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Biomedical subjects

P Croft

Publications and source records attributed to P Croft.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of knee pain in older adults in primary care: development of an evidence-based model of care.

OBJECTIVE: To develop a stepped model of care for the treatment of knee pain in older adults in primary care based on recommended interventions. METHODS: A systematic search was undertaken to identify interventions recommended for knee osteoarthritis or knee pain in clinical guidelines and systematic reviews. Following this, a nominal group consensus exercise was conducted with members of the Primary Care Rheumatology Society to allocate the interventions to a stepped model of care. RESULTS: Twenty-seven recommended interventions were identified from 77 publications following the systematic search. A four-step model of care incorporating these interventions was developed through the consensus exercise. Step 1 comprised ten interventions that should be offered to all older adults with knee pain, but could also be provided through self-care. These included exercise, weight loss, paracetamol and written information. Steps 2 and 3 comprised 10 and 6 interventions, respectively, to be considered for people with persisting pain and disability. These included pharmacological interventions such as non-steroidal anti-inflammatory drugs in step 2 and intra-articular corticosteroids in step 3, and non-pharmacological interventions such as physiotherapy in step 2 and occupational therapy in step 3. Step 4 was referral for surgery. CONCLUSIONS: Previous evidence-based guidelines for the treatment of knee problems have been developed in secondary care. A systematic search for recommended interventions, and a consensus exercise, has now enabled an evidence-based and practical model of care for knee pain in older adults to be developed for use in primary care.

Aged↗
PubMed2006

Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be?

OBJECTIVES: Joint pain and radiographic osteoarthritis are often discordant. AIM: To investigate this issue more closely by studying the detailed nature of pain and disability, and how this relates to radiographic osteoarthritis. METHODS: Population-based study of 819 adults aged >or=50 years with knee pain. The severity of knee pain, stiffness and disability was measured using a validated scale (the Western Ontario and McMaster Universities (WOMAC) Score) and pain persistence was recorded. Global severity was measured by the graded chronic pain scale. Three radiographic views of the knees were obtained-weight-bearing posteroanterior metatarsophalangeal, supine skyline and supine lateral. RESULTS: 745 participants with knee pain in the past 6 months were eligible (mean age 65 years, 338 men). Radiographic osteoarthritis was more common in those with a longer history and more persistent symptoms. A strong trend was found of radiographic osteoarthritis being more strongly associated with higher WOMAC scores for pain severity, stiffness and disability (adjusted odds ratio (95% confidence interval (CI)) for highest v lowest WOMAC category: 3.7 (2.0 to 6.7), 3.0 (2.0 to 4.6) and 2.8 (1.6 to 5.0), respectively). Those individual WOMAC items for pain and disability pertaining to weight-bearing mobility were the most strongly associated with radiographic osteoarthritis. Combining pain persistence and global severity, persistent severe pain was associated with a significant increase in the occurrence of radiographic osteoarthritis (2.6 (95% CI 1.5 to 4.7)). CONCLUSIONS: A consistent association was found between severity of pain, stiffness and physical function and the presence of radiographic osteoarthritis. This study highlights the potential contribution of underlying joint disease to the degree of pain and disability.

Age Factors↗
PubMed2006

Clinical classification criteria for knee osteoarthritis: performance in the general population and primary care.

BACKGROUND: Doubts have been expressed about the performance of the American College of Rheumatology (ACR) clinical classification criteria for osteoarthritis when applied in the general population. OBJECTIVE: To investigate whether the distribution of population subgroups and underlying disease severity might explain the performance of these criteria in the population setting. METHODS: Population-based cross-sectional study. 819 adults aged > or = 50 years reporting knee pain in the last 12 months were clinically assessed by research therapists using standardised protocols and blinded to radiographic status. All participants underwent plain radiography of the knees, scored by a single reader blinded to clinical status. The relationship between fulfilling the ACR clinical classification criteria for knee osteoarthritis and the presence of symptomatic radiographic knee osteoarthritis was summarised for the sample as a whole and within subgroups. RESULTS: Radiographic osteoarthritis was present in 539 participants (68%) and symptomatic radiographic knee osteoarthritis in 259 (33%). 238 participants (30%) fulfilled the ACR clinical criteria for knee osteoarthritis. Agreement between the ACR clinical criteria and symptomatic radiographic knee osteoarthritis was low (sensitivity 41%; specificity 75%; positive predictive value 44%; negative predictive value 72%). Sensitivity and specificity did not vary markedly between population subgroups, although they were influenced by the underlying severity of radiographic osteoarthritis. CONCLUSION: The ACR clinical criteria seem to reflect later signs in advanced disease. Other approaches may be needed to identify early, mild osteoarthritis in the general population and primary care.

