment for ineligible, incapacitated, and deceased individuals). The distribution of scores on the three dimensions common to both instruments (i.e., pain, physical function, and overall score) showed consistently higher scores on the WOMAC, on a scale of 0 (worst) to 100 (best), than on the SF-36, indicating less disability from arthritis than from other conditions after knee surgery in this elderly population. Statistically significant differences in the number of people with perfectly healthy scores were detected between the instruments; with regard to pain, 32.2% of the sample reported no pain due to arthritis on the WOMAC, compared with only 13.6% reporting no pain due to any conditions on the SF-36. The figures for physical function and overall score were 9.6% versus 1.4%, and 6.9% versus 0.2%, respectively. Examination for discriminant validity showed that the scores on the two scales followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. The results of this study support the inclusion of both a generic and a disease-specific HRQOL measure to assess patient outcomes fully.

Aged↗
PubMed1995

Salsalate, a nonacetylated salicylate, is as efficacious as diclofenac in patients with rheumatoid arthritis. Salsalate-Diclofenac Study Group.

OBJECTIVE: To investigate the efficacy of salsalate, a nonacetylated salicylate, in the treatment of patients with rheumatoid arthritis (RA). METHODS: Three hundred and one patients meeting the ACR criteria for RA were drawn from 16 centers. After withdrawal of nonsteroidal antiinflammatory drugs (NSAID) and subsequent flare, patients were randomized to receive either salsalate or diclofenac for 8 weeks, according to a double blind, double dummy protocol. Initial doses of salsalate 3.0 g/day and diclofenac 75 mg/day were titrated for the first 5 weeks. The primary outcome measure was a multivariate analysis at 8 weeks of tender joint count, pain, visual analog scale score, and physician's global assessment. RESULTS: One hundred and ninety patients completed the study. The mean stabilized dose of salsalate was 3.55 g/day, and that of diclofenac 112 mg/day. Discontinuations were due to lack of efficacy (17 salsalate vs 15 diclofenac); adverse events [19 salsalate (mainly tinnitus and hearing loss; p = 0.0001 and p = 0.04, respectively) vs 9 diclofenac]; laboratory abnormalities (3 salsalate vs 1 diclofenac); and other reasons, including protocol violations, intercurrent illness, and personal factors (24 salsalate vs 23 diclofenac). Both treatments produced significant improvement from flare (p < 0.0001). Post hoc power analysis showed that the study had sufficient power (0.60 to 0.90) to detect clinically important differences between the 2 drugs in the primary outcome measures; however, no statistically significant (p = 0.29) or clinically important treatment differences were recorded. Other than a difference in erythrocyte sedimentation rate that favored salsalate, there were no significant differences in secondary outcome measures between the 2 groups. All outcomes showed a tendency for more improvement with salsalate. CONCLUSION: Salsalate is as efficacious as diclofenac. Salsalate may be considered an alternative to other NSAID in the first line treatment of patients with RA.

Aged↗
PubMed1995

A critical appraisal of toxicity indexes in rheumatology.

Our objective was to design a grading system to judge the methodological quality of toxicity symptoms assessment in rheumatologic randomized controlled trials, and to use this grading system to evaluate rheumatology case report forms. For comparison, we also evaluated instruments derived in other clinical specialties. To further determine whether variability seen on the rheumatology case report forms would lead to variability of side effect measurement in a clinical trial setting, we conducted a survey of investigators and their coordinators in a multicenter randomized trial. We used Feinstein's definition of sensibility and a conceptual model of the process of toxicity measurement in the clinical trial setting to develop a grading system. Thirty case report forms were obtained from a convenience sample, and 7 other instruments from other disciplines were obtained through literature review. These forms were evaluated in a blinded manner by 3 reviewers. A survey of 30 trial staff from 15 centers involved in a multicenter, randomized trial of 2 active nonsteroidal antiinflammatory drugs (NSAID) in rheumatoid arthritis (RA) was undertaken to evaluate whether the variability identified in the review of the case report forms translated into variability in the measurement of side effects in clinical trial setting. The rheumatology case report forms had a mean score of 9.1 (SD = 2.6) out of 20, where 0 is the worst score and 20 is a perfect score. The structured instruments from other disciplines had a mean score of 14.9 (SD = 2.7). These means were significantly different, with p = 0.001.(ABSTRACT TRUNCATED AT 250 WORDS)

