Biomedical subjects

D Cynn

Publications and source records attributed to D Cynn.

4 recordsLinked to original sources

PubMed2001

Relative contribution of mental health and exercise-related pain increment to treadmill test intolerance in patients with chronic low back pain.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To determine the relative contribution of pain increase and mental health to testing performance during a single bout of exercise in patients with chronic low back pain. BACKGROUND: Controversy exists as to which factors principally limit physical performance in patients with chronic low back pain. Some believe psychological factors limit physical performance, whereas others believe activity-related increases in pain intensity limit performance. METHODS: Seventy-five patients with chronic low back pain reported pain intensity before and after undergoing a maximal, symptom-limited modified treadmill test. Walking time (in minutes) and aerobic fitness were measured. The Short Form 36 Health Survey was administered to all patients. RESULTS: Fifty-four percent of the sample stopped testing because of a significant increase in pain intensity (P = 0.0001). Treadmill performance was lower in patients who stopped because of pain than in those who stopped because of fatigue (P = 0.02). The patients who stopped because of pain were also more likely to have low mental health as assessed by the Short Form 36 Health Survey. Low mental health, however, did not have a statistically significant influence on treadmill performance. CONCLUSION: The data indicate that impairment of physical performance during treadmill testing in patients with chronic low back pain is attributable to testing-induced increase in pain intensity rather than to individual low mental health scores.

Adult↗

PubMed2001

The Work Limitations Questionnaire.

OBJECTIVE: The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment ("work limitations"). RESEARCH DESIGN: Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity. SUBJECTS: The study subjects were employed individuals (18-64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects. MEASURES: Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items. RESULTS: In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of > or = 0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P < or = 0.05). CONCLUSIONS: With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.

Adult↗

PubMed2000

Using the "TOPS," an outcomes instrument for multidisciplinary outpatient pain treatment.

OBJECTIVE: To assess the reliability of an augmented SF-36 instrument, the Treatment Outcomes in Pain Survey ("TOPS"), in patients treated in two pain management programs, and present norms for initial values and treatment-related improvements. DESIGN: Prospective case series at two sites with longitudinal follow-up. SETTING: Multidisciplinary, comprehensive outpatient pain treatment centers in university hospitals in Salt Lake City and Boston. PATIENTS: Nine hundred and forty seven adult outpatients with a range of socioeconomic, demographic, and ethnic characteristics, all referred for evaluation and treatment of chronic pain. INTERVENTIONS: Usual practice multidisciplinary pain treatment. OUTCOMES MEASURES: TOPS prior to pain treatment and 5-week nominal follow-up. Means and standard deviations of baseline and follow-up results. Psychometric results for reliability (Cronbach alpha), validity (item discriminant validity, validity coefficients), and related statistical precision measures for group and individual designs. RESULTS: Several measures were precise enough to permit following individual patients in standard clinic treatment, of which the Total Pain Experience dimension was the most powerful. Similar psychometrics were observed in the Boston and Salt Lake City sites. The Pain Symptom, Objective Family/Social Disability, Objective Work Disability, and Upper Body Functional Limitations scales were validated. DISCUSSION: The TOPS was designed to satisfy several models of clinical pain treatment. It successfully monitored treatment based on those models. Not all patients improve with treatment, but most do. The TOPS can be administered in a variety of ways, but we found paper and pencil administration with computer scanning of results quick and efficient for making the data available to clinicians as part of treatment. CONCLUSIONS: The accuracy of the TOPS is sufficient to monitor the response of individual patients during multidisciplinary treatment of chronic pain. The TOPS provides needed documentation (e.g., to third-party payors) of the aggregate value of multidisciplinary outpatient treatment of chronic pain as well as its benefit for individual patients.

Journal Article↗

PubMed2000

Assessing individual outcomes during outpatient multidisciplinary chronic pain treatment by means of an augmented SF-36.

OBJECTIVE: To meet the growing demand for objective outcomes measurement during treatment of chronic pain, we developed an instrument to track outcomes of individual patients. METHOD: In a 2-phase study, existing and novel outcomes instruments were applied in an interdisciplinary pain management program. In the initial phase, 408 patients were administered the Short Form 36-item questionnaire and during phase 2, 437 patients (87 of whom were followed) were given an expanded (191-item) questionnaire. RESULTS: When applied to individual patients, the Short Form 26-item questionnaire lacked measurement reliability for assessment of treatment outcomes and sensitivity to upper extremity or facial pathology, and failed to separate limitations of work versus everyday activity. A novel group of scales derived from responses to 61 questions, including the Short Form 36-item questionnaire, proved sufficiently reliable for routine follow-up of individual chronic pain patients. CONCLUSIONS: This new Treatment Outcomes in Pain Survey allows assessment of individual patient outcomes, and aggregate or individual clinician performance, during interdisciplinary treatment of chronic pain.

Journal Article↗