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Biomedical subjects

E M Badley

Publications and source records attributed to E M Badley.

At least 55 records · Page 3Linked to original sources
PubMed1994

Socioeconomic risk factors and musculoskeletal disability.

INTRODUCTION: Musculoskeletal disorders are the major cause of disability in adults, and increased understanding of the determinants of disability could have important implications for the health of the population. OBJECTIVES: To explore the socioeconomic risk factors associated with the reporting of musculoskeletal disability in the Canadian Health and Activity Limitation Survey, and to investigate whether these associations are unique or are shared by other causes. METHODS: Stepwise logistic regression analyses were used to calculate adjusted odds ratios to compare the risk of disability vs no disability in relation to sociodemographic risk factors (age, sex, marital status, number in household, income, education, employment status) for 4 causes of disability: musculoskeletal, nonmusculoskeletal, arthritis and back disorders. RESULTS: Findings for sociodemographic risk factors, apart from sex are similar for musculoskeletal and nonmusculoskeltal causes of disability. Disability is independently associated with increasing age, not being married, less years of schooling, lower income and not being employed. CONCLUSIONS: Data from a Canadian cross sectional study show that the risk factors associated with musculoskeletal disability are similar to those for other causes of disability. Discussion of the meaning of these associations needs to take into account the broader context of disability as a whole, rather than focussing solely on musculoskeletal disorders.

Activities of Daily Living↗
PubMed1993

Disablement associated with rheumatic disorders in a British population: problems with activities of daily living and level of support.

A survey of rheumatic disablement in the population used a measure of physical independence handicap (PIH) to indicate the impact in terms of need for help. One in three households in Calderdale, West Yorkshire, were screened by using a postal questionnaire to identify individuals with disability and reporting a rheumatic disorder, followed by in-depth structured interviews with a stratified random sample. The estimated population prevalence of 8.2% (95% C.I.: 7.9-8.4; ages > or = 16 years) and degree of dependence increased with age, and was linked to disability in activities of daily living and locomotion. Few reported receiving services in their home during the previous 12 months; mainly nursing (18%) and local authority home helps (16%). Overall 84% reported contact with the primary health care team and 52% with hospital and rehabilitation services. Most people received informal care; 14% identified needs for help or care that were not being met. These findings highlight the wide-ranging impact on the lives of those affected.

Activities of Daily Living↗
PubMed1993

Impact of disablement due to rheumatic disorders in a British population: estimates of severity and prevalence from the Calderdale Rheumatic Disablement Survey.

A survey of rheumatic disablement in the population has enabled the comparative impact of self reported causes of disability to be studied. One in three households in Calderdale, West Yorkshire, United Kingdom was screened in 1986 with a postal questionnaire (87% response rate), followed by in depth interviews with a sample of subjects reporting disability in conjunction with a rheumatic disorder (608 interviews). Severity of disablement was assessed using the physical independence handicap classification. The estimated prevalence of disability in conjunction with reported rheumatic disorders is 82/1000 population aged at least 16 years (95% confidence interval (CI) 77 to 87). Arthritis (mainly osteoarthritis) is the most commonly reported cause (47/1000 population; 95% CI 43 to 51), followed by back or neck disorders (25/1000; 95% CI 23 to 28), soft tissue disorders (18/1000; 95% CI 15 to 20), and rheumatoid arthritis (RA) (4/1000; 95% CI 3 to 5). A total of 30% reported more than one category of rheumatic disorder (mean number 1.3) and 63% reported non-rheumatic comorbidity. Current joint symptoms were reported by 98%, current antirheumatic drugs (including analgesics) by 70%, and severe pain by 62%. Overall 82% of subjects had seen their general practitioner in the past year, and 71% reported having attended an outpatient clinic; 26% reported current outpatient clinic attendance, and 15% a hospital inpatient stay during the previous year. Forty six per cent reported some dependence, with 12% reporting being dependent on a daily basis. Rheumatoid arthritis was the most disabling disorder with 73% dependent. Taking into account prevalence, osteoarthritis and back disorders are the most, and RA the least, common causes of dependence and incapacitating pain in the population. This challenges stereotypes and raises questions about the organisation and priorities for specialist services and for research.

