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Biomedical subjects

M H Liang

Publications and source records attributed to M H Liang.

At least 109 records · Page 6Linked to original sources
PubMed1994

Differences between men and women undergoing major orthopedic surgery for degenerative arthritis.

OBJECTIVE: To determine whether women have worse functional status than men at the time of laminectomy for degenerative spinal stenosis or total joint arthroplasty for degenerative arthritis of the hip and knee. METHODS: Consecutive patients undergoing laminectomy for degenerative lumbar spinal stenosis or unilateral, primary hip or knee arthroplasty for advanced degenerative arthritis were recruited. Functional status was measured with self-administered questionnaires. We compared preoperative functional status scores of men and women, using linear regression models that adjusted for age, comorbid conditions, work status, education, living arrangement, and body mass index. We also compared the rates of in-hospital complications and 6-month followup functional status scores for men and women. RESULTS: Women had much worse functional status than men prior to laminectomy for spinal stenosis (P < 0.01) and prior to total hip arthroplasty (P < 0.001) and total knee arthroplasty (P < 0.0001). These differences persisted after statistical adjustment for demographic and clinical characteristics. Women had comparable or greater functional improvement following surgery and experienced a similar number of complications compared with men. CONCLUSIONS: The observed gender differences in functional status prior to major orthopedic surgery indicate that women are operated on at a more advanced stage in the course of their disease. These results are not due to gender differences in demographic or clinical characteristics of the patients, and cannot be justified by differences between men and women in the outcome of surgery. The role of patient preferences and differential access to these procedures should be explored in future studies.

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PubMed1994

Efficacy of rehabilitation interventions in rheumatic conditions.

All industrialized nations are facing a crisis in health care financing. Rising expectations coupled with increasing specialization and technologic capacities have forced health care payers to examine their assumptions and to seek data on the outcomes of medical interventions. Clinical investigators who have been taught to use randomized controlled trials that evaluate efficacy under experimental conditions have been redirected toward studies that can help answer health policy questions. Such studies examine the effectiveness of interventions in more realistic settings on a richer array of patient-centered outcomes such as function and consider cost effectiveness and relative cost effectiveness. Rehabilitation interventions, which are by and large pragmatic, have never had a strong scientific basis grounded in controlled trials, and this lack of evidence has put tremendous pressure on clinicians to justify their practices. In this article, we review the recent literature on effectiveness of rehabilitation interventions in rheumatic disorders.

Cost-Benefit Analysis↗
PubMed1994

Responsiveness of self-reported and objective measures of disease severity in carpal tunnel syndrome.

Responsiveness, the ability to detect meaningful clinical change, is a critical attribute of instruments used to evaluate outcomes of treatments. The authors hypothesized that self-administered symptom severity and functional status questionnaires are more responsive to clinical improvement after carpal tunnel release than traditional physical examination measures of strength and sensibility. Data were obtained from a randomized clinical trial of endoscopic versus open carpal tunnel release conducted in four university medical centers. Patients were evaluated before surgery and 3 months after surgery. Seventy-four patients indicating that they were more than 80% satisfied with the results of surgery were assumed to have clinically meaningful improvement and were the focus of the analysis. Evaluations included questionnaires assessing symptom severity, functional status, and activities of daily living as well as measurement of grip, pinch, and abductor pollicus brevis strength, and 2-point discrimination and Semmes-Weinstein pressure sensibility. Responsiveness was calculated with the standardized response mean (mean change/standard deviation of change) as well as the effect size (mean change/standard deviation of baseline values). The symptom severity scale was four times as responsive, and the functional status and activities of daily living scales were twice as responsive, as the measures of strength and sensibility. Self-administered symptom severity and functional status scales are much more responsive to clinical improvement than measures of neuromuscular impairment and should severe as primary outcomes in clinical studies of therapy for carpal tunnel syndrome.

Activities of Daily Living↗
PubMed1994

Contribution of neuromuscular impairment to physical functional status in patients with lumbar spinal stenosis.

