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L H Daltroy

Publications and source records attributed to L H Daltroy.

At least 37 records · Page 2Linked to original sources
PubMed1995

The independence and stability of socioeconomic predictors of morbidity in systemic lupus erythematosus.

OBJECTIVE: We studied the relationship between systemic lupus erythematosus (SLE) morbidity and socioeconomic status (SES) at 5 centers. METHODS: Ninety-nine patients who met American College of Rheumatology criteria for SLE were randomly sampled at each center, balancing by race and insurance status. Subjects were interviewed for current and past SES factors, such as insurance, occupation, employment, education, and income. SLE disease activity was measured by the SLE Activity Measure (SLAM). RESULT: Higher education, private insurance/Medicare, and higher income were associated with less disease activity at diagnosis. Controlling for SES, race, and center, the best predictors of less active disease at diagnosis were private insurance/Medicare (P = 0.002) and higher education (P = 0.007). From the time of diagnosis to the study visit (mean 3.5 years), insurance, income, and employment status changed for a significant number of subjects (37%, 16%, and 21%, respectively). CONCLUSION: Private insurance or Medicare and higher education are associated with less active disease at diagnosis of SLE. Health insurance, income, and employment status are unstable measures of socioeconomic status and may explain the variability in conclusions of previous studies on the role of SES in SLE.

Adult↗
PubMed1995

A connective tissue disease screening questionnaire for population studies.

To develop a technique to screen populations for potential connective tissue disease (CTD), we mailed a 30-item questionnaire to 253 randomly selected patients with systemic lupus erythematosus, rheumatoid arthritis, scleroderma, polymyositis, dermatomyositis, mixed connective tissue disease (MCTD), or Sjögren's syndrome and to 340 randomly selected control subjects. The response rate after four mailings was 71% for case subjects and 54% for control subjects. Test-retest reliability for detection of any CTD was 0.82. Sensitivity for specific CTDs was 83 to 96% and specificity was 83 to 93%. The positive predictive value for any CTD (assuming an overall prevalence of 1.3%) was 5.5%; negative predictive value was 99.7%. The CTD Screening Questionnaire has high sensitivity and specificity for screening large populations.

Adolescent↗
PubMed1995

Effectiveness of minimally supervised home aerobic training in patients with systemic rheumatic disease.

The effectiveness of an exercise prescription and unsupervised home exercise programme was tested on 37 subjects with rheumatoid arthritis and 34 with systemic lupus erythematosus. Subjects were randomly assigned to control or stationary bicycling at home, using loaned bicycles. Exercise subjects (with bicycles) did better than controls, but not significantly, on all outcomed measures (exercise tolerance test, fatigue, depression and helplessness) at 3 months. Bicycles were reclaimed at 3 months and all subjects in both groups given instructions for home exercise. Exercise in the second 3 months was predicted primarily by baseline exercise habits and fatigue. It is concluded that although safe, unsupervised home exercise programmes may benefit few patients. Future research should address methods of stimulating and maintaining unsupervised exercise programmes in patients with systemic rheumatic disease.

Adolescent↗
PubMed1995

Objectively measuring physical ability in elderly persons: the Physical Capacity Evaluation.

The Physical Capacity Evaluation, a performance measure of functional capabilities comprised of 13 tasks simulating those used in activities of daily living, was tested on 289 community-dwelling elderly people and compared against a widely used self-report measure of function, the Health Assessment Questionnaire. Factor analysis identified one dominant component in each instrument. Internal consistency reliability (Cronbach's alpha) was .90 for both instruments. Global disability (Health Assessment Questionnaire) and function (Physical Capacity Evaluation) scores were correlated -.74. One-week retest reliabilities on 58 subjects were .94 for the Physical Capacity Evaluation and .95 for the Health Assessment Questionnaire. The Physical Capacity Evaluation is a valid and reliable measure of physical performance for use with elderly people.

Activities of Daily Living↗
PubMed1993

Doctor-patient communication in rheumatological disorders.