Adolescent↗
PubMed1993

Modelling the population health impact of musculoskeletal diseases: arthritis.

OBJECTIVE: A model adjusting for reductions in quality and quantity of life was developed to estimate the population health impact of musculoskeletal diseases. METHODS: Using arthritis as the prototype, prevalence, mortality, and severity data from a variety of sources were combined to model a hypothetical cohort of 1,000 individuals through life. Quality adjusted life years and population health expectancy were calculated for those with arthritis and compared to the general population. RESULTS: Without adjusting for quality of life, a cohort of 1,000 women and 1,000 men at age 15 years could expect 65,010 and 58,735 life years, respectively. Adjusting for quality of life, women with arthritis could expect 61,719 life years, and men 57,123 life years. The unadjusted population health expectancy was 65.0 for girls and 58.7 for boys (at age 15 years). Adjusting for quality of life, the population health expectancies were 61.7 and 57.1, years for women and men, respectively. CONCLUSION: Using this model, the typical adult woman with arthritis can expect to lose 3.3 healthy years of life, and a man, 1.6 healthy years of life. Overall, the model provided a general methodology for determining the population health impact of musculoskeletal diseases. In addition, it is hoped that the methodology will stimulate further research into this area, raise awareness about the uses and limitations of currently available data, and provide a useful model for monitoring the impact of interventions.

Adolescent↗
PubMed1992

Changing profile of joint disorders with age: findings from a postal survey of the population of Calderdale, West Yorkshire, United Kingdom.

A survey of the age-sex specific prevalence of joint problems in a population and associated features such as disablement and use of treatment was carried out in 1986 in Calderdale, West Yorkshire, United Kingdom. A postal questionnaire was sent to 25,168 households; 87% were returned, representing households containing 42,826 people aged 16 years and over. Positive answers to a question about pain, swelling, or stiffness in the joints, neck, or back were given by 10,246 subjects, 24% of the population aged 16 years and older, of whom 6181 (60.3%) were women. The rate of reporting of joint problems increased markedly with age, from 5% for subjects aged 16-24 years to 54% for those aged 85 years and older. The joint sites most often reported as affected were the knee and the back, with a frequency in the population of about 10%. The increase in joint problems with age was accompanied by an increase in reported morning stiffness of more than half an hour, taking drugs, and disability, but not in reporting seeing a specialist for these conditions. Of those aged 85 years and older who reported joint problems, most also had difficulty or dependence in activities of daily living. The increasing prevalence of joint problems with age has implications for the provision of care, both in the community and in hospitals, especially in view of the aging of the population as a whole. The planning of health services for those with rheumatic disorders needs to take into account the high incidence of joint problems in the population.

Adolescent↗
PubMed1992

Physical disability among Canadians reporting musculoskeletal diseases.

About one million Canadian adults are estimated to have physical disabilities attributed to a musculoskeletal condition, a prevalence of 50.1/1,000 adults (all rates expressed/1,000). The specific musculoskeletal disease rates were arthritis/rheumatism (27.2), back (16.2), "other" (4.6), trauma (3.6) and bone (0.6). More women reported disabling musculoskeletal disease (61.0 versus 38.6, respectively). Prevalence rates increased with age from 6.2 among Canadians aged 15-24 years, to 264.7 aged 85 years and over. Limitations of mobility were more common than those of agility. Adults in institutions reported more disabilities than did adults in households (means 7.7 and 4.4, respectively).

Adolescent↗
PubMed1991

A confidence interval approach to investigating non-response bias and monitoring response to postal questionnaires.

