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Biomedical subjects

J C Fairbank

Publications and source records attributed to J C Fairbank.

At least 19 recordsLinked to original sources
PubMed2000

The Oswestry Disability Index.

STUDY DESIGN: The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. OBJECTIVES: To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. SUMMARY OF BACKGROUND DATA: It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. METHODS: All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. RESULTS: Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. CONCLUSIONS: The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

Databases, Bibliographic↗
PubMed1998

Oxygen and lactate concentrations measured in vivo in the intervertebral discs of patients with scoliosis and back pain.

STUDY DESIGN: Oxygen concentrations in intervertebral discs were measured in 10 patients during discography and in 13 patients with scoliosis and 11 patients with back pain during spinal surgery. Lactate concentration profiles were measured in 12 of these discs. The discs were graded for degeneration by magnetic resonance imaging and histology where possible. OBJECTIVES: To determine if oxygen and lactate levels in human discs vary with degree of degeneration. Failure of nutrient transport is thought to lead to disc degeneration. SUMMARY OF BACKGROUND DATA: The disc is avascular. Oxygen is used by the disc cells, and lactate is produced. Low oxygen and high lactate concentrations have been measured in the center of healthy animal discs. METHODS: Oxygen concentrations were measured amprometrically. The sterilized gold-needle electrode was introduced into the disc during discography or after the disc was exposed surgically via an anterior approach. Concentration profiles of each disc took approximately 5 minutes to measure. Lactate concentrations were measured biochemically on the excised disc segment. RESULTS: Oxygen concentrations were highest at the disc surface and fell toward the center. Lactate concentrations showed the reverse profile. Oxygen levels were very variable, ranging from 5-150 mm Hg in the center of the nucleus. No correlation was seen with age, pathology, or degree of degeneration. Lactate concentrations ranged for the most part from 2 mmol/L to 6 mmol/L. CONCLUSIONS: Concentrations of metabolites depend on cellular activity and on transport of the metabolite between the blood supply and the cell. The correlation between degeneration and nutrition cannot be determined only from metabolite concentrations; measurements of metabolic activity and nutrient transport rates also are required.

Adolescent↗
PubMed1998

Variation with age in the pattern of type X collagen expression in normal and scoliotic human intervertebral discs.

The distribution and expression of type X collagen, a calcium-binding collagen, which is a marker of hypertrophic chondrocytes and thought to be involved in cartilage calcification, was examined in situ in nondegenerate (grade I or II) human discs taken at autopsy over a wide age range (fetal->80 years) and also in scoliotic discs removed at surgery. In the fetal vertebral column, type X collagen was strongly expressed in the hypertrophic chondrocytes of the endplate, but was not seen in other areas. In the cartilaginous endplate of adults, it was found over the whole age range examined, with intensity increasing with age. In the disc matrix itself, type X collagen was demonstrated around individual cells from all individuals older than 50 years, but not in any fetal or autopsy disc from individuals younger than 40 years. In scoliotic discs, however, focal type X collagen expression was seen in 3/8 patients younger than 40 years including one 12-year-old. No type X collagen was found in the outer annulus in any autopsy or scoliotic disc, supporting the idea that cells of the outer annulus are phenotypically distinct from cells of the inner annulus and the nucleus. Our results demonstrate for the first time that type X collagen is a possible gene product of the intervertebral disc cells and a potential biochemical component of the disc matrix. They indicate that with age or in scoliosis, some cells from the inner annulus or nucleus of the disc differentiate to the hypertrophic chondrocyte phenotype. This might be the initiating event for the abnormal calcification described in aged and scoliotic discs in other studies.

Adolescent↗
PubMed1998

A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial.