Adverse Drug Reaction Reporting Systems↗
PubMed1994

Waiting times for knee-replacement surgery in the United States and Ontario.

BACKGROUND: Canada, which has universal single-payer health insurance, is often criticized for waiting times for surgery that are longer than those in the United States. We compared waiting times for orthopedic consultations and knee-replacement surgery and patients' acceptance of them in the United States and in the province of Ontario, Canada. METHODS: A stratified random sample of 1486 Medicare recipients (629 from the U.S. national sample, 428 from Indiana, and 429 from western Pennsylvania) and 516 people from Ontario who had been hospitalized for knee replacement between 1985 and 1989 were surveyed by mail in 1992. Patients were asked how long they had waited to see an orthopedic surgeon and to have surgery, the acceptability of these waiting times, and their overall satisfaction with surgery. RESULTS: About 80 percent of the questionnaires were returned, but not all the respondents answered all the questions. The rate of response to specific questions was about 60 to 65 percent in both countries. The median waiting time for an initial orthopedic consultation was two weeks in the United States and four weeks in Ontario. The median waiting time for knee replacement after the operation had been planned was three weeks in the United States and eight weeks in Canada. In the United States, 95 percent of patients in the national sample considered their waiting time for surgery acceptable, as compared with 85.1 percent in Ontario. Overall satisfaction with surgery ("very or somewhat satisfied") was 85.3 percent for all U.S. respondents and 83.5 percent for Canadian respondents. CONCLUSIONS: Waiting times for initial orthopedic consultation and for knee-replacement surgery were longer in Ontario than in the United States, but overall satisfaction with surgery was similar.

Aged↗
PubMed1994

A brief introduction to the critical reading of the clinical literature.

Clinicians are bombarded by reports of new diagnostic tests or treatments for patients with spine problems. To provide the best possible patient care, clinicians need to be able to critically appraise the results of such studies for validity and relevance to patient care. Important questions to be asked of any description of diagnostic or treatment studies are the following questions: 1) Are the patients described in detail so that you can decide whether they are comparable to those that you see in your practice? 2) Are the treatments or assessments described well enough so that you could provide the same for your patients? 3) Was a clinically relevant endpoint measured? 4) Is there an appropriate comparison group? 5) Are potential sources of bias appropriately attended to? 6) Are the results clinically significant?

Humans↗
PubMed1994

Outcome measures for studying patients with low back pain.

There is growing recognition in the treatment of back pain that patient perspectives are essential in judging the results of treatment. Improving the patient's "quality of life" is often the main goal of therapy. Thus, although clinical research in the past has focused on physiologic outcomes, such as range of motion, muscle strength, or neurologic deficits, increasing attention is being given to the rigorous measurement of symptoms, functional status, role function, satisfaction with treatment, and health care costs. In many cases, these so-called "soft" outcomes can be measured with a level of reproducibility similar to more conventional clinical data such as imaging test results. Because symptoms and functional outcomes are sometimes only loosely associated with physiologic phenomena, the former outcomes should be measured directly. Modern questionnaires for measuring patient quality of life combine the expertise of social scientists and clinicians and have demonstrated validity. Furthermore, they have some important advantages over simple ratings of "excellent, good, fair, and poor" outcomes, or work status alone. Several modern instruments for measuring health-related quality of life in patients with low back pain are reviewed briefly, describing their content and length. Wider use of these instruments would help to increase clinician familiarity with their meaning and avoid duplication of effort in questionnaire development.

