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Biomedical subjects

G Waddell

Publications and source records attributed to G Waddell.

At least 37 records · Page 2Linked to original sources
PubMed1998

Clinical guidelines in the management of low back pain.

With the emergent concept of evidence-based practice, various countries have produced clinical guidelines for the management of acute low back pain since 1993-94. By and large the evidence-base for these proposals is consistent, though over the last 4 years it has increased considerably, and there has been a slight change of emphasis in several aspects. As all the guidelines are based on the same evidence, the similarity between them is not surprising. The common features are diagnostic triage along with periodic assessment to guide management strategies. There has been progressive reduction in the recommendation of rest as a treatment option, and early activation is increasingly recognized as a potent intervention. There has been a progressive recognition that psychosocial factors are important determinants for the risk of chronicity, and that such factors need to be addressed clinically. Specific therapeutic recommendations vary, but these are probably less important than the overall strategy. It is obviously hoped that clinical management should improve as a result of these initiatives, but effective dissemination and implementation are persisting concerns, and the effectiveness of clinical guidelines in changing clinical practice is still unproven.

Acute Disease↗
PubMed1998

Medically certified work loss, recurrence and costs of wage compensation for back pain: a follow-up study of the working population of Jersey.

The 1 yr incidence, prevalence and wages compensation costs of work loss due to medically certified back pain in the working population of Jersey were identified by analysis of the Social Security database for the year 1994. A total of 2291 subjects absenting due to back pain during this period were followed for up to 3 yr to identify return to work rates and subsequent absences. Incidence and prevalence rates were 5.6 and 6.3%, respectively. The cost of wages compensation was 1.29 million pounds or 10.5% of such benefits paid. Work loss was greater for the second absence. The rate of return to work was broadly in line with that suggested by the Clinical Standards Advisory Group (CSAG), but the number still absent at 1 yr was less, suggesting that the CSAG figures for long-term absence may have been overestimated. The influence of compensation systems and unemployment on work-related absence due to back pain is highlighted.

Absenteeism↗
PubMed1997

Systematic reviews of bed rest and advice to stay active for acute low back pain.

BACKGROUND: In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. AIM: To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain. METHOD: A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, and further health care use). RESULTS: Ten trials of bed rest and eight trials of advice to stay active were identified. Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery. Advice to stay active and to continue ordinary activities results in a faster return to work, less chronic disability, and fewer recurrent problems. CONCLUSION: A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain.

Acute Disease↗
PubMed1996

Low back pain: a twentieth century health care enigma.

Despite greater knowledge, expertise, and health care resources for spinal pathologies, chronic disability resulting from nonspecific low back pain is rising exponentially in western society. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pain: What has changed in our understanding and management. There are striking differences in health care for low back pain in the United States and the United Kingdom, although neither delivers the kind of care recommended by recent evidence-based guidelines. Medical care for low back pain in the United States is specialist-oriented, of high technology, and of high cost, but 40% of American patients seek chiropractic care for low back pain instead. National Health Service care for low back pain in the United Kingdom is underfunded, too little and too late, and 55% of British patients pay for private therapy instead. Despite the different health care systems, treatment availability, and costs, there seems to be little difference in clinical outcomes or the social impact of low back pain in the two countries. There is growing dissatisfaction with health care for low back pain on both sides of the Atlantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.

Delivery of Health Care↗
PubMed1996

Patient educational material in the management of low back pain in primary care.

Distributing educational material about low back pain to patients is increasingly seen as a possible adjunct to clinical management and a potential means of reducing the risk of the progression of the disorder toward chronic disability. Most back pain is managed in the primary care setting, where such material could save time and support the efforts of these practitioners. Recent evidence-based clinical guidelines for acute low back pain in U.S. and U.K. have advocated the use of educational material, but most of the available booklets are based on traditional biomedical theory about back pain and are neither evidence-based nor in line with recent guidelines. The few of these booklets that have been tested have had inconsistent effects. A new booklet has been developed which is evidence-based, in line with recent guidelines, and states its messages in a firm, uncluttered, and unambiguous manner. Preliminary studies show that it is readily accepted by patients, that they understand the messages, and that it creates a positive shift in beliefs about low back pain. Further studies regarding the use of this booklet are required to determine its effect on clinical outcomes.

Humans↗
PubMed1994

Semi-open needle biopsy of the upper thoracic spine.

STUDY DESIGN: A semi-open needle technique allowing safe biopsy of the upper thoracic spine is described. SUMMARY OF BACKGROUND DATA: It has been performed in five cases with an accuracy of 100% and no complications. CONCLUSION: The authors recommend its use between T1 and T4, or where the normal anatomy is very distorted.

Adult↗
PubMed1994

An international comparison of back surgery rates.