Aged↗
PubMed2005

A comparison of two primary care trials on tennis elbow: issues of external validity.

OBJECTIVE: To assess clinical heterogeneity across two studies with respect to study population, interventions, and outcome measures, and to evaluate the influence of these sources of heterogeneity on the results of the studies. METHODS: The individual patient data were used from two randomised controlled trials investigating the effectiveness of conservative treatments in patients with tennis elbow in primary care. Patients were allocated at random to treatment with steroid injection, wait and see policy, non-steroidal anti-inflammatory drugs, placebo tablets, or physiotherapy. Outcome measures included severity of the main complaint, inconvenience of the elbow complaints, pain during the day, elbow disability, pain-free grip strength, and global improvement. All outcomes were assessed at 1, 6, and 12 months after randomisation. RESULTS: The two study populations were similar with respect to age, sex, comorbid neck/shoulder complaints, and baseline scores for the severity of pain. However, significant differences were observed for employment status, duration of elbow complaints, dominant side affected, previous history of elbow complaints, and use of analgesics. Local injections differed between the two studies with respect to volume, number, and steroid preparation. However, after 1, 6, and 12 months, the treatment effects of steroid injections were very similar between the study populations. CONCLUSIONS: Despite large differences in study population at baseline, the responses to steroid injections were remarkably similar. Also the responses to other conservative interventions and the placebo treatment were very consistent, suggesting a uniform course of a tennis elbow and a lack of influence of clinical heterogeneity.

Adult↗
PubMed2005

The epidemiology of osteoarthritis: Manchester and beyond.

The paper describes the contribution made to the understanding of the epidemiology of osteoarthritis by the Arthritis Research Campaign Epidemiology Unit. Kellgren and Lawrence defined the condition radiographically and produced the widely used Atlas of Standard Radiographs of Arthritis. They documented the age- and sex-specific prevalence of osteoarthritis. Based on studies in occupational groups, they proposed that local biomechanical stress was linked to causation. Philip Wood focused on osteoarthritis as a syndrome of pain and disability. During the directorship of Alan Silman the emphasis has been on osteoarthritis as a public health problem.

Arthrography↗
PubMed2005

Evaluation by dental students of a communication skills course using professional role-players in a UK school of dentistry.

This paper reports student (n = 180) feedback on the role-play teaching methodology used in behavioural sciences teaching at The School of Dentistry in Birmingham (UK). The feedback received on this well-established (since 1995) educational programme was collected via questionnaire (100% response rate), requiring Likert scale and free text responses. Generally students reported that they had enjoyed and valued the session. Over two-thirds (69.7%) of students rated the role-players as 'very real' and over three-quarters (78.9%) rated their feedback as 'very fair'. The data collected from this study will inform future curriculum development. Student feedback was very positive and demonstrated that the cohort (86% of all students studying in years 1, 2 and 3) found the use of professional role-players involved in behavioural sciences teaching to be both acceptable and valuable.

Attitude↗
PubMed2003

A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over.

OBJECTIVE: To use a brief screening tool to identify knee pain (all knee pain, non-chronic and chronic knee pain) and associated health-care use in the general population aged 50 yr and over. METHODS: A cross-sectional survey was mailed to 8995 individuals registered with three general practices in North Staffordshire, UK. The questionnaire included a Knee Pain Screening Tool (KNEST), the Short Form 36 (SF36), demographic questions and, for those who reported knee pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: The survey achieved a 77% response. The 12-month period prevalence of all knee pain was 46.8% [95% confidence interval (CI) 45.6%, 48.0%]. Figures for non-chronic knee pain (pain of less than 3 months duration) and chronic knee pain (pain of more than 3 months duration) were 21.5% (95% CI 20.5%, 22.5%) and 25.3% (95% CI 24.3%, 26.4%) respectively. An estimated 6% of the older population had non-chronic but severe knee pain or disability. Thirty-three per cent of all knee pain sufferers had consulted their general practitioner (GP) about their symptom in the last year. This included 34% of those with non-chronic but severe knee pain or disability and 56% of those with chronic and severe knee pain or disability. The use of private treatments or services for knee pain was minimal. A third of those with chronic and severe knee pain or disability had not used any services (including GP) in the last year. CONCLUSIONS: The KNEST is a simple tool for the identification of individuals with knee pain and their health-care use. Focusing only on chronic knee pain will underestimate the total need and demand for health-care in knee pain sufferers in the general older population, as non-chronic as well as chronic knee pain has a significant impact on people's lives and on their use of primary health-care. The KNEST, when combined with the WOMAC, identifies population groups who have potentially diverse health-care needs and who might benefit from effective health-care. These data can be used alongside evidence on effective treatments by service planners when considering needs for the care of older adults in primary care.

Aged↗
PubMed2003

Prophylactic aspirin use in the adult general population.