The aim of this study was to assess the long-term effect of a supervised fitness programme on patients with chronic low back pain. The design of the study was a single blind randomised controlled trial with follow-up, by postal questionnaire, 2 years after intervention. The Oswestry Low Back Pain Disability Index was used as the outcome measure to assess daily activity affected by back pain. Eighty-one patients with chronic low back pain, who were referred to the physiotherapy department of a National Health Service orthopaedic hospital, were randomised to either a supervised fitness programme or a control group. Patients in the intervention group and control group were taught specific exercises to be continued at home and referred to a backschool for back care education. In addition, the intervention group attended eight sessions of a supervised fitness programme. Sixty-two patients (76%) with a mean age of 37 years, returned the Oswestry Low Back Pain Disability Index questionnaire. Of these, 29 were in the intervention group and 31 in the control group. Patients in the intervention group demonstrated a mean reduction of 7.7% in the Oswestry Low Back Pain Disability Index score (95% confidence interval of mean paired difference 3.9, 11.6 P < 0.001), compared with only 2.4% in the control group (95% confidence interval of mean paired difference -2.0, 6.9 P > 0.05). Between group comparisons demonstrated a statistically significant difference in disability scores between the treatment and control group (mean difference 5.8, 95% confidence interval 0.3, 11.4 P < 0.04). This study supports the current trend towards a more active treatment approach to low back pain. We have demonstrated clinical effectiveness of a fitness programme 2 years after treatment but this needs to be replicated in a larger study which should include a cost effectiveness analysis, further analysis of objective functional status and a placebo intervention group.

Adolescent↗
PubMed1997

Early detection of progression in adolescent idiopathic scoliosis by measurement of changes in back shape with the Integrated Shape Imaging System scanner.

STUDY DESIGN: A retrospective study of 78 patients with right thoracic idiopathic scoliosis was done. OBJECTIVES: To evaluate the reliability of the integrated Shape Imaging System scan (Oxford Metrics Ltd, Oxford, UK) in detecting progression of scoliosis and the use of back shape data in predicting scoliosis progression. SUMMARY OF BACKGROUND DATA: At first presentation and every 3-6 months during the follow-up period, all patients underwent integrated Shape Imaging System scans and radiographic examinations, from which the Cobb angle was measured. The follow-up period was 18-49 months (mean = 31.4 months). METHODS: Patients were divided into three groups according to the severity and progression of the Cobb angle. The spinal fusion, brace, and observation groups were compared using analysis of variance and the student's t test to detect significant differences among groups in the progression of deformity as measured by the integrated Shape Imaging System parameters and the Cobb angle. RESULTS: Three of the Integrated Shape Imaging System parameters detected significant progression in the spinal fusion group 1 year earlier than the Cobb angle. Only one of the Integrated Shape Imaging System parameters detected a significant difference in progression between the brace and observation groups. CONCLUSIONS: The Integrated Shape Imaging System technique demonstrated significant changes in this group of patients with progressive scoliosis. Serial measurements of back surface shape, particularly the size of the rib hump, may be predictive of progression. Serial Integrated Shape Imaging System scanning has advantages over serial radiography in the management of idiopathic scoliosis in addition to the avoidance of exposure to ionizing radiation.

Adolescent↗
PubMed1995

Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain.

OBJECTIVE: To evaluate a progressive fitness programme for patients with chronic low back pain. DESIGN: Single blind randomised controlled trial. Assessments were carried out before and after treatment by an observer blinded to the study and included a battery of validated measures. All patients were followed up by postal questionnaire six months after treatment. SETTING: Physiotherapy department of orthopaedic hospital. SUBJECTS: 81 patients with chronic low back pain referred from orthopaedic consultants for physiotherapy. The patients were randomly allocated to a fitness programme or control group. INTERVENTION: Both groups were taught specific exercises to carry out at home and referred to a back-school for education in back care. Patients allocated to the fitness class attended eight exercise classes over four weeks in addition to the home programme and backschool. RESULTS: Significant differences between the groups were shown in the changes before and after treatment in scores on the Oswestry low back pain disability index (P < 0.005), pain reports (sensory P < 0.05 and affective P < 0.005), self efficacy reports (P < 0.05), and walking distance (P < 0.005). No significant differences between the groups were found by the general health questionnaire or questionnaire on pain locus of control. A benefit of about 6 percentage points on the disability index was maintained by patients in the fitness group at six months. CONCLUSION: There is a role for supervised fitness programmes in the management of moderately disabled patients with chronic low back pain. Further clinical trials, however, need to be established in other centres to confirm these findings.

Adult↗
PubMed1993

Quantifying the cosmetic defect of adolescent idiopathic scoliosis.

Cosmesis is important in the treatment of adolescent idiopathic scoliosis patients. The aim of this study was to quantify the cosmetic defect using parameters of the ISIS (Oxford Metrics Ltd., Oxford, England) scan. Ten nonmedical judges scored photographs of 100 adolescent idiopathic scoliosis patients based on cosmetic criteria. This Cosmetic Spinal Score proved to be a reliable figure. The Cosmetic Spinal Score was then compared with ISIS parameters and the Cobb angle. An equation based on ISIS parameters was developed, which could predict Cosmetic Spinal Score with sufficient reproducibility to have a useful clinical application. Bracing reduced the rib hump but not enough to improve the cosmetic appearance. Spinal fusion and Harrington instrumentation improved all measured parameters influencing physical appearance.