Organized educational programmes and individual educational counselling are primary means by which health care providers equip rheumatic disease patients with the skills and knowledge necessary to monitor and manage variable symptoms. Many outpatients educational programmes were evaluated in the 1980s. In brief, well designed programmes are generally effective in improving knowledge and compliance with a regimen, and in reducing pain, depression, and disability. However, most persons with arthritis never use such programmes. Greater emphasis is needed on education of patients at the time of the clinical encounter, where the greatest opportunity lies for reaching the greatest number. Researchers have examined the dynamics of the doctor-patient interaction during the clinical encounter. Results show that: better information sharing leads to improved patient satisfaction, compliance, and health outcomes; information sharing could be greatly improved; and doctors and patients can be trained to improve information sharing, resulting in improved outcomes. A review of attribution and decision-making theory and the empirical literature on doctor-patient communication suggests a number of techniques that could be usefully incorporated into the management of each patient. These include: (1) encouraging patients to write down their concerns before each visit; (2) addressing each concern specifically, however briefly; (3) asking patients what they think has caused their problems; (4) tailoring treatments to patients' goals and preferences as possible; (5) explaining the purpose, dosage, common side-effects and inconveniences, and how to judge the efficacy of each treatment, including length of trial; (6) checking patients' understanding; (7) anticipating problems in compliance with treatment plans, and discussing methods to cope with common problems; (8) writing down the diagnosis and treatment plan to help patients remember; (9) giving out written materials that are now widely available; (10) reinforcing patients' confidence in their ability to manage their regimen; (11) using ancillary personnel in patient education; and (12) referring patients to organized programmes in the community.

Communication↗
PubMed1993

Arthritis education: opportunities and state of the art.

Health education research in arthritis and musculoskeletal disease experienced extraordinary growth in the 1980s. In this article we discuss opportunities for health education in arthritis and musculoskeletal disease, and the effectiveness of evaluated programs to influence knowledge, behavior, and health status of persons with arthritis. Additionally, we review developments in theory and trends in research that we expect to be influential in the next decade. Educational opportunities for primary prevention of arthritis are limited. However, a large variety of organized programs, planned according to commonly accepted principles of education, psychology, and psychotherapy, and applied consistently by personnel with some kind of training, have been able to produce desirable changes in knowledge, behavior, and health outcome in arthritis patients, over and above the medical treatment and incidental education to which they have already been exposed. As a result, national dissemination of programs and standards for arthritis patient education is in progress. In the next decade, researchers will increasingly turn to new populations and methods of delivery, investigation of conditions less well studied, such as osteoporosis, education of patients in generic communication and coping skills, and development of arthritis-specific applications of theory, especially in areas such as social support, control and helplessness, cognitive processing, and pain management.

Adult↗
PubMed1993

Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry.

An educational program designed to reduce low back injuries was modeled after several well-known back schools and taught to postal workers in a randomized trial of about 4,000 workers. Physical therapists taught 3 hours of class sessions, including knowledge, skills, and individual work station assessment, to small groups of workers and supervisors, with reinforcement every 6 months afterward. At 2 1/2 years, a random sample of 209 workers was surveyed for program impact on intermediate outcomes. We observed increased knowledge among experimental unit workers, but no significant improvements in behaviors associated with back health or in proportion of workers with tired backs. Experimental unit workers who had received training by the time of the survey were less likely to report helping/reinforcement for healthy behaviors than controls or untrained experimental unit workers. The program might have led trained workers to perceive a lack of support and reinforcement for back safety among coworkers and supervisors by sensitizing them to what is possible and raising expectations. There appeared to be group social effects in the dissemination of knowledge and perhaps of helpful behaviors; however, it is apparent that worker social support for change in health behaviors is a complex phenomenon that cannot always be relied upon to enhance program goals.

Back↗
PubMed1993

A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.

We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.

Adult↗
PubMed1992

A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty.

