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Biomedical subjects

H McNaughton

Publications and source records attributed to H McNaughton.

16 recordsLinked to original sources
PubMed2001

Rehabilitation that works--vocational outcomes following rehabilitation for occupational musculoskeletal pain.

AIMS: To describe the short term vocational outcome for accident compensation claimaints with disabling musculoskeletal pain following a comprehensive, interdisciplinary rehabilitation programme. METHODS: A telephone follow-up audit of clients who had undertaken a rehabilitation programme characterised by a cognitive-behavioural approach with self-management, reconditioning, vocational rehabilitation and psychological pain management. RESULTS: Of 62 clients who had undergone a rehabilitation programme, we obtained follow-up information on 49 (79%). These were predominantly male, aged in their mid 30s, manual workers with low back pain and a median sick leave of twelve months. At a median of five months a vocational success was achieved in 75%: working full time (47%), part time (12%) or actively looking for work (16%). Of those in work, 48% went back to the same job, 7% went back to the same job but with a different employer and 15% went to a different job that used the same skills. Logistic regression analysis showed that duration of work disability was the major predictor of vocational success (OR 0.36, 95% CI 0.18 to 0.78, for a difference of twelve months). CONCLUSION: Despite the uncontrolled nature of these results, it is likely that the rehabilitation programme had a significant impact in getting compensation claimants back to work. Only a minority require substantive retraining and early intervention is associated with a better outcome.

Adult↗
PubMed2001

Evidence for inadequate construct validity of the Disease Repercussions Profile in people with rheumatoid arthritis.

OBJECTIVE: To re-evaluate the construct validity of the Disease Repercussions Profile (DRP), a measure of handicap in arthritis populations. METHODS: We used the multitrait-multimethod approach to determine convergent and discriminant validity in a postal survey of randomly selected patients with rheumatoid arthritis who had attended the Wellington Regional Rheumatology Unit since 1988. Respondents (n=142) completed the following self-report instruments: Disease Repercussions Profile, EuroQol EQ-5D, Health Assessment Questionnaire, London Handicap Scale and WHOQOL-BREV. RESULTS AND CONCLUSIONS: The pattern of correlation supported the construct validity of the dichotomous response question (DRP domain affected or not) for the activity and relationships domain, provided ambiguous support for the appearance and emotion domain and no support for the social and financial domains. There was no support for construct validity of any of the domains on the importance rating part of the DRP. We suggest that the DRP be interpreted cautiously in aggregated group data.

Arthritis, Rheumatoid↗
PubMed2001

Factors influencing rate of Barthel Index change in hospital following stroke.

BACKGROUND AND PURPOSE: Randomized controlled trials of specific interventions in stroke rehabilitation are few. In using this study design to compare different rehabilitation interventions or different intensity of those interventions, measuring disability status at a fixed time point is one outcome option. In order for this approach to be valid, factors that might independently affect the speed of disability change have to be matched at baseline. We sought to investigate the impact of different factors on rate of disability change following stroke. METHODS: A prospective hospital-based study of consecutive patients admitted to each of three general hospitals in Wellington, New Zealand with acute stroke. Patients were assessed using the Barthel Index (BI, scored 0-20) within a few days of stroke and fortnightly until hospital discharge. Strokes were classified using the Oxfordshire Community Stroke Project classification. MAIN OUTCOME MEASURE: Barthel Index rate of change (BRC) computed from the difference between the first and last hospital BI scores divided by the time in weeks between these assessments. RESULTS: Of 104 subjects with two or more disability assessments in hospital, BRC was a mean 1.26 units per week (95% confidence interval (CI) 0.97, 1.56). The only factors significantly associated with BRC on univariate analysis were stroke type, pre-stroke Modified Rankin Scale (MRS) and pre-stroke London Handicap Score. In a general linear model analysis of covariance, stroke type (p = 0.015) and pre-stroke MRS (p < 0.001) remained significant. The mean BRC for lacunar infarcts (1.76 units per week, 95% CI 1.22, 2.30) was over three times that of total anterior circulation infarcts (0.48 units per week, 95% CI 0.20, 0.76). CONCLUSIONS: Future randomized controlled trials of rehabilitation interventions for stroke in hospitalized patients need to allow for pre-stroke level of dependence and stroke type in the study design, either excluding particular patients or ensuring even randomization of these key variables if speed of disability change is to be a valid outcome variable.

Aged↗
PubMed2000

Assessing the accuracy of hospital admission and discharge diagnosis of traumatic brain injury in a New Zealand hospital.