OBJECTIVE: To evaluate the relationship between neuromuscular impairment and physical functional status in patients with lumbar spinal stenosis. METHODS: Cross sectional analysis of 217 consecutive patients with lumbar spinal stenosis referred to 3 teaching hospitals. Physical functional status was measured with the physical dimension of the Sickness Impact Profile (P-SIP). Physical and radiological findings were abstracted from clinical records. The neuromuscular findings included pin sensation, strength, deep tendon reflexes and vibration. They were aggregated in a neuromuscular impairment index (NMI). Univariate relationships of the P-SIP and the NMI were analyzed with nonparametric methods. The determinants of physical functional status were evaluated using multiple linear regression models. RESULTS: In 148 patients with complete clinical data, objective weakness of the lower extremity as measured at rest was not related to physical functional status in univariate analyses. Decreased vibration was common and was associated with balance disturbance and reduced physical functional status, reflecting the importance of proprioception loss. In the multivariate regression analysis, neuromuscular deficit explained only 2.5% of the variance in physical functional status. The primary determinants of physical functional status were pain, depression, comorbid conditions and work status. CONCLUSION: While neuromuscular impairment is an indispensable feature of the diagnostic evaluation, its value in assessing outcome is limited. The decision whether to intervene surgically in patients without cauda equina syndrome or rapidly progressive neurological deficits should therefore be driven by pain and physical disability rather than the degree of neuromuscular impairment.

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PubMed1994

Sensitivity to change of 3 Systemic Lupus Erythematosus Disease Activity Indices: international validation.

OBJECTIVE: Three indices, the SLE Disease Activity Index (SLEDAI), the Systemic Lupus Activity Measure (SLAM) and the British Isles Lupus Assessment Group (BILAG), have been found to be reliable and valid measures of disease activity in patients with systemic lupus erythematosus (SLE). Our aim was to investigate their use and comparative ability to assess change in disease activity over time. METHODS: Clinical and laboratory features of 8 patients with SLE on each of 3 consecutive visits were abstracted and sent in 3 separate packages to physicians from 8 centers. The order of the patient visit summaries was randomized, and the 3 indices rated in one of 6 specific sequences. RESULTS: The 3 indices were significantly (p < 0.01) correlated: SLEDAI/SLAM = 0.61, BILAG/SLAM = 0.55, SLEDAI/BILAG = 0.35. The sequence presented, the order of patients and order of index scoring did not contribute significantly (p > 0.05) to the variation of any of the 3 indices. All 3 indices detected differences among patients (p < 0.01). Differences between visits were detectable with SLEDAI (p = 0.04) but not with SLAM or BILAG: CONCLUSION: Our study confirms that the SLEDAI, SLAM and BILAG are comparable disease activity measures. SLEDAI appears to be sensitive to change in disease activity over time.

Computers↗
PubMed1994

The study of practice variation in managing rheumatic diseases.

In summary, variation is grist for the traditional epidemiologic study of etiologic and prognostic factors. In health service research, it provides an approach to describe what is done in everyday practice, where it's done, and, with more detailed study, what works. Interpretation of such data is complex and fraught with difficulties. Nevertheless, the use of large data sets for research and administrative decisions and the study of practice variation are increasing and make it important for the profession to understand its strengths and limitations.

Humans↗
PubMed1994

Prevalence of rheumatic diseases in Taiwan: a population study of urban, suburban, rural differences.

OBJECTIVE: To determine the prevalence of symptomatic rheumatic disease in rural, urban and suburban areas of Taiwan by a 2-staged population survey. METHODS: Nine thousand subjects over 20 years old were sampled proportional to age and sex for the area from 3 administrative areas in Taiwan. A pretested questionnaire to screen for potential rheumatic disorders and/or disability was administered in the communities by health workers. Subjects who screened positive were examined by a rheumatologist who assigned a final diagnosis based on established criteria. RESULTS: A total of 8998 persons over age 20 residing in Hen-San (rural area), Sien-Dien (suburban), and Cu-Tien (urban) were studied. Twenty-five percent (2272) of the population indicated rheumatic problems: 1124 of 2271 were evaluated by a rheumatologist with serological and radiological testing. The response rates were 49.7% in Hen-San, 50.7% in Sien-Dien and 48.5% on Cu-Tien. After age and sex adjustment, the prevalence of rheumatic symptoms in Hen-San, Sien-Dien, and Cu-Tien was 24.3, 18.4 and 26.3% respectively. It was significantly higher in rural Hen-San and urban Cu-Tien than in Sien-Dien. The prevalence of rheumatoid arthritis (RA) in Hen-San, Sien-Dien, and Cu-Tien was 0.26, 0.78, and 0.93%, osteoarthritis (OA) was 6.3, 5.8, 5.1%, ankylosing spondylitis (AS) was 0.54, 0.19, 0.4%, gout was 0.16, 0.67, 0.67%, respectively. The prevalence of RA in Sien-Dien and Cu-Tien was significantly higher than in Hen-San (p < 0.05) but were not statistically different for OA, AS and gout among those 3 sites. Only one case of systemic lupus erythematosus (SLE) was found in urban Cu-Tien for a prevalence of 0.033%. CONCLUSION: Our results suggest that the prevalence of RA and AS is similar to that reported in Caucasians. We could not confirm anecdotal reports that SLE was common or that it is more common than RA in people of Chinese ancestry. The prevalence of OA of the hip is comparatively uncommon in our population. The difference in prevalence of rheumatism, RA, OA and gout in these areas suggests areas of further study.

