Biomedical subjects

L G Kennedy

Publications and source records attributed to L G Kennedy.

31 records · Page 2Linked to original sources

PubMed1994

A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index.

OBJECTIVE: After pain and stiffness, one of the most important complaints of patients with ankylosing spondylitis (AS) is disability. The main aims of treatment are to control pain but also to improve function. Various methods of assessing function exist but are either not specific for the disease or have not been adequately validated. As a result of this deficiency we developed the Bath Ankylosing Spondylitis Functional Index (BASFI) as a new approach to defining and monitoring functional ability in patients with AS. METHODS: This self-assessment instrument was designed by a team of medical professionals in conjunction with patients, and consists of 8 specific questions regarding function in AS and 2 questions reflecting the patient's ability to cope with everyday life. Each question is answered on a 10 cm horizontal visual analog scale, the mean of which gives the BASFI score (0-10). The questionnaire was completed 257 times in total: once by 116 outpatients and by 47 inpatients on 3 occasions over a 3-week intensive physiotherapy course. In addition, the instrument was compared with the Dougados functional index. RESULTS: Patients scores covered 95% of the BASFI range, giving a normal distribution of results. In contrast only 65% of the Dougados functional index scale was used. Furthermore, over the 3 week period of inpatient treatment, the BASFI revealed a significant improvement in function (20%, p = 0.004) while there was a less impressive change in the Dougados functional index (6%, p = 0.03). This demonstrates the superior sensitivity of the BASFI: Consistency was good for both indices (p < 0.001), as was the relationship between patient perception of function and function as assessed by an external observer (p < 0.001). CONCLUSION: The BASFI satisfies the criteria required of a functional index: it is quick and easy to complete, is reliable and is sensitive to change across the whole spectrum of disease.

Activities of Daily Living↗

PubMed1994

A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index.

OBJECTIVE: Disease status, in terms of disease activity, disease progression and prognosis is difficult to define in ankylosing spondylitis (AS). No gold standard exists. Therefore, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), a self-administered instrument, has been developed as a new approach to defining disease activity in patients with AS. METHODS: The index, designed by a multidisciplinary team with input from patients, consists of six 10 cm horizontal visual analog scales to measure severity of fatigue, spinal and peripheral joint pain, localized tenderness and morning stiffness (both qualitative and quantitative). The final BASDAI score has a range of 0 to 10. The index was distributed to a cross section of patients, including inpatients receiving 3 weeks of intensive physiotherapy treatment and hospital outpatients. BASDAI was completed by a total of 154 patients. Validation of the new instrument was achieved through analysis of user friendliness, reliability (consistency), score distribution and sensitivity to change. Comparisons were made with a previous Bath disease activity index (DAI) and the Newcastle Enthesis Index. RESULTS: The BASDAI was found by patients to be quick and simple to complete (mean: 67 s). Test-retest reliability was good (r = 0.93; p < 0.001), as was the distribution of scores across the scale (score range: 0.5-10; mean: 4.31). BASDAI was sensitive to change, reflecting a 16% (mean) improvement in inpatient scores after 3 weeks of treatment. It is superior to the DAI in terms of construct and content validity and to the Enthesis Index in all aspects. CONCLUSION: In summary, BASDAI is user friendly, reliability, sensitive to change and reflects the entire spectrum of disease. It is a comprehensive self-administered instrument for assessing disease activity in AS.

Data Interpretation, Statistical↗

PubMed1994

Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index.

OBJECTIVE: To determine the most appropriate clinical measurements for the assessment of ankylosing spondylitis (AS) to develop the new metrology index. METHODS: One hundred and ninety-three individuals with AS were studied. The patients reflected the entire spectrum of cases of AS. Metrology was performed on 327 occasions. First the metrology (20 measurements) of 43 patients was analyzed. From this, 5 simple clinical measurements were defined which most accurately reflect axial status: cervical rotation, tragus to wall distance, lateral flexion, modified Schober's, and intermalleolar distance. These measurements were assessed for reliability, speed and both inter and intraobserver variability in another 40 patients. RESULTS: Analysis of the first group of 43 patients and a subsequent group of 54 patients, using the 5 measurements that constitute this new Bath AS Metrology Index (BASMI), demonstrated that they accurately and reliably mirror the 20 clinical measurements assessed previously (r = 0.92, p < 0.001). In a new group of 40 patients the measurements were demonstrated to be accurate and reproducible for both intraobserver variability (r = 0.99, p < 0.001) and interobserver variability (r = 0.97, p < 0.001). In a further 56 patients, admitted for inpatient therapy, an improvement in the BASMI from 3.34 (SD 2.71) to 2.16 (SD 2.42) was noted over a period of 3 weeks (regardless of disease severity) which indicates a sensitivity to change (chi 2 = 6.55, p < 0.01). The mean improvement over baseline was about 30%. CONCLUSION: Five clinical measurements provide a composite index (BASMI) and define disease status in AS. The BASMI is quick (7 min), reproducible and sensitive to change across the disease spectrum.

