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Peter R Croft

Publications and source records attributed to Peter R Croft.

At least 19 recordsLinked to original sources
PubMed2006

The assessment of the prognosis of musculoskeletal conditions in older adults presenting to general practice: a research protocol.

BACKGROUND: Musculoskeletal conditions represent a common reason for consulting general practice yet with the exception of low back pain, relatively little is known about the prognosis of these disorders. Recent evidence suggests that common 'generic' factors may be of value when assessing prognosis, irrespective of the location of the pain. This study will test a generic assessment tool used as part of the general practice consultation to determine prognosis of musculoskeletal complaints. METHODS/DESIGN: Older adults (aged 50 years and over) presenting to six general practices with musculoskeletal complaints will be assessed as part of the routine consultation using a generic assessment of prognosis. Participants will receive a self-completion questionnaire at baseline, three, six and 12 months post consultation to gather further data on pain, disability and psychological status. The primary outcome measure is participant's global rating of change. DISCUSSION: Prognosis is considered to be a fundamental component of scientific medicine yet prognostic research in primary care settings is currently neglected and prognostic enquiry is disappearing from general medical textbooks. This study aims to address this issue by examining the use of generic prognostic factors in a general practice setting.

Age Factors↗
PubMed2006

A comparison of two consensus methods for classifying morbidities in a single professional group showed the same outcomes.

OBJECTIVE: To investigate whether consensus differs when reached by the Nominal or the Delphi method. STUDY DESIGN AND SETTING: Seventeen general practices from North Staffordshire, England were randomly allocated to Delphi (postal feedback only) or Nominal group (also had group discussion). General practitioners classified 56 morbidities according to four scales of severity (chronicity, time course, health care use, patient impact) in two consensus rounds. Consensus outcomes were assessed by between-group comparison of severity scores at baseline and follow-up rounds, and consensus process by within-group change in the variance of severity scores between the two rounds. RESULTS: Consensus rounds were completed by 21 out of 35 Nominal GPs and 23 out of 43 Delphi GPs. Baseline scores for three of the four severity scales were significantly higher for Nominal compared to Delphi GPs, but there were no differences at follow-up. Between the two rounds, variance reduced within the Nominal and Delphi group, respectively, by 61% and 35% (chronicity), 40% and 62% (time course), 42% and 36% (health care use), and 19% and 38% (patient impact). CONCLUSION: The Nominal and Delphi methods did not result in different outcomes and we conclude that either method can be used in health services research.

Consensus↗
PubMed2006

Repeat assessment improves the prediction of prognosis in patients with low back pain in primary care.

Low back pain is considered to fluctuate over time, and related prognostic factors may behave similarly, therefore classification of prognosis may be affected by timing of assessment. We aimed to investigate the implications of timing of assessment of prognosis in low back pain. In a prospective cohort of primary care low back pain consulters aged 30-59 years, 359 returned questionnaires at baseline, one-month and one-year. The stability of selected prognostic indicators between baseline and one-month later was assessed, and relative risks for their association with outcome (individually and in combination) were calculated. Reported absence of most outcome indicators was stable between baseline and one-month. However, among people reporting presence of indicators at baseline, only around half still reported them a month later. There were no important differences between the prognostic strength of indicators measured at baseline or one-month. People reporting presence of indicators at either point had significantly higher risk of poor outcome than people not reporting the indicator at all. Presence of the indicators at both time points was associated with even higher risk; people with persistent high pain intensity had 15 times the risk of a poor outcome (relative risk 15.1; 95% confidence interval 6.7-33.8) compared with people not reporting high pain at either point. Combining information on prognostic indicators from two time points provides better classification of low back pain patients' eventual outcome than a single measurement alone. This increased accuracy in predicting prognosis is relevant to both clinical and research practice.

Adult↗
PubMed2006

Does back pain prevalence really decrease with increasing age? A systematic review.