STUDY OBJECTIVE: The aim was to develop an alternative method of investigating non-response bias in postal surveys, including a method of calculating a final full (100%) coverage confidence interval which avoids the wide intervals of existing approaches. DESIGN AND SETTING: As part of a two stage survey of disablement in the community, a first phase postal questionnaire was sent to 25,168 households in Calderdale, West Yorkshire, England. Confidence intervals were calculated to investigate the precision of estimates using a "no bias" model, where the prevalence in non-responders is assumed to be the same as in responders. RESPONDENTS: A total of 21,889 postal questionnaires were returned (87%), representing households containing 42,826 people aged 16 years and over. This was achieved by the original post (1st wave, 57% response); two further postal follow ups (2nd and 3rd waves, taking the response to 73% and 81% respectively), the latter including a small personal call back; and a final postal follow up (the 4th wave). RESULTS: The cumulative estimated prevalence of those with dependence was plotted as the survey progressed. The final wave full coverage estimated prevalence for those aged 16-64 years was 12.8 per 1000 with 95% confidence intervals of 11.3-14.4 per 1000. The integrity of this estimate holds as long as the true prevalence in non-responders is within the calculated non-response confidence interval under the no bias assumption, 9.7-16.0 per 1000 people. This latter interval represents the tolerance of prevalence in non-responders implied by the no bias assumption. CONCLUSIONS: The findings have general implications for monitoring non-response bias in postal screening questionnaires. The confidence interval approach developed in this paper offers an alternative to existing regression based estimates, giving an indication of the range of prevalence amongst non-responders that could be tolerated before the no bias assumption used by the model is breached. It is suggested that this approach can be used to determine both the extent of bias, and to aid decision making about the appropriate juncture to terminate follow up. It highlights the potential, particularly in the context of a computerised survey operation, of methodological investigation occurring simultaneously with survey operation.

Adolescent↗
PubMed1991

Investigating non-response bias in a survey of disablement in the community: implications for survey methodology.

STUDY OBJECTIVE: The aim was to investigate the pattern of age specific non-response bias in a two phase survey of disablement in the community. It seeks to examine patterns of response in different age groups to a household based postal questionnaire, and the implication of such trends for the estimation of prevalence of reported dependence. It also looks at the effect that the readiness to respond during the first phase postal questionnaire had on participation in the interview based second phase of the study. DESIGN AND SETTING: A two stage survey of disablement in the population was undertaken. A first phase postal questionnaire was sent to 25,168 households in Calderdale, West Yorkshire, England, to ascertain the prevalence of physical disability. The second phase comprised in depth interviews with a sample of individuals identified in the first phase as being disabled. RESPONDENTS: A total of 21,889 postal questionnaires were returned (87%) representing households containing 42,826 people aged 16 years and over. A disproportionately stratified random sample of 950 respondents reporting disability was taken for the second phase. Of these 891 were still available, and 838 (94%) were interviewed. MEASUREMENTS AND MAIN RESULTS: A study of the timing of response to a postal questionnaire showed that patterns differed for different age groups. The estimated prevalence of those aged 65 years and over who were dependent was steady over time whereas for those in the 16-64 age range the estimated prevalence fell as the survey progressed, indicating a tendency for those who were dependent to respond sooner. Examination of the relationship of responses at phase 1 and phase 2 showed that response to invitation to interview was much less in those who had responded later, and presumably more reluctantly, in the first phase. CONCLUSIONS: These findings raise questions about how different patterns of response might be indicative of bias which could differentially affect final age specific prevalence estimates. They also have methodological implications for the follow up of reluctant responders both to increase the response rate and to secure cooperation in the second phase of a two phase survey.

Age Factors↗
PubMed1991

Investigating the proxy effect and the saliency principle in household based postal questionnaires.