Adult↗

PubMed1993

Familial versus sporadic ankylosing spondylitis. Two different diseases?

OBJECTIVE: To define potential differences and the possible contribution of susceptibility or severity genes in familial versus sporadic ankylosing spondylitis (AS). METHODS: Three hundred twenty patients with AS were studied: 160 who had first-degree relatives with AS (familial) and 160 age- and sex-matched controls who had no first-degree relative with the disease (sporadic). Disease expression in the two groups was evaluated using an index of physical, psychological, and social functioning (the Arthritis Impact Measurement Scales [AIMS]) and an assessment of spinal mobility. RESULTS: Familial disease was significantly milder than sporadic disease as assessed by all measures, e.g., spinal mobility score (mean 4.08 versus 4.65, P < 0.038), AIMS overall impact score (mean 2.63 versus 3.59, P = 0.002), AIMS physical activity score (4.19 versus 5.10 [P = 0.004]), AIMS social function score (4.02 versus 4.60, P = 0.023), and AIMS pain score (4.15 versus 5.33, P = 0.002). CONCLUSION: The greater prevalence of AS in at-risk families may be explained by the occurrence of more AS "susceptibility" genes in those families, whereas the more severe disease, seen in patients with sporadic AS, is conferred by the presence of more "severity" genes than "susceptibility" genes.

Adolescent↗

PubMed1993

Sex ratio in the spondyloarthropathies and its relationship to phenotypic expression, mode of inheritance and age at onset.

OBJECTIVE: To investigate the interrelated effect of phenotypic expression [i.e., primary ankylosing spondylitis (1 degree AS) or disease secondary to psoriasis (Ps) AS or inflammatory bowel disease (IBD)AS], age at onset, sex and inheritance of responsible genes in AS. METHODS: Three studies were performed to evaluate 1949 subjects with AS. Subgroups of the patients were formed for each study depending on disease type (1 degree AS = 1695; Ps AS = 173; IBD AS = 81), nature of inheritance or age at onset of AS symptoms. These groups were further subdivided to assess the effect of sex. RESULTS: The sex ratio of the entire group was 2.6:1 in favor of men. However, IBD AS had an equal sex distribution as does IBD alone. By contrast, Ps, which has an equal sex ratio as a lone event or in association with arthritis, resulted in a male dominance of 4.1:1 when it occurred as Ps AS. Women with IBD AS had a significantly younger onset compared to women with 1 degree AS [mean onset 21.7 years (SD 6.65) vs mean onset 24.4 years (SD 9.79), respectively; p = 0.019]. A younger age at onset was found in women with familial disease [mean 22.2 years (SD 7.55)] compared with the mean onset of sporadic disease in women [24.5 years (SD 10.0); p = 0.0059]. There was a progressive fall in the sex ratio as the age at onset increased (p = 0.053). For example: M:F ratio of < 20 years old was 3:1 compared to 1.8:1 for those with an onset of > 40 years. CONCLUSION: Sex ratio and age at onset are influenced both by each other and such factors as disease type and familial versus sporadic occurrence. These data help provide a predictable pattern of disease in spondyloarthropathy.

Adolescent↗

PubMed1993

Fatigue in ankylosing spondylitis--why is it ignored?

OBJECTIVE: Fatigue in ankylosing spondylitis (AS) is largely ignored by physicians and classical texts. By contrast, patients frequently allude to it as a major complaint. METHODS: To address the situation, 3 studies were performed: (1) Symptoms were defined in a cross sectional evaluation of 1950 consecutive patients with AS. (2) From each of the 3 groups who specified a particular main symptom (pain, stiffness or fatigue), a random cohort of 20 was selected and all 60 were prospectively followed over a 14-day period. (3) An additional 100 patients [50 randomly selected with AS and 50 with rheumatoid arthritis (RA)] took part in a comparative prospective study. RESULTS: In the first study for those with a definitive major symptom, 34% (n = 670) described pain while stiffness and fatigue were reported by 25% (n = 492) and 6% (n = 124), respectively. Thirty-two percent (n = 616) could not distinguish between the 3. Strikingly, when prospectively studied over a 2-week period, over 50% of the patients revealed that fatigue was the main symptom. Moreover, in the cohort which expressed pain as their major problem initially, fatigue had the highest prevalence (mean fatigue value versus mean stiffness, p = 0.009; fatigue versus pain, p < 0.001). In the direct comparison between patients with RA and those with AS, the RA cohort had statistically more fatigue and pain than the AS cohort (p = 0.002, p = 0.007, respectively) with a similar amount of stiffness expressed by both groups (n = 0.149). In both subsets, pain had the least impact on the patients (mean 2.60 and 1.87, respectively). CONCLUSION: Our data reveal that fatigue should be considered a major problem for patients with AS, worthy of further exploration in terms of both etiology and therapy.