BACKGROUND: It is believed that the prevalence of back pain decreases around the middle of the sixth decade. However, back pain is still among the most commonly reported symptoms in the elderly and osteoarthritis, disc degeneration, osteoporosis and spinal stenosis all increase with age. In light of this, it is difficult to understand why the prevalence of back pain would decrease with increasing age. OBJECTIVE: This study aimed at summarising the scientific evidence on the trends of back pain prevalence with age. METHODS: Population-based studies reporting the prevalence of back pain, including people aged 65 years and over, were systematically retrieved from several bibliographic databases. These were read and assessed by two reviewers, and papers retained ('good quality studies') were aggregated according to specific criteria. RESULTS: Good quality studies showed a large heterogeneity as to their methods and prevalence figures. No specific patterns were detected by country nor outcome measure. However, most studies that considered severe forms of back pain found an increase of prevalence with increasing age. The curvilinear association between age and back pain prevalence that is widely mentioned in the literature was found only for benign and mixed problems. CONCLUSIONS: The evidence concerning the association of back pain prevalence with age is more sparse than currently believed and this association seems to be modified by the severity of the problem. This knowledge could have important public health implications, as the proportion of older people will increase considerably in the coming years in most industrialised societies.

Age Distribution↗
PubMed2006

Characterizing the course of low back pain: a latent class analysis.

Understanding the course of back pain is important for clinicians and researchers, but analyses of longitudinal data from multiple time points are lacking. A prospective cohort study of consecutive back pain consulters from five general practices in the United Kingdom was carried out between 2001 and 2003 to identify groups defined by their pain pathways. Patients were sent monthly questionnaires for a year. Longitudinal latent class analysis was performed by using pain intensity scores for 342 consulters. Analysis yielded four clusters representing different pathways of back pain. Cluster 1 ("persistent mild"; n = 122) patients had stable, low levels of pain. Patients in cluster 2 ("recovering"; n = 104) started with mild pain, progressing quickly to no pain. Cluster 3 ("severe chronic"; n = 71) patients had permanently high pain. For patients in cluster 4 ("fluctuating"; n = 45), pain varied between mild and high levels. Distinctive patterns for each cluster were maintained throughout follow-up. Clusters showed statistically significant differences in disability, psychological status, and work absence (p < 0.001). This is the first time, to the authors' knowledge, that latent class analysis has been applied to longitudinal data on back pain patients. Identification of four distinct groups of patients improves understanding of the course of back pain and may provide a basis of classification for intervention.

Adult↗
PubMed2006

The importance of symptom duration in determining prognosis.

Symptom duration is integral to clinical and epidemiological research on pain. It is widely used for sample selection and commonly assessed in clinical practice. However, there has been little specific investigation of the link between duration and outcome. This work aimed to examine the association of episode duration with symptoms and clinical course in primary care consulters with low back pain (LBP). In a cohort of general practice LBP consulters, 619 patients returned two or more questionnaires during a 12-month period. LBP episode duration at baseline consultation was defined by time since their last pain-free month. Associations of duration with pain, disability and psychological status at baseline were examined. Survival analysis was used to assess the association between episode duration and time taken for disability to improve by 30%. At baseline, increasing episode duration was associated with worse pain, disability and psychological status (p < 0.001), but there were no differences between people with more or less than 3 months of pain. People with 3 years' or more duration at baseline took significantly longer to improve than those with shorter duration (adjusted hazard ratio 1.57, 95% confidence interval 1.27-1.95). In conclusion, memory of LBP episode duration is associated with pain, disability and psychological status, and is an independent predictor of time to improvement. There are important differences between people who recall more or less than 3 years' duration. Mechanisms for these associations are poorly understood, but this research suggests that duration itself is an important focus for research.

Adult↗
PubMed2006

Is chronic musculoskeletal pain in adulthood related to factors at birth? A population-based case-control study of young adults.