STUDY OBJECTIVE: The aim was to investigate two possible sources of bias inherent in using a household based postal questionnaire, the "proxy effect", inaccurate reporting about characteristics of others, and the "saliency principle", reporting of only the most salient features. This is of importance in surveys concerned with screening the population to identify individuals with certain characteristics, and so possibly relying on one member of the household to reply on behalf of all others. DESIGN AND SETTING: A two stage survey of disablement in the population was undertaken. A first phase postal questionnaire was sent to 25,168 households in Calderdale, West Yorkshire, England, to ascertain the prevalence of physical disability and of troubles with the joints. The second phase comprised in depth interviews with a sample of individuals identified in the first phase as being disabled. RESPONDENTS: A total of 21,889 postal questionnaires were returned (87%) representing households containing 42,826 people aged 16 years and over. A disproportionately stratified random sample of 950 respondents reporting disability was taken in the second phase. Of these 891 were still available, and 838 (94%) were interviewed. MEASUREMENTS AND MAIN RESULTS: The postal questionnaire found that almost 29% of those who lived "alone" (without another adult) reported some level of disability, compared to only 10% of those who lived with others. The difference remained significant after standardisation. This apparent underreporting or "proxy effect" was present for reporting about disability overall, but not for severe disability (dependence on help of others), which suggests the operation of the "saliency principle". Reporting on joint troubles appeared to be affected by the proxy effect both for any joint problems, and when more than five joints were affected. Analysis of a small set of postal questionnaires from respondents who reported joint problems only at interview and where we could identify who had completed the postal questionnaire supports the hypothesis of a proxy effect; two thirds of the original postal questionnaires had been completed by a proxy. The results were further complicated by an interaction between reporting of disability and joint troubles: the greater the level of disability, the less likely the reporting of joint troubles. CONCLUSIONS: The findings have general implications for studies involving postal household screening questionnaires, and raises additional concerns about those that are multitopic in content. In surveys of symptoms and minor disability, a proxy effect is likely to be operative. This effect is not apparent for obvious and long standing problems such as dependence on others for help. However the interaction between the reporting of disability and joint symptoms carries important implications for the development of multitopic postal screening questionnaires.

Adolescent↗
PubMed1989

Visual analogue scales as a measure of pain in arthritis: a study of overall pain and pain in individual joints at rest and on movement.

Visual analogue scales (VAS) for overall and individual joint pain at rest and on movement were completed by 105 patients with polyarthritis as part of a study of the relationship between overall pain and pain in individual joints. Not all subjects recorded pain on a conventional VAS although all had at least 2 painful joints on movement. At best only 25% of the variance in overall pain was explained by pain in individual joints. Our findings suggest that conventional overall measures of pain in arthritis may neglect aspects of pain experience which relate to individual joints and to pain on movement.

Adult↗
PubMed1989

The quality of pain in arthritis: the words patients use to describe overall pain and pain in individual joints at rest and on movement.

One hundred and five patients with polyarthritis chose from 14 sensory and 5 affective pain descriptors derived from the McGill Pain Questionnaire (MPQ), and completed visual analogue scales (VAS) for overall and individual joint pain at rest and on movement. The relative frequency of sensory pain descriptor choice varied for the 4 different circumstances of pain. Over one third of patients volunteered affective words not included in the MPQ. This study suggests that conventional overall measures of pain, such as the MPQ, when used for patients with arthritis may neglect differences in pain experience perceived in individual joints and on movement.

Adult↗
PubMed1987

The consultant's role in continuing medical education of general practitioners: the case of rheumatology.

Consultant rheumatologists were surveyed by questionnaire about their contribution to the continuing education of general practitioners, and 84% (203/243) replied. Altogether 157 respondents had participated in some form of teaching, 147 in collective teaching sessions such as lectures and 99 in the teaching of small groups. Arthritis comprised 44% of the rheumatological topics taught; there was a noticeable lack of teaching on problems commonly encountered in general practice, such as soft tissue rheumatism and injury and back pain, and on clinical skills including examination and injection of joints. Eighty eight respondents made comments and suggestions. The favoured educational strategies were small group teaching, apprenticeship schemes, and interchange between general practitioners and consultants about shared cases. This contrasts with what was typically done--namely, formal lectures on rheumatoid arthritis in postgraduate medical centres. These findings raise questions about the continuing education of consultants themselves as well as about the consultants' role in teaching others.

Education, Medical, Continuing↗
PubMed1987

Impairment, disability, and the ICIDH (International Classification of Impairments, Disabilities, and Handicaps) model. I: The relationship between impairment and disability.