BACKGROUND: The aim of the study was to establish the prevalence and patterns of aspirin use in people with vascular problems. METHODS: A cross-sectional population survey was carried out on a stratified random sample of 10,000 adults aged 35 and over in North Staffordshire. RESULTS: A total of 6322 adults replied to the questionnaire (adjusted response 67 percent). The prevalence of vascular problems was 12.9 percent, and 67.6 per cent of respondents were using aspirin. The main association with aspirin use was previous advice about aspirin: adults who recalled being given advice were more likely to be using aspirin. Increasing age, disease severity and level of deprivation were also associated with increased aspirin use. Of adults without vascular problems, 7.1 percent also reported using aspirin regularly. CONCLUSIONS: There is still potential to increase aspirin use in those with vascular problems. The extent and quality of health care professionals' advice may be an important area to target. The reasons why some people without vascular problems take regular aspirin is an area for further investigation.

Adult↗
PubMed2003

Syndrome of symptomatic adult acetabular dysplasia (SAAD syndrome).

OBJECTIVES: To determine the prevalence of acetabular dysplasia in subjects presenting with hip pain to primary care and its relationship with radiographic osteoarthritis (OA) of the hip. DESIGN: Cross sectional analysis of a prospective cohort. SETTING: 35 general practices across the UK. SUBJECTS: 195 patients (63 male, 132 female) aged 40 years and over presenting with a new episode of hip pain RESULTS: The prevalence of acetabular dysplasia in this study of new presenters with hip pain was high (32%). There was no significant relationship between acetabular dysplasia and radiographic OA overall. CONCLUSIONS: The high prevalence of acetabular dysplasia across all grades of OA severity suggests that dysplasia itself may be an important cause of hip pain ("symptomatic adult acetabular dysplasia").

Adult↗
PubMed2003

How do GPs use x rays to manage chronic knee pain in the elderly? A case study.

OBJECTIVES: To determine whether clinical signs and symptoms of osteoarthritis influence general practitioners' (GPs) decisions about x raying older patients with knee pain and whether x ray reports alter their initial treatment or referral plan. METHODS: A cross sectional survey of 1000 GPs in England and Wales using "paper cases" in three questionnaires mailed at two-weekly intervals. The first questionnaire assessed GPs' management of patients with knee pain using four case scenarios, two with features of clinical knee osteoarthritis. The second questionnaire contained the same scenarios with information on x ray findings added. The third questionnaire considered management of knee pain in general. RESULTS: 447 GPs responded to questionnaire 1, 316 (71%) to questionnaire 2, 287 (64%) to questionnaire 3. 106 responders (25%) would have x rayed all four patients and 64 (15%) none. Choosing to carry out an x ray examination was not influenced by the presence of clinical signs and symptoms of osteoarthritis but was linked to other management choices, such as referral to orthopaedics (odds ratio (OR) 2.13; 95% confidence interval (CI) 1.62 to 2.81). The strongest predictor in questionnaire 2 of a treatment or referral was whether it had been chosen in the first survey. However, the x ray report was associated with a significant change in treatment and referrals. Where radiographic osteoarthritis was present, GPs were less likely to refer to a physiotherapist (OR 0.64; 95% CI 0.50 to 0.83) or rheumatologist (OR 0.15; 95% CI 0.08 to 0.28), and more likely to refer to an orthopaedic surgeon (OR 31.34; 95% CI 21.51 to 45.66). Questionnaire 3 showed that GPs' general views on the use of x rays correlated with the frequency of their choosing to x ray in the four individual case scenarios. CONCLUSIONS: A GP's choice to x ray older people with knee symptoms is linked with decisions on treatment and referral even before the x ray result is known, but it does not appear to be influenced by clinical features of osteoarthritis. The presence of radiographic osteoarthritis has a marked impact on the decision to refer to secondary care. More evidence on the outcome of management without x rays is needed to help GPs in decision making.

Adrenal Cortex Hormones↗
PubMed2003

Previous consultation and self reported health status as predictors of future demand for primary care.