OBJECTIVE: To evaluate the efficacy of continuous passive motion (CPM) in the postoperative management of patients undergoing total knee arthroplasty. DESIGN: A randomized controlled single-blind trial of CPM plus standardized rehabilitation vs standard rehabilitation alone. SETTING: A referral hospital for arthritis and musculoskeletal care. PATIENTS: Consecutive patients with end-stage osteoarthritis or rheumatoid arthritis undergoing primary total knee arthroplasty who had at least 90 degrees of passive knee flexion. One hundred fifty-four patients were eligible and 102 patients agreed to participate and were randomized. Ninety-three patients completed the study protocol. INTERVENTION: Continuous passive motion machines programmed for rate and specified arc of motion within 24 hours of surgery with range increased daily as tolerated with standardized rehabilitation program compared with standardized rehabilitation program alone. MAIN OUTCOME MEASURES: Primary outcomes were pain, active and passive knee range of motion, swelling (or circumference), quadriceps strength at postoperative day 7, as well as complications, length of stay, and active and passive range of motion and function at 6 weeks. RESULTS: Use of CPM increased active flexion and decreased swelling and the need for manipulations but did not significantly affect pain, active and passive extension, quadriceps strength, or length of hospital stay. At 6 weeks there were no differences between the two groups in either range of motion or function. In this series, use of CPM resulted in a net savings of $6764 over conventional rehabilitation in achieving these results. CONCLUSION: For the average patient undergoing total knee arthroplasty, CPM is more effective in improving range of motion, decreasing swelling, and reducing the need for manipulation than is conventional therapy and lowers cost.

Aged↗
PubMed1992

Informed consent and the prescription of nonsteroidal antiinflammatory drugs.

OBJECTIVE: To examine disclosure of side effects of nonsteroidal antiinflammatory drugs (NSAIDs) and to identify patient- and physician-specific factors associated with greater disclosure. METHODS: Forty-six encounters between rheumatologists and new adult outpatients who were prescribed an NSAID they had not been taking prior to the visit were audiotaped. Reviewers coded the NSAID prescribed, specific side effects mentioned, demographic features of patients and physicians, and patient clinical characteristics. Neither patients nor physicians were aware that side effect disclosure was being studied. RESULTS: A mean of 1.7 side effects was mentioned per encounter. Epigastric discomfort was mentioned in 72% of encounters, while other side effects, including hepatic, renal, hematologic, or central nervous system effects, were mentioned in < or = 15% of encounters. Three factors were identified as independent predictors of less disclosure of side effects: senior clinician (versus less experienced), patient not taking another NSAID immediately prior to the visit, and patient age < 40. Increased disclosure by less experienced clinicians occurred exclusively with patients who were taking another NSAID prior to the visit. CONCLUSION: Disclosure of side effects other than epigastric discomfort to patients who are prescribed a new NSAID is limited. Patients not taking NSAIDs previously, who presumably have the most to gain from such discussions, are told the least. These results have implications with regard to doctor-patient decision-making and malpractice litigation in the outpatient setting.

Adult↗
PubMed1992

Does musculoskeletal function deteriorate in a predictable sequence in the elderly?

A variety of functions decline with aging, but whether losses occur in a predictable sequence is unknown. Improved understanding might facilitate the early detection and possible prevention of functional deterioration. We assessed self-reported difficulty with functional tasks in 288 community-dwelling elderly aged 65 to 97. We hypothesized that the ability to perform tasks involving strength, skill, and endurance (run errands, shop, yardwork or housework) would be lost first, followed by activities requiring less strength or mobility (rise from a chair with no hands, walk), followed by easier, but essential tasks (pick up clothes, rise from bed, lift a cup to the mouth). The patterns of decline were evaluated with Guttman scalograms. Picking up clothes and walking were reversed from the predicted order. Scale reliability was 0.92, indicating that functional decline is ordered; 75% of subjects fell into one of the modal sequence types. Analysis by self-reported presence of arthritis showed that 83% of nonarthritic subjects fit the predicted patterns (reliability = 0.95) versus 65% of arthritic subjects (reliability = 0.86), who tended to lose hand ability out of sequence. Sequential functional loss scales may tell more than the typical simple summation of functional loss, and may have predictive value to the clinician monitoring an elderly patient. If the sequence is accelerated or out of order, such as was seen in patients with arthritis, it may indicate the need for intervention. Examination of sequences of loss may help characterize adaptations to impairment and differences among subgroups.

Activities of Daily Living↗
PubMed1992

A psychometric analysis of the Mental Adjustment to Cancer scale.