Chronic musculoskeletal pain affects one-third of the general population, yet apart from occupational and psychosocial risk factors, relatively little is known about its aetiology. Exposures in very early life may influence the development of chronic pain as a young adult. However, unlike the study of early life influences on some other common chronic diseases, little research has been conducted in this area. Using a nested case-control analysis of a population-based cross-sectional survey, this pilot study investigated associations of selected birth-related factors with chronic pain in young adults living in North Staffordshire. 858 participants responded to the survey (adjusted response 37%). 580 were included in the case-control analysis. No association was found between prematurity (OR: 0.14 95% CI: 0.0, 1.1), foetal distress (OR: 0.80 95% CI: 0.4, 1.8), artificial commencement of labour (OR: 1.04 95% CI: 0.6, 1.8), or non-vaginal delivery (OR: 1.03 95% CI: 0.5, 2.0) and chronic pain at age 18-25 years. Associations were observed between pain status and low birth weight (OR: 2.17 95% CI: 0.6, 7.0) and neonatal ITU admission (OR: 1.63 95% CI: 0.4, 7.4). Although these estimates were not statistically significant in this exploratory study they may be worthy of further investigation.

Adolescent↗
PubMed2006

A systematic review of postcoital bleeding and risk of cervical cancer.

BACKGROUND: Postcoital bleeding may be a symptom of cervical cancer. Guidance to aid a GP in determining whom to investigate or refer exists but recommendations vary. Women need to be involved in decisions about their care and this involves communicating risk and an exploration of the implications of the risk. Risk estimates of postcoital bleeding for cervical cancer are not available. AIM: To provide an estimate of the positive predictive values of postcoital bleeding for cervical cancer to aid decision making in primary care about whom to investigate for cervical cancer. DESIGN OF STUDY: A systematic review. SETTING: Community, primary and secondary care. METHOD: Six electronic databases were searched from the beginning of each of their time frames. Inclusion criteria were that the study was published in English and reported or contained enough data to calculate the prevalence or incidence of postcoital bleeding within the study population. No studies were excluded on issues of methodological quality. RESULTS: The search strategy identified 910 unique articles. The point prevalence of postcoital bleeding in the community ranged from 0.7 to 9% among women. One study reported an annual cumulative incidence of 6% of menstruating women. The prevalence of postcoital bleeding in women with cervical cancer ranged from 0.7 to 39%. Calculation of risk that a woman in the community developing postcoital bleeding has cervical cancer ranges from 1 in 44,000 at age 20-24 years to 1 in 2 400 aged 45-54 years. There was no information allowing the direct calculation of risk in women presenting to primary care. CONCLUSION: The evidence base for management strategies of postcoital bleeding and calculations of risk for cervical cancer in women with postcoital bleeding are poor. Recommendations for clinical practice are made on the current evidence.

Adult↗
PubMed2006

Is chronic pain in adulthood related to childhood factors? A population-based case-control study of young adults.

OBJECTIVE: To investigate whether recalled childhood pain experiences and illnesses are associated with chronic pain in young adults. METHODS: A cross-sectional population-based survey recruited participants aged 18-25 years for a case-control study and obtained information on current pain and recalled childhood experiences. In total, 858 respondents were classified as either non-pain controls (n = 276), non-chronic pain cases (pain for < or = 3 months in the previous 6 months, n = 435), or chronic pain cases (pain of > 3 months' duration, n = 119). RESULTS: 858 young adults responded to the survey (adjusted response rate 37%). Of the recalled exposures in childhood, family members with pain (OR 2.48, 95% CI 1.48, 4.15), having more than 2 relatives with pain during childhood (OR 3.03, 95% CI 1.44, 6.40), being admitted to hospital during childhood (OR 1.71, 95% CI 1.04, 2.80), and having more illness than one's peer group at secondary school (OR 3.98, 95% CI 1.99, 7.96) were significantly associated with having chronic pain as a young adult, after adjustment for age, sex, and current psychological distress scores. Recall bias was assessed by comparing actual and recalled admission to the neonatal intensive care unit, with no significant differences being found between the participating groups. CONCLUSION: Several associations were observed between pain status as a young adult and selected self-reported childhood experiences of illness and pain. The role of recall bias cannot be excluded in this retrospective study, but the results emphasize the importance of family and childhood experiences of pain in potentially influencing future adult pain status.