Health Status Indicators↗
PubMed1994

Strategies for outcome research in spinal disorders. An introduction.

The evaluation of the clinical utility of the clinical diagnostic tests and procedures, what works in spinal disorders, and for whom and how treatment affects a patient's symptoms and function are key questions of outcomes research. This paper describes the advantages and limitations of the main study approaches used. Examples from the spine literature on spinal stenosis are used for illustration.

Female↗
PubMed1994

A guide to interpreting epidemiologic studies on the etiology of back pain.

Understanding disease etiology is key for effective preventive or therapeutic interventions. Knowledge about risk factors is useful to the clinician to answer patients' questions about the possible cause(s) of their presenting disorders. This article describes the three most common types of etiologic studies using examples from the published literature on the risk factors for back pain. Cohort studies typically follow a group of "healthy" people forward in time to assess disease outcome after risk factors have already been measured. Case-control studies use people selected on the basis of outcome status; risk factors are assessed after the fact. Although more prone to bias than cohort studies, case control studies are more common in back pain research because of the ease of examining several risk factors simultaneously and the expense of cohort studies. Prevalence studies use a random sample of people collected at a single point in time; consequently there is no predetermined number of "cases" and "controls," their numbers depending on the prevalence of disease and exposures in the samples. To assist in the interpretation of research findings this paper presents a general framework for assessing the strengths and weaknesses of an individual study. Case-control studies are discussed in more detail because they are so commonly encountered in the etiologic literature. Finally, because the evidence from a single study, no matter how well designed and executed, is never enough on its own to decide if a risk factor is causal or not, the paper concludes by briefly summarizing the criteria for inferring causation using the full body of available biologic and epidemiologic literature.

Back Pain↗
PubMed1994

Group education interventions for people with low back pain. An overview of the literature.

STUDY DESIGN: This study systematically reviewed the literature on group education for people with low back pain. Findings are considered in relation to parameters such as the characteristics of the study participants, the intervention, and the setting. OBJECTIVE: To make a recommendation regarding the effectiveness of group education as an intervention for people with low back pain. RESULTS: Based on a systematic search of the literature, 13 primary studies are cited; 6 of these were sufficiently well designed and executed for their findings to be considered. Of the four quality studies with chronic back pain subjects, only one found a positive short-term effect on one of the outcome measures considered (pain intensity). In the two studies with acute cases, group education was found by one of the studies to reduce pain duration and initial sick leave duration in the short term, but the intervention also included work-site visits. At 1 year of follow-up, there was no evidence in the six studies of clinically important benefits on any of the outcome measures. CONCLUSIONS: There is insufficient evidence to recommend group education for people with low back pain.

Adult↗
PubMed1994

Criteria for rheumatic disease. Different types and different functions. The American College of Rheumatology Diagnostic and Therapeutic Criteria Committee.

Criteria sets formalize our approach to studying the etiology, course, and management of rheumatic diseases, and provide a conceptual base for measuring future improvements in clinical care. They focus our clinical objectives and improve our clinical research activities. They are dynamic, evolving, and will certainly undergo major changes. Understanding the purposes of specific criteria sets and the differences between different criteria categories is crucial for understanding the rheumatic disease literature and for the design and conduct of clinical and epidemiologic investigations.

Forecasting↗
PubMed1994

Kidney biopsy in systemic lupus erythematosus. III. Survival analysis controlling for clinical and laboratory variables.

OBJECTIVE: To examine the importance of renal biopsy as a predictor of death due to any cause in patients with systemic lupus erythematosus (SLE). METHODS: The study included 123 SLE patients who had a renal biopsy between 1970 and 1984 and were followed up as part of a prospective study. Data were initially analyzed to identify clinical and laboratory features that were significantly associated with the risk of dying. Renal biopsy variables were then examined to determine whether they contributed additional information about prognosis. RESULTS: The clinical and laboratory factors most closely associated with the risk of dying in multivariate analyses were the serum creatinine level and the SLE Disease Activity Index score. The presence of chronic renal lesions on biopsy contributed significantly to the prognostic information offered by clinical and laboratory factors in the subset of patients who had normal serum creatinine levels--the majority (85%) of patients in this study. CONCLUSION: These results indicate that renal biopsy serves an important role in the assessment of prognosis in patients who do not have advanced renal disease.