AIMS: To investigate the accuracy of admission and discharge coding of traumatic brain injury (TBI) in a New Zealand hospital. METHOD: Prospective study of all patients over fifteen years of age admitted to Hutt Hospital over a six-month period with an actual or potential diagnosis suggesting TBI. RESULTS: During the six month period of study, 65 patients with the diagnosis of TBI were admitted to Hutt Hospital. Of these, 21 (32.3%) met the criteria for diagnosis of TBI ('Definite TBI'). A further eighteen patients, not admitted with a diagnosis of TBI, met the TBI criteria. Only 14/39 (35.9%) of 'Definite TBI' cases were identified at both admission and discharge. Discharge diagnosis of TBI identified correctly 26/39 (66.7%) of definite cases, with 34/60 (56.7%) cases with a discharge diagnosis of TBI not meeting our criteria for the diagnosis of TBI. Six out of 39 'Definite TBI' cases (15.4%) were not identified by either admission or discharge diagnosis. Thirty of the 65 patients (46.2%) admitted to hospital with the diagnosis of TBI showed clinical evidence of having taken alcohol, although only 12 had blood alcohol concentration measured. CONCLUSIONS: The admission and discharge diagnoses of TBI were not accurate when compared to a standard definition of TBI. For hospital discharge data to have any value, agreement on an operational diagnosis of TBI needs to be made, which should include measurement of the blood alcohol concentration. A suggestion for a diagnostic strategy is presented, along with ICD-10-AM codes that could be used to improve the current situation.

Adolescent↗
PubMed2000

Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders.

BACKGROUND: The study was concerned with the secondary functional compromise persons with long-term paraplegia contend with, that has been shown to be associated with wheelchair use. Of particular interest was the relationship between the level of thoracic spinal cord injury (SCI) and factors predisposing to rotator cuff disorders (RCD), one of the most common upper extremity musculoskeletal complications linked with long-term SCI. Disorders of these peri-articular structures have previously been associated with impaired trunk postural control and abnormal muscle strength ratios in both able-bodied groups and in paraplegic athletes. Despite their neurologically intact shoulder joint musculature, high-level and low-level paraplegics have different degrees of trunk and pelvic stability available to them during activities of daily living (ADL). This fundamental functional anatomical difference between high-level and low-level paraplegics had not previously been related to the diagnosis of RCD in a non-athletic long-term paraplegic population. METHODS: A descriptive cross sectional study was undertaken to demonstrate the differences in the prevalence of clinically diagnosed RCD in a high-level (n=22) and a low-level (n=20) group of persons with long-term paraplegia. Any perceived differences were then related to the functional anatomical variations between the two groups. Inferences were made based on factors predisposing to RCD known to exist among both able-bodied and paraplegic athletes. The 42 subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) to establish the presence or absence of shoulder pain and the Musculoskeletal Function Assessment (MFA) instrument to determine differences in functional ability and perceived degree of difficulty within five categories of ADL. Each participant underwent a clinical examination using validated provocative clinical tests and isometric muscle strength ratio testing. RESULTS: There was a higher prevalence of RCD in the high-level group (P=0.009) which correlated with decreased trunk control (P=0.009). Differences in ability to perform functional tasks were not shown to be greater in the high-level group, although there was a higher degree of perceived difficulty in ADL. Muscle strength imbalances between the shoulder adductors and abductors were shown to be greater in the high-level group. CONCLUSIONS: The results of this study suggest that the functional anatomical differences that exist within paraplegia contribute to the propensity of high-level paraplegic persons to suffer from RCD. These findings send a clear message to service-providers that greater acknowledgement of the differences in trunk postural control specific to the level of thoracic SCI is required. This may have implications for the prescription of wheelchairs, assistive devices and instruction for alternative ADL techniques to this specific population.

Adult↗
PubMed2000

Information needs of families when one member has a severe brain injury.

Despite calls for health and social services to respond to the needs of informal carers, there is little evidence to guide practioners in the best way to provide support and/or information in situations of complex need such as brain injury. This study addressed such an intervention in a prospective descriptive study, using both qualitative and quantitative methodology. Eighty-nine patients who had been admitted to a regional neurorehabilitation unit for management of traumatic or haemorrhagic brain injuries were consecutively discharged to the community over a period of 12 months. Eighty-two of these people identified a carer who agreed to be interviewed at approximately six weeks after discharge regarding their concerns. The study identified that even soon after discharge from inpatient rehabilitation, carers wanted more information. In many cases the need for information was unrelated to either the severity of injury or level of functional deficit. In addition, requests for information were in many cases not sought spontaneously, but required prompting. Such findings have implications if interventions in this field are to have the optimum chance of succeeding in providing support and assistance.

Activities of Daily Living↗
PubMed1996

Stroke audit in a New Zealand hospital.

AIMS: This study was designed to test the Royal College of Physicians Stroke Audit Package in a general hospital in New Zealand, to identify the strengths and weaknesses of the package and to determine its applicability to the New Zealand environment. A secondary aim was to identify strengths and weaknesses in the process of stroke care at Hutt Hospital. METHODS: A retrospective case-note review of 50 consecutive discharges with a diagnosis of stroke or intracerebral haemorrhage. RESULTS: The Royal College of Physicians (RCP) Stroke Audit Package proved easy to use. The hospital audit revealed significant weaknesses in evaluation of stroke patients with inadequate documentation in the medical notes of important items including heart rate and rhythm (58%), blood pressure (74%), visual field assessment (33%), ability to swallow (2%) and conscious level (68%). CONCLUSIONS: The RCP Stroke Audit Package is a simple, validated and potentially valuable tool for stroke audit in New Zealand hospitals. Using it, deficiencies in the process of stroke care can be readily identified, improvements made, and the results re-audited to demonstrate change.

Cerebrovascular Disorders↗