Adolescent↗
PubMed2005

Classification of low back pain in primary care: using "bothersomeness" to identify the most severe cases.

STUDY DESIGN: Prospective inception cohort. OBJECTIVE: To investigate the validity and use of a single question on the bothersomeness of low back pain (LBP) as a method of classifying the severity of symptoms among patients seen in clinical practice. SUMMARY OF BACKGROUND DATA: There is no widely accepted method for classifying patients with nonspecific LBP in clinical practice. There have been no previous reports of the validity and use of a question on bothersomeness as a method of classifying patients with LBP. METHODS: Consecutive patients (30-59 years old) with LBP consulting at 5 United Kingdom general practices (n = 1464) were mailed a questionnaire after consultation and 6 months later. Construct validity was assessed by comparing baseline responses on the single bothersomeness question with pain, disability, general health, and psychologic health measures. The ability of bothersomeness to predict outcomes at 6 months was assessed against pain, disability, work absence, and health care use. RESULTS: A total of 935 patients (65%) completed baseline questionnaires. There were 776 (83%) patients who consented to enter the follow-up study, and 447 returned the 6-month questionnaire. At baseline, bothersomeness correlated with pain, disability, and other measures (P < 0.001), and had 80% sensitivity (61% specificity) to detect people in the highest category of pain and disability. People with bothersome LBP at baseline evaluation had an increased risk of work absence or health care consultations for LBP 6 months later (relative risks 2.8 and 1.9, respectively). CONCLUSIONS: There is evidence for the validity of a single bothersomeness question as a measure of LBP severity. It has the potential to provide a practical standard scheme for classifying patients with LBP in clinical practice. However, further work is needed to clarify its usefulness in a clinical setting.

Absenteeism↗
PubMed2005

A method to determine if consenters to population surveys are representative of the target study population.

BACKGROUND: Searching medical records of study non-responders to investigate selection bias is no longer acceptable. We explore an alternative by comparing consultation rates in survey responders who consented to medical record review, with anonymized consultation rates for the total practice populations. METHODS: Anonymized aggregated consultation rates for the year following a population-based survey were calculated for headache and a number of other conditions (chosen to reflect a mixture of chronic and episodic conditions). These rates were compared across two groups of adults: (i) responders to the survey who consented to medical record review and (ii) a 'population group' created from records of the general practices participating in the survey to represent all patients aged 18 years and over at the mid-point in the study year. The consultation rates for the conditions were compared across the two groups using direct standardization. RESULTS: Adjusted consultation rates were similar but generally higher in the responders. CONCLUSIONS: This alternative method applied here offers one potential approach to determine whether study respondents are representative of the population from which they were sampled with respect to general practice consultations.

Adolescent↗
PubMed2005

The Keele Assessment of Participation: a new instrument to measure participation restriction in population studies. Combined qualitative and quantitative examination of its psychometric properties.

The World Health Organization has proposed participation restriction to reflect the societal consequences of health conditions. Despite its importance, participation restriction appears to be inconsistently represented or absent from the content of many health status instruments. This paper describes the development and testing of a new self-complete measure of participation restriction from the conceptual basis of participation as an individual's perception of their actual involvement in life situations. The psychometric properties (face, content and construct validity, responder burden, performance and repeatability) of the instrument were examined using qualitative and quantitative methods. Person-perceived participation restriction did not reflect the frequency of participation but was associated with participants' expectations, aspirations, and needs, as well as contextual factors. We conclude that the instrument can provide estimates of person-perceived participation restriction in population surveys.

England↗
PubMed2005

Clinical comorbidity was specific to disease pathology, psychologic distress, and somatic symptom amplification.