Adolescent↗
PubMed1990

Discography.

Explore the source record for details and available documents.

Back Pain↗
PubMed1989

Computer interview system for patients with back pain.

We describe a computer-based interview system for patients with back pain. The system uses a light-pen for the patient--computer interface. The questionnaire consists of over 200 multiple and single choice questions. Graphic presentations are used to identify pain patterns. The procedure has been well accepted by patients and is in routine clinical use in several hospitals.

Adolescent↗
PubMed1989

A computer-based interview system for patients with back pain. A validation study.

A microcomputer-based system has been designed to interview patients with a view to investigating and establishing common syndromes of back and leg pain. In a randomized crossover validation study, 50 consecutive outpatients were interviewed by the computer and had a conventional clerking by a doctor. The conventional clerking made minor errors in 3.75% of questions answered and major errors in 0.90%. The computer made minor errors in 6.75% of questions and major errors in 5.45%. The majority of the computer errors were due to inadequate question design. These have been corrected, and it is anticipated that the computer will now have an overall rate of 94% correct answers and be sufficiently accurate to pursue the aim of clinical syndrome identification.

Back Pain↗
PubMed1989

1989 Volvo Award in clinical sciences. Reproducibility of physical signs in low-back pain.

The reproducibility between observers of physical signs in patients with low-back pain was investigated. Fifty patients were examined by two surgeons and another sample of 33 patients was examined by a surgeon and a physiotherapist. Continuous data on five signs were analyzed by Pearsons' correlation coefficient, and binary data on 54 signs were analyzed by the Kappa agreement coefficient. Reliable signs consisted of measurements of lordosis and flexion range, determination of pain on flexion and lateral bend, nearly all measurements associated with the straight leg raising test, determination of pain location in the thigh and legs, and determination of sensory changes in the legs. Signs of root tension showed better agreement when qualified with a description of where the pain was experienced. Bony tenderness was more reliable than soft tissue tenderness.

Adult↗
PubMed1984

Quantitative measurements of joint mobility in adolescents.

Six measurements of joint mobility were made in a group of 446 normal adolescents. A method of measuring hip and knee rotation is presented. All these data are normally distributed, and would suggest that joint hypermobility lies at the end of the normal spectrum. There was a weak but significant correlation between each of the different measures of joint mobility except elbow hyperextention. Criteria for joint laxity are discussed in this age group, and the importance of quantitative techniques of measuring joint mobility are emphasised.

Adolescent↗
PubMed1984

Mechanical factors in the incidence of knee pain in adolescents and young adults.

Mechanical abnormalities of the patellofemoral joint are among the many causes that have been suggested for adolescent knee pain. This study seeks to identify these factors. Measurements of joint mobility and lower limb morphology were made on 446 pupils at a comprehensive school, 136 of whom had suffered knee pain in the previous year. The pupils with symptoms enjoyed sporting activities significantly more than their symptom-free contemporaries. Joint mobility, the Q-angle, genu valgum and anteversion of the femoral neck were not significantly different between those pupils with and those without anterior knee pain. Data on lower limb morphology of normal adolescents are presented. Examination of 52 hospital outpatients aged 13 to 36 years with anterior knee pain produced results comparable with those for the pupils. It is concluded that chronic overloading, rather than faulty mechanics, is the dominant factor in the genesis of anterior knee pain in adolescent patients.

Adolescent↗
PubMed1984

The crooked semantics of valgus and varus.

The meanings of the terms "valgus" and "varus" are clear to orthopedic surgeons but remain confusing to others. The inadequate definitions given in many medical dictionaries and the contradictory meanings listed in Latin lexicons and English dictionaries compound the confusion. Based on a review of the evolution of these terms, standard definitions are offered.

Orthopedics↗
PubMed1983

Computer recording of anatomical points in three dimensional space.

A microcomputer based system has been designed to obtain spatial information for orthopaedic measurements, using three potentiometers as the transducer. Both hardware and software are described, including algorithms for converting the raw data to lengths and angles in three dimensional space.

Adolescent↗