Adult↗
PubMed1993

Management of work disability. Resources for vocational rehabilitation.

OBJECTIVE: To review the state-federal vocational rehabilitation (SF-VR) system and its utilization by persons with rheumatic conditions. METHODS: SF-VR system instruction manuals, and literature on rheumatology rehabilitation, work disability, and rehabilitation counseling were reviewed. National and Massachusetts state SF-VR system data on persons with "arthritis and rheumatism" were analyzed. RESULTS: The SF-VR system is used by a small proportion of persons with rheumatic diseases. Fifty-two percent of clients with arthritis are employed after receiving services. CONCLUSION: Although evidence indicates that VR services for persons with rheumatic conditions improves their chances for reemployment, the SF-VR system is underutilized.

Disability Evaluation↗
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

Towards more informative pilot studies with new anti-rheumatic drugs.

No subject should be exposed to a new drug without fully studying the experience. Methodologic standards implemented in Phase I trials can improve their usefulness. Standardization of outcome measures of impairment and function to permit pooling of data; utilization of techniques to minimise measurement error; collecting information on co-variates known to affect outcome-socioeconomic status, co-morbidity, etc; definition of a meaningful clinical change in absolute and relative forms by consensus techniques. Phase I trials should also incorporate features from single subject crossover designs and sequential trials.

Anti-Inflammatory Agents↗
PubMed1992

Anticardiolipin antibodies and the risk for ischemic stroke and venous thrombosis.

OBJECTIVE: To determine whether the presence of anticardiolipin antibodies is a risk factor for ischemic stroke and venous thrombosis in healthy adult men. DESIGN: A nested, case-control study in a prospective cohort. SETTING: A nationwide study of physicians. PARTICIPANTS: The study sample was drawn from the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 male physicians. At entry, 68% of the participants submitted plasma samples that were subsequently frozen at -80 degrees C. During 60.2 months of follow-up, follow-up for nonfatal outcomes was 99.7% complete and ascertainment of fatal outcomes was 100% complete. We identified men with documented ischemic stroke, deep venous thrombosis of the leg, or pulmonary embolus and for whom a plasma sample was available. A control was matched by age, smoking history, and length of follow-up to each of the 100 patients with ischemic stroke and the 90 patients with deep venous thrombosis or pulmonary embolus. MEASUREMENTS: Plasma samples were assessed for IgG anticardiolipin antibodies by enzyme-linked immunosorbent assay. The mean anticardiolipin antibody titers of the case patients in the two diagnostic groups (ischemic stroke; venous thrombosis or pulmonary embolus) were compared with those of the control groups, and relative risks were calculated for patients in increasing percentile categories of anticardiolipin antibodies by conditional logistic regression. RESULTS: The anticardiolipin antibody titers were higher in case patients with deep venous thrombosis and pulmonary embolus than in their matched controls (P = 0.01). Persons with anticardiolipin antibody titers above the 95th percentile had a relative risk for developing deep venous thrombosis or pulmonary embolus of 5.3 (95% CI, 1.55 to 18.3; P = 0.01). The anticardiolipin antibody titers in case patients with ischemic stroke and controls were not significantly different (P > 0.2), and no clear trend of higher risks among those with elevated levels of anticardiolipin antibodies was observed. CONCLUSION: An anticardiolipin antibody level above the 95th percentile is an important risk factor for deep venous thrombosis or pulmonary embolus but not for ischemic stroke in healthy adult men.

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.

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