Adult↗

PubMed1993

The natural history of ankylosing spondylitis. Does it burn out?

Initially, 1,492 patients with ankylosing spondylitis (AS) were assessed by a new disease activity index. This addressed the degree of pain, severity and overall disease activity (scale 3-26). As expected, there was a normal distribution with a median of 12. Sixty-five patients, selected from the extremes of the disease activity scale, (< 5, > 22), were prospectively followed over a 2-year period: 30 with high activity mean score 24.1 (SD 1.2) and 35 with low mean score 3.4 (SD 0.5). At followup, subjects were assessed with this new index and a validated functional index. Although at followup the high activity mean score was significantly reduced to 21.1 (p < 0.001) and the low activity mean score was significantly increased to 6.1 (p = 0.002), the majority of the patients had remained in their original quartiles i.e., 63 and 77%, respectively. Disease status at followup was independent of disease duration; i.e., high activity group mean 27.1 (SD 5.3) and remission group 26.9 (SD 13.77) years, respectively (NS). When the 2 disease indices were compared, an excellent correlation existed: r = 0.788, p < 0.001. Our data suggest (1) < 1% of patients with AS who present to a rheumatologist enter longterm remission ("burn out"). (2) Some 20% of patients in remission will develop active disease 2 years later. (3) The prognosis over 2 years for those with active disease is poor.

Female↗

PubMed1991

Primary ankylosing spondylitis, psoriatic and enteropathic spondyloarthropathy: a controlled analysis.

Within our ankylosing spondylitis (AS) population (n = 1331), 85% (n = 1128) had primary AS (1 degree AS), 9% (n = 121) had psoriatic AS (PsAS) and 6% (n = 82) enteropathic AS (IBDAS). In an attempt to explore further the relationship between 1 degree AS and the secondary spondyloarthritides, we evaluated 121 consecutive patients with PsAS and 82 with IBDAS, as well as 202 controls with primary disease. The patients were matched for sex and age at review PsAS:48.1 (SD 11.3) years vs 1 degree AS:48.4 (SD 11.5), and IBDAS:46.0 (SD 12.7) vs 1 degree AS:45.9 (SD 12.7). The sex distribution for IBDAS (M:F, 1:1), was significantly less (p less than 0.001) than that for PsAS (M:F, 3.5:1) or 1 degree AS (M:F, 2.4:1). Overall, compared to 1 degree AS the PsAS and IBDAS tended to have greater disease severity as defined by e.g., (1) those taking non-steroidal antiinflammatory drugs, 86 vs 72% (p less than 0.01) and 71 vs 60% (p less than 0.05), respectively; (2) decreased spinal mobility (scale 0-8) 5.0 (SD 2.0) vs 4.4 (SD 2.3); p = 0.029 and 4.9 (SD 2.0) vs 3.9 (SD 2.4); p = 0.024, respectively; and (3) PsAS resulted in a higher AIMS pain score; 4.9 (SD 2.5) vs 4.0 (SD 2.4): p = 0.042. By contrast, peripheral joint involvement, number of total hip replacements and capacity for employment were similar in all 3 groups. In conclusion (1) among the AS population the prevalence of 1 degree AS, PsAS and IBDAS is 90, 6 and 4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Effects of long-term administration of pituitary-derived bovine growth hormone and estradiol on growth in steers.

Sixty-three Friesian steers (9 mo old, 257 kg; n = 15 or 16/treatment) were employed in a 2 x 2 factorial to test bovine growth hormone (bGH) and estradiol (Compudose implant). Steers received daily subcutaneous injections of vehicle or bGH (40 micrograms/kg body weight) for 22 wk. Steers were slaughtered 8 wk after the end of bGH treatment (wk 30). Steers had ad libitum access to silage plus a fixed amount (4 to 5.5 kg/d) of concentrate. Average daily gain (ADG) and feed conversion efficiency (FCE) improved (P less than .05) in response both to bGH and to estradiol during wk 0 to 22. Although bGH did not affect ADG or FCE during wk 23 to 30, estradiol improved (P less than .05) them; bGH and estradiol appeared additive (nonsignificant interactions) during wk 0 to 22. At slaughter, estradiol increased (P less than .05) carcass weight and carcass and leg length while decreasing (P less than .05) conformation score and percentage of kidney, knob and channel fat (KHP); bGH decreased (P less than .05) KHP. Although both bGH and estradiol increased (P less than .01) plasma GH, their effects were not additive. Both bGH and estradiol increased (P less than .01) plasma somatomedin-C and decreased (P less than .01) plasma urea nitrogen concentrations; effects were additive. Estradiol, but not bGH, increased (P less than .05) plasma glucose, whereas neither bGH nor estradiol altered plasma creatinine and nonesterified fatty acids. In summary, both bGH and estradiol improved growth and FCE, and their effects appeared to be additive. It is likely that some of their effects were mediated by somatomedin-C.

Animals↗

PubMed1981