This paper describes a psychometric replication study of a British coping scale, the Mental Adjustment to Cancer scale, on 239 USA cancer patients. The internal consistency and construct validity were similar to the original validation study. However, the factor structure was different. Cultural differences between the British and USA patient populations are discussed.

Adaptation, Psychological↗
PubMed1992

Psychosocial adjustment in juvenile arthritis.

Psychosocial adjustment in 102 children with arthritis, ages 4-16, and their families was assessed by parents, who completed the Child Behavior Checklist (CBCL) and Profile of Mood States (POMS). On average, parental distress (POMS) was lower than reference norms. POMS distress was correlated with children's behavioral problems (r = .41) but not with children's social competence (r = .15). General linear models explained 25% of the variance in CBCL behavioral problem scores. Older age was associated with more behavior problems in males, but not females. Disease severity and disease activity were also associated with behavioral problems. Although 27% of the variance in CBCL social competence could be explained, no single predictor variable was especially strong. Poorer social competence was associated with older age and shorter disease duration. Teenagers, especially those with recent onset and those with mild disease activity, may be at increased risk for psychosocial maladjustment.

Adaptation, Psychological↗
PubMed1991

Evaluation of Social Security disability in claimants with rheumatic disease.

We compared the Social Security Administration's (SSA) judgment of disability with uninvolved rheumatologists' evaluations of ability to work. With the cooperation of the SSA, 52 new disability claimants who alleged rheumatoid arthritis, osteoarthritis, or systemic lupus erythematosus were identified at the beginning of their claim. At the same time that their claim was being formally reviewed, they had a standardized examination by an independent rheumatologist who was not involved with their care, and they had a standardized test of observed performance. Rheumatologists' judgments of ability to work were compared with the SSA judgments. Rheumatologist and SSA judgments were in agreement for 35 of the 52 claimants (67%). All 11 claimants who met or equaled the SSA medical evaluation criteria were judged work-disabled by the rheumatologist. Of 27 judged able to work by the SSA, the rheumatologist judged 11 to be unable. Agreement between the SSA judgment of residual functional capacity and observed performance was no more than would be expected by chance. Most SSA judgments agree with a clinician's evaluation but a standardized physical evaluation by a rheumatologist and performance-based tests appear to add important information.

Activities of Daily Living↗
PubMed1991

A case-control study of risk factors for industrial low back injury: implications for primary and secondary prevention programs.

Data were collected on 228 consecutive back injuries in Boston's General Mail Facility and 228 non-injured controls drawn randomly from each case's work unit, matching on craft (clerk, mailhandler, maintenance), shift, and general supervisor. Data were collected on age, gender, duration of employment, 3 year history of injury claims, overtime work in the past 2 weeks, job change in the past 60 days, and machine vs. manual job. Risk factors for back injury were examined simultaneously in a conditional logistic regression for matched pairs. Risk factors included history of back injury claim (OR = 16.5, p less than 0.0001), younger age (OR = 3.0, p = 0.0001), shorter duration of employment (OR = 2.6, p = 0.0007), recent job change (OR = 2.5, p = 0.06), and history of non-back injury claim (OR = 2.0, p = 0.08). Among heavy lifters (vs. clerks) overtime and being female increased the risk of injury. In this setting, higher risk workers who may benefit from preventive education programs can be identified.

Accidents, Occupational↗
PubMed1991

Strategies for reducing excess morbidity and mortality in blacks with systemic lupus erythematosus.

The epidemiology of systemic lupus erythematosus suggests that the excess morbidity and mortality in blacks with the disease is related to lower socioeconomic status. Poverty and factors associated with poverty are powerful predictors of poor outcome in a variety of chronic diseases, and lupus appears to be no exception. A body of studies in other illnesses suggests ways to neutralize, at least partially, the disadvantages of lower socioeconomic status, even though the root causes of poverty may be insurmountable. These include improving access to quality health care; targeting educational programs to promote recognition and understanding of the disease and the comorbid conditions that affect outcome; implementing programs to improve self-monitoring and adherence to medical regimens; developing opportunities to facilitate homemaking, childrearing, and working outside the home; and applying psychosocial interventions to enhance self-confidence and social support. Improved access to quality health care may actually lead to a decrease in health care costs.

Black or African American↗