The conceptual scheme put forward in the International Classification of Impairments, Disabilities, and Handicaps suggests that impairment should be related to disability. This paper examines the proposition that disability should be related to impairment in terms of parts of the body involved, both in the physical requirements to carry out a given activity and as regards the site and types of functional limitation, by secondary analysis of data collected in a survey of disabled people in Great Britain. Factor analysis of data on functional limitations showed that these impairments could be considered in four groups representing manual dexterity, movements of the arm, strength, and lower limb function. These were found to be correlated with ability in self-care activities depending on the part of the body involved in the activity.

Activities of Daily Living↗
PubMed1987

Impairment, disability, and the ICIDH (International Classification of Impairments, Disabilities, and Handicaps) model. II: The nature of the underlying condition and patterns of impairment.

This paper presents a further exploration of the conceptual scheme proposed in the International Classification of Impairments, Disabilities, and Handicaps which links underlying condition, impairment and disability. It examines the proposal that three general patterns of impairment profile might be expected depending on whether the underlying condition affects control (as in stroke or multiple sclerosis), mechanical performance (as in arthritis) or energy (as in cardiorespiratory conditions). Examination of patterns of functional limitation shows more resemblance between conditions in each of these groups than between the groups lending support to the proposal.

Activities of Daily Living↗
PubMed1987

Impairment, disability, and the ICIDH model. III: Underlying disease, impairment, and disability.

Secondary analysis of data carried out in a national survey of the disabled is used to explore the relationship between underlying condition, impairment and disability, where the conditions are considered in three groups depending on whether they affect control, mechanical performance or energy. Comparison of impairment and disability profiles highlights the role of functional limitation in mediating between disease and disability. Disability profiles were found to be less associated with the underlying condition than were impairment profiles, but this can to some extent be explained by the nature of the functional limitation.

Activities of Daily Living↗
PubMed1987

The ICIDH: format, application in different settings, and distinction between disability and handicap. A critique of papers on the application of the International Classification of Impairments, Disabilities, and Handicaps.

Recent papers on the ICIDH generally agree about the need for and the usefulness of the ICIDH, although inevitably some difficulties are reported in applying it. Some of these stem from the context and professional purpose of the assessments (on the whole the rehabilitation setting was found to be less problematic than community surveys), and others from the application to particular sub-groups, such as children, the elderly, the mentally ill, or those with milder or fluctuating disability. Most problems concerned the nature of the relationship between disability and handicap and the distinction between these concepts. This review suggests an alternative formulation of the disablement model which shows handicap as arising out of an interaction between impairment and disability and the environment in which the individual lives, the resources available, and the social and cultural setting. While on the whole optimistic, the papers reviewed indicate that there is still more work required both on a practical and conceptual level.

Disability Evaluation↗
PubMed1984

Measures of functional ability (disability) in arthritis in relation to impairment of range of joint movement.

In the World Health Organisation's supplementary classification of the consequences of disease a distinction is made between impairments, such as are related to the site and nature of joint involvement, and any disabilities in everyday activities to which these may give rise. This paper considers the application of these ideas to people with arthritis by examining the extent of graded relationship between individual impairments, reflected by limitations in the range of joint movement, and the number or type of disabilities. Ninety-five people with three different types of arthritis were studied. A 41-item disability questionnaire was completed. Most of the variation was described by only 24 of the latter items. These fell into five broad functional groups--predominantly concerned with mobility, bending down, manual dexterity, bending the arm, and reaching above the head. The constituent activities could be scaled in order of difficulty of accomplishment. Aggregated scores for each of the functional groups were correlated with observed ranges of motion in relevant joints, and the ordering of difficulty was related to decreasing ranges of movement. These findings shed light on the genesis of disability and have implications for the development of more sensitive, specific, and simple methods of assessment in rheumatology. Appreciation of how disability relates to the localisation of disease manifestations provides a means for evaluating current methods of functional assessment and exposes potential biases in such appraisals.

Adult↗