Adult↗
PubMed1994

Sleep disorders in patients with chronic fatigue.

This prospective, cohort study examined the prevalence of sleep disorders among highly selected patients with chronic fatigue. On the basis of responses suggestive of sleep pathology on a screening questionnaire, 59 patients from a university-based clinic for chronic fatigue who had undergone a medical and psychiatric evaluation underwent polysomnography. Criteria for chronic fatigue syndrome (CFS) were met by 64% of patients and those for a current psychiatric disorder were met by 41%. Overall, 41% of patients had abnormal results for a multiple sleep latency test and 81% had at least one sleep disorder, most frequently sleep apnea (44%) and idiopathic hypersomnia (12%). In comparing patients who did and did not meet CFS criteria, no significant differences were found in individual sleep symptoms or sleep disorders. Likewise, symptoms and sleep disorders were unrelated to psychiatric diagnoses. In conclusion, chronically fatigued patients with suggestive symptoms may have potentially treatable coexisting sleep disorders that are not associated with meeting criteria for CFS or a current psychiatric disorder.

Adult↗
PubMed1994

Ontario patients' acceptance of waiting times for knee replacements.

OBJECTIVE: To determine waiting times for an initial orthopedic consultation and subsequent knee replacement surgery in Ontario and patients' acceptance of these waiting times. METHODS: Mailed patient survey to 185 randomly selected knee replacement recipients discharged from 5 Ontario hospitals between 1985 and 1990, with telephone followup after 2 mailings, implemented between May and July, 1992. Patients were asked about waiting times for their initial orthopedic consultation and subsequent knee replacement surgery and their acceptance of these waiting times. RESULTS: Of the 185 patients, 40 were excluded because they were deceased, unable to respond, or not traceable. Of the 145 eligible patients, 127 or 87.6% responded. The median waiting times for an initial consultation and for knee replacement surgery were 4.0 and 9.5 weeks, respectively. Waiting times did not change significantly over the 5-year study period (Pearson correlation coefficients: 0.07, p = 0.53, for consultation, and -0.08, p = 0.44, for surgery). The waiting times for consultation and surgery were acceptable to 93.2% (95% confidence interval: 88.7-97.7%) and 88.1% (95% confidence interval: 82.3-93.9%) of respondents, respectively. The average acceptable surgical waiting time of 13.2 weeks was significantly shorter than the not acceptable average of 34.3 weeks (p < 0.001). CONCLUSION: The average waiting periods for an initial orthopedic consultation and subsequent knee replacement surgery were relatively short, and the majority of patients considered their waiting times acceptable.

Data Collection↗
PubMed1994

Functional disability in early rheumatoid arthritis: description and risk factors.

OBJECTIVE: To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA). METHODS: A cohort of 337 patients with early RA with disease duration under 5 years was constituted in 2 areas in France and The Netherlands. Examination included the Ritchie index, the presence of nodes and other extraarticular manifestations, and the erythrocyte sedimentation rate (ESR). The Health Assessment Questionnaire, adapted and validated in the French and Dutch languages, was used to assess functional disability. RESULTS: The results allowed for the cross sectional description of a marked early functional disability, with a score of 1 (adjusted for disease activity variables) from the first year of the disease. Functional disability was increasing nonlinearly with the disease duration in a quadratic model. Disease activity variables, namely ESR and Ritchie index, were identified as other important components of functional disability. CONCLUSION: Consequences for the early management of RA are underlined.

Arthritis, Rheumatoid↗