OBJECTIVE: To test the hypothesis that disease pathology, psychologic distress, and somatic symptom amplification separately influence health care use by investigating the patterns of comorbidity in patients with diabetes, anxiety, and upper respiratory tract infection (URTI), respectively. METHODS: Adult diabetes (n=4,365), anxiety (13,421), and URTI (9,854) cases, and 15,000 randomly selected controls were identified from a 1-year national survey of general practice consultations. Comorbidity was based on a standard clinical morbidity classification used by general practitioners in actual consultations. RESULTS: In case-control analyses of 122 morbidities, the number of significant comorbid associations (P<.01) for diabetes was 30, anxiety was 72, and URTI was 49. These associations showed significant heterogeneity in the odds ratios estimated using Cochran's Q and I2 statistic, both between case groups and within each case group. Diabetes associations were stronger with peripheral vascular disease (odds ratio 2.7), candidiasis (2.5), cataract (2.4), obesity (2.2), and hypertension (1.7); anxiety with depressive disorder (4.1), affective psychosis (4.0), adjustment reaction (3.2), functional gastrointestinal disorders (2.5) and general symptoms (2.5); and URTI with nonspecific blood findings (5.5), bronchitis (5.2), and injury (3.5). CONCLUSION: Our study shows patterns of clinical comorbidity specific to the case conditions that supports the hypothesis that different mechanisms (disease pathology, psychologic distress, and somatic symptom amplification) operate to influence consultation behavior and comorbidity.

Adolescent↗
PubMed2005

One-year follow-up of headache in an adult general population.

OBJECTIVE: To investigate variation in headache occurrence and characteristics over 1 year. BACKGROUND: Headache is a common condition which can affect the work, home, and social lives of sufferers, yet surprisingly little is known about how headache changes over time. METHODS: Postal survey to a random general population sample of 5000 adults aged 18 years plus, with follow-up survey to all baseline responders at 1 year and a subsample of 500 being surveyed at 3-monthly intervals between the baseline and 1-year surveys. RESULTS: A total of 1589 (74% response) responded to the 1-year follow-up and 282 of the subsample responded to all five surveys at 3-monthly intervals. Among 1-year respondents with recent headache at baseline (defined as occurring during the previous 3 months), nearly all (94%) also reported headache during the follow-up year. One-third of respondents without recent headache at baseline reported a new episode of headache during the follow-up year. Most (85%) respondents with recent headache at both baseline and 1-year follow-up reported a variation in at least one headache characteristic. These findings were replicated in the sample completing the 3-monthly surveys. Although most of this subgroup reported their headache occurrence status was unchanged during each 3-month period, only a few (3%) respondents with headache in each period reported no variation at all in headache characteristics during the study. CONCLUSIONS: While prevalence of recent headache was stable over time for individuals, there was considerable variation in headache characteristics.

Adolescent↗
PubMed2005

Is chronic widespread pain a predictor of all-cause morbidity? A 3 year prospective population based study in family practice.

OBJECTIVE: To investigate whether chronic widespread pain predicts illness seen in general practice in a 3 year followup period. METHODS: A postal questionnaire was conducted in an adult family practice population sample of 3968, and there were 2606 responders (66%). From the 2296 responders who consented to their record review, we identified 184 subjects with chronic widespread pain and assessed their outcome based on the first recorded morbidity within each of 15 categories during a 3 year followup period of computerized family practice records. Psychological distress at baseline was also measured using the Hospital Anxiety and Depression scale. RESULTS: Of the survey responders, 2089 subjects (91%) completed the full 3 year followup period. Out of the 15 main morbidity categories examined, 11 were associated with pain status at baseline. The strongest associations between chronic widespread pain at baseline and subsequent morbidity, adjusted for age, sex, and social deprivation, were for musculoskeletal (MSK) disorders (rate ratio 4.36; 95% confidence interval 3.2-5.9), accidents (2.46; 95% CI 1.2-5.1), mental health disorders (2.24; 95% CI 1.5-3.3), dermatological disorders (2.16; 95% CI 1.6-2.9), and infections (1.96; 95% CI 1.3-2.9). Controlling for psychological distress reduced the strength of associations between chronic widespread pain and future morbidity, but 9 of the 11 were still statistically significant. In the 3 year followup period, an estimated 7.7% of all non-MSK and 12.6% of all MSK morbidity consultations were related to chronic widespread pain as reported at baseline. CONCLUSION: People who report chronic widespread pain subsequently consult more frequently about non-MSK and MSK problems than people with no pain, and this is not explained by psychological distress. The overall impact on healthcare use is substantial. Our study provides more evidence for overlap and links between morbidities that may be part of a larger pathological or somatization syndrome.