SUMMARY OF BACKGROUND DATA: Although high geographic variation in back surgery rates within the United States have been documented, international comparisons have not been published. METHODS: The authors compared rates of back surgery in eleven developed countries to determine if back surgery rates are higher: 1) in the United States than in other developed countries, 2) in countries with more neurologic and orthopaedic surgeons per capita, and 3) in countries with higher rates of other surgical procedures. Data on back surgery rates and physician supply were obtained from health agencies within these eleven countries. Country-specific rates of other surgical procedures were available from published sources. RESULTS: The rate of back surgery in the United States was at least 40% higher than in any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per capita supply of orthopaedic and neurosurgeons in the country. Countries with high back surgery rates also had high rates of other discretionary procedures such as tonsillectomy and hysterectomy. CONCLUSIONS: These findings illustrate the potentially large impact of health system differences on rates of back surgery. Better outcome studies, however, are needed to determine whether Americans are being subjected to excessive surgery or if those in other developed countries are suffering because back surgery is underutilized.

Australia↗
PubMed1993

Trunk strength testing with iso-machines. Part 2: Experimental evaluation of the Cybex II Back Testing System in normal subjects and patients with chronic low back pain.

This experimental evaluation of Cybex II isokinetic measurement was based on 70 normal subjects and 120 patients with chronic low back pain. It considered: reliability and learning effect; discrimination of individual patients versus normal subjects; relationship to clinical measures; assessment of effort; and a prospective 2-year follow-up of normal subjects to predict future low back pain.

Adult↗
PubMed1992

Observation of overt pain behaviour by physicians during routine clinical examination of patients with low back pain.

Observation of overt pain behaviours was carried out by physicians during routine clinical examination of 120 patients with chronic low back pain. Reliable ratings were achieved but only after very careful standardization in an additional 60 pilot patients. Overt pain behaviour was found to be related to other clinical measures of illness behaviour--pain drawing, behavioural symptoms, behavioural signs, use of walking aides and downtime--but did tap an additional dimension. It is concluded that clinical observation of overt pain behaviour can provide useful additional information about illness behaviour in low back pain. Reliable observations can be achieved in a carefully standardized research situation but in routine clinical practice are vulnerable to considerable observer error and bias.

Adult↗
PubMed1992

The Distress and Risk Assessment Method. A simple patient classification to identify distress and evaluate the risk of poor outcome.

The integration of physical and psychological assessment is frequently problematic. Psychological tests are often cumbersome and difficult to interpret. There would appear to be a need for a simple assessment method that would identify distress and help alert the clinician to the need for a more comprehensive assessment. The Distress and Risk Assessment Method is derived from a simple set of scales validated for use with patients with low-back pain. It offers a simple classification of patients into those showing no psychological distress, those at risk of developing major psychological overlay, and those clearly distressed. Four patient types can be identified on the basis of scores on two short questionnaires. The construction of the Distress and Risk Assessment Method is described and validity data (both clinical and psychological) are presented. The use of the Distress and Risk Assessment Method in the prediction of outcome of treatment is presented, and the paper concludes with general guidelines for its use.

Adult↗
PubMed1992

Objective clinical evaluation of physical impairment in chronic low back pain.

The aim of this study was to investigate physical impairment in patients with chronic low back pain, to develop a method of clinical evaluation suitable for routine use, and to consider the relationship between pain, disability, and physical impairment. Twenty-seven physical tests were investigated. Permanent anatomic and structural impairments of spinal deformities, spinal fractures, surgical scarring, and neurologic deficits were excluded as not relevant to the patient with low back pain in the absence of nerve root involvement or previous surgery. Three consecutive 20-patient reproducibility studies were used to develop reliable methods of examination for 23 of the tests. Only four tests were excluded as unreliable: sacral angle, pelvic tilt, and separate lumbar and pelvic extension, none of which are part of routine clinical examination or have any proven relationship to disability. The remaining 23 physical tests were evaluated in 70 asymptomatic subjects and 120 patients with chronic low back pain. Passive knee flexion, passive hip flexion, hip flexion strength, hip abduction strength, pain reproduction on each of these tests, and the prone extension strength test were excluded because they were too closely related to nonorganic and behavioral responses to examination. Eight tests successfully discriminated patients with low back pain from normal subjects and were significantly related to self-report disability in activities of daily living: pelvic flexion, total flexion, total extension, lateral flexion, straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up. Factor analysis failed to demonstrate an underlying statistical dimension of physical impairment. However, an empirical combination of total flexion, total extension, average lateral flexion, average straight leg raising, spinal tenderness, bilateral active straight leg raising, and sit-up provided an equally satisfactory alternative. Simple cut-offs from normal subjects made the scale simple and quick to use. This final scale successfully discriminated 78% of patients and normal subjects and explained 25% of the variance of disability, with a specificity of 86% and sensitivity of 76%. This scale provides an objective clinical evaluation that meets the criteria for evaluating physical impairment, yet is simple, reliable, and suitable for routine clinical use. It should, however, be emphasized that all the tests included in the final scale are measures of current functional limitation rather than of permanent anatomic or structural impairment. This raises questions about the physical basis of permanent disability due to chronic low back pain.

Activities of Daily Living↗
PubMed1991

Clinical tests applicable to the study of chronic low-back disability.

This symposium has evaluated the possible directions to be taken in designing reliable and valid questionnaires, screening examinations, and paraclinical tests applicable to studies in LBP. The detailed design of such test instruments, field testing, measures of reliability, and validity represent the next step if the current barriers to collaborative clinical research in LBP are to be overcome.

Back Pain↗