STUDY OBJECTIVE: There has been little prospective investigation of what predicts general practice consultation. The objective of this study was to investigate the extent to which previous primary care consultation and self reported health status are predictors of future primary care consultation. DESIGN: Population based cohort study in two phases. Firstly, a baseline survey (1995/96) to identify the cohort and to obtain self reported health status using the UK census limiting long term illness (LLI) question and the Short Form-36 (SF-36) health profile. Secondly, analysis of general practice medical records for two years (1994/1995) before the survey and for two years (1997/1998) after the survey. Analysis was performed on: (a) all contacts coded by the GP, (b) the subgroup of contacts given a diagnostic morbidity code by the GP. SETTING: One general practice in North Staffordshire, UK. PARTICIPANTS: 738 survey respondents who had consented to viewing of medical records including all those who reported LLI together with an age-gender matched control group of those who reported no LLI. MAIN RESULTS: High frequency consulters in 1994/95 were more likely than non-consulters or average consulters in that year to be high consulters in 1997/98 (odds ratio 5.6, 95% confidence interval 3.82 to 8.25, for all contacts; 4.4 for diagnostic coded consultations). Self reported role disability and physical limitation from the SF-36 at baseline increased the probability of being a future high consulter but the effects were weaker than for previous consultation. Previous consultation within a diagnostic group was the main predictor for future consultation within that group with weaker but significant prediction by self reported health status. CONCLUSIONS: Reliable morbidity coding in general practice provides the best available basis for predicting future demand in primary care. Self reported health status survey instruments add to this information but on their own are weaker predictors of future consultation.

Adult↗
PubMed2002

The impact of sporadic campylobacter and salmonella infection on health and health related behaviour: a case control study.

The aim of the work was to explore the impact on general and psychological health of those with a proven bacterial gastrointestinal infection and to compare this with controls from whom no bacterial pathogen was identified. A case control study was conducted using an interviewer-administered questionnaire. Thirty-nine cases from whose faeces salmonella or campylobacter had been cultured were compared with matched controls. Reported gastrointestinal symptoms, general health and self-reported hygiene practices were compared. At the time of acute illness the General Household Questionnaire suggested similar levels of morbidity, though by follow up the controls were substantially more likely to be distressed. Cases were more likely to have changed their food preparation practices, to avoid certain eating places and to have been given advice about food preparation. In this small study a positive diagnosis of salmonella or campylobacter seems to have had a reassuring effect when compared with those for whom no diagnosis was made.

Acute Disease↗
PubMed2002

Health status in patients awaiting hip replacement for osteoarthritis.

BACKGROUND: Hip osteoarthritis is a major cause of pain and disability, especially in the elderly. As part of a study investigating factors that could be associated with advanced osteoarthritis of the hip, we compared the health status of patients awaiting arthroplasty for hip osteoarthritis with controls. We further investigated the interaction of hip osteoarthritis with other variables (age, gender, social class and concurrent pain) in relation to health status. METHODS: A case-control study was performed in two English health districts (Portsmouth and North Staffordshire) during 1993-1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period formed the case group and were compared with an equal number of controls selected from the general population and individually matched for age, gender and general practice. Cases and controls completed a structured interviewer-administered questionnaire, which included queries about their medical condition, occupation (from which a measure of social class was derived), and general health status using the SF36. RESULTS: Physical function (t=32.1, P<0.001), social function (t=16.8, P<0.001) and perceived general health (t=4.1, P<0.001) were worse in the case group, but energy/vitality and mental health showed little difference between cases and controls. Cases were more likely to report knee pain than controls, but case-control status was not associated with pain in the fingers or shoulders, or with social class. However, differences in physical and social function between cases and controls did vary with socio-demographic factors and concurrent knee pain status. CONCLUSION: Patients awaiting hip-replacement because of osteoarthritis were more likely to be restricted in their physical and social life than adults in the general population, but mental state and vitality appear unimpaired in this group. This contrasts with findings from other chronic pain disorders. Manual social class is not linked to being on a waiting list for osteoarthritic hip replacement but does add to the burden on health status, particularly social functioning in those with osteoarthritis of the hip.

Aged↗
PubMed2001

Use of a cross-sectional survey to estimate outcome of health care: the example of anxiety and depression.

Our study proposes that a population-based cross-sectional survey can be used to estimate the outcome of health care by linking general practice morbidity records to the survey. Using the example of anxiety and depression to test this idea, we conducted a survey of an adult population registered with one general practice in the UK. The Hospital Anxiety and Depression (HAD) questionnaire was used to identify cases and controls. After mailing to a randomly selected adult population of 4002, there was an adjusted response rate of 66% (n = 2,606), with 416 (16%) high-score cases, 506 (19%) medium-score cases, and 1684 (65%) low-score controls. All cases were compared with a sample of controls (n = 450). In the 12 months before the survey, the high-score case group had experienced significantly higher GP contacts (n = 377 [91%] versus 354 [79%]), diagnoses for anxiety or depression (119 [29%] versus 21 [5%]), and related drug treatments (111 [27%] versus 22 [5%]) compared with the control sample. Most of the diagnoses and drug treatments had been initiated at least 9 months before the survey. The linkage between the survey and the clinical records suggested that the health outcome of previously identified anxious and depressed patients was poor, with an estimated two-thirds who will not have fully recovered within an average of 9 months. This study demonstrates the potential for using cross-sectional population surveys to estimate not only the need for health care but also the outcome of health care.

Adolescent↗