Adolescent↗
PubMed2004

The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP).

Although pain is experienced at all ages, there is uncertainty about the pattern of its occurrence in older people. We have investigated the prevalence of three aspects of self-reported pain-occurrence of any recent pain, number and location of pain sites, and interference with daily life-to determine their association with age in older people. A cross-sectional postal survey of all adults aged 50 years and over registered with three general practices (n = 11230) in North Staffordshire using self-complete questionnaires was conducted. Respondents' gender, age, employment status, socio-economic classification, and general health status were gathered to characterise the population under study. The location of any recent pain (past 4 weeks) was recorded on a full-body manikin and pain interference was based on a single question. Completed questionnaires were received from 7878 respondents (adjusted response of 71.3%). The 4-week prevalence of any pain was 72.4%; similar across 10-year age-groups, and higher in females than males. In those with pain the median number of painful areas (from 44) was 6, and 12.5% of the responding population were classified as having widespread pain, both figures similar across age-groups. Most regional pains showed a decline in prevalence in the older age-groups, the exceptions being the lower limb regions (hip, knee, foot). Pain that interfered with daily activities was reported by 3002 (38.1%) respondents overall. There was a clear age-related rise in this prevalence with age up to and including the oldest group. Within each regional pain subgroup, the proportion of people who also reported pain interference rose with age. Our study has provided evidence that increasing age in the elderly population is not associated with any change in the overall prevalence of pain, although, as previous studies have suggested, the pattern of pain prevalence in different body regions does change with age. More importantly the extent to which pain interferes with everyday life increases incrementally with age up to the oldest age-group in the community-dwelling general population.

Activities of Daily Living↗
PubMed2004

What influences participants' treatment preference and can it influence outcome? Results from a primary care-based randomised trial for shoulder pain.

BACKGROUND: In randomised clinical trials (RCTs), outcome may be influenced by the opinions of the participants about the efficacy of treatments. AIM: To examine how initial treatment preferences of participants in a shoulder pain trial affected functional outcome and future treatment preferences. DESIGN OF STUDY: Observational cohort study nested within a multicentre, pragmatic RCT of steroid injection versus physiotherapy for unilateral shoulder pain. SETTING: Nine general practices in north Staffordshire. METHOD: Two hundred and seven adults were randomised in the trial. Disability scores and preferences of the participants for the trial treatments were elicited at two points: prior to randomisation and 6 months post-randomisation. A good functional outcome was defined as at least a halving in the disability score at the 6 months follow-up point. RESULTS: Pre-randomisation preferences were: 40% for injection and 20% for physiotherapy, and 40% gave no preference. A good outcome was achieved in a higher percentage of participants who gave a pre-randomisation treatment preference compared with those who did not (62% compared with 48% percentage difference = 14%; 95% confidence interval [CI] = -1 to 27%) with similar percentages in each preferred treatment group. However, receiving the preferred treatment did not confer any additional benefit in those who expressed a preference (receiving preferred treatment = 56%; not receiving preferred treatment = 69%). At 6 months post-randomisation, participants with a good, as opposed to poor, outcome were more likely to report as their preferred treatment the one to which they had been randomised, irrespective of pre-randomisation preference and whether the preferred treatment was received. CONCLUSION: This analysis suggests that preferences prior to treatment can affect outcome, but that treatment outcome is a stronger influence on post-treatment preferences. We present some empirical evidence to support the statement that treatment preferences can have important effects on the results of RCTs.

Adrenal Cortex Hormones↗