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Biomedical subjects

R D Wigley

Publications and source records attributed to R D Wigley.

At least 37 records · Page 2Linked to original sources

Rehabilitation in chronic back pain: employment status after four years.

Of 129 chronic back pain patients treated consecutively at the Palmerston North hospital rehabilitation unit in 1982-3, 102 responded to a questionnaire in 1987. The 27 nonresponders had had pain for a shorter time and were considered to have a better prognosis. Of the 102 responders, 31 no longer had back pain; 51 (six women) were employed full or part time and 17 (two women) were looking for work. Two men had reversed roles and 17 had retired. Women who no longer had a job outside the home classed themselves as housewives rather than as retired or unemployed. This study provides data for future planning but without controls, confident conclusions cannot be drawn on the efficacy of the rehabilitation programme. There is a need for further controlled studies.

Adolescent↗

Rheumatic complaints in Tokelau. I. Migrants resident in New Zealand. The Tokelau Island migrant study.

The three Tokelau atolls are 8 degrees south of the equator. In 1966 the islands were involved in a severe hurricane which drew attention to overcrowding and led to resettlement of more than half the population in New Zealand. One thousand three hundred and eighty one migrants over 15 years old were examined in New Zealand in 1980 and 1981 for rheumatic complaints as part of a continuing assessment. Clinical criteria for osteoarthritis (COA), including crepitus in any joint and in the knee, showed an increase in prevalence with age and weight in both sexes. Partial correlation coefficient analysis showed an association of the number of affected joints or the severity of knee COA (COAK) with both age and weight. Stepwise regression showed that age was the best predictor of both COA and COAK scores. Weight had predictive value only for COAK and only in women. Using the tracking method, previous high and/or increasing weight was related to COAK observed at this assessment. Heberden nodes increased with age and were more prevalent in women but were not associated with weight. Low back, dorsal and neck pain showed no association with age or sex. Low back pain was associated with weight. Joint pain following injury occurred in 15.4% of men. Gout, more common in men, was the only frequent inflammatory arthritis found. Two definite cases of rheumatoid arthritis (RA) were identified and four had criteria 1 and 2 for the New York criteria.

Adolescent↗

Rheumatic complaints in Tokelau. II. A comparison of migrants in New Zealand and non-migrants. The Tokelau Island migrant study.

The migration of 1381 Tokelauans 15 years and over to New Zealand leaving 811 in Tokelau, provided a unique opportunity to test centuries of speculation on the impact of environment on rheumatic disease. There was no change in all rheumatic complaints. The migrant men had more gout, joint pain following injury, and neck pain. The migrant women had more dorsal back pain. There was no change in the prevalence of clinically defined osteoarthritis (COA) despite positive associations with weight and higher weights in the migrants. Rheumatoid arthritis was infrequent in both populations. Low back pain was common but was not more common in migrants, though compensation payments are readily available in New Zealand and are not in the Islands.

Adolescent↗

Double-blind evaluation of piroxicam and naproxen following missed dosage in patients with inflammatory arthritis.

We conducted two separate double-blind withdrawal studies in parallel; one involved 20 patients taking piroxicam 20 mg daily, and the other involved 20 patients taking naproxen 750 mg daily. After 48 hour withdrawal of active medication, the naproxen group showed significant deterioration in eight of the 14 parameters measured and the piroxicam group in one of the 14 parameters measured. The deterioration in the naproxen group was significantly greater than that in the piroxicam group in five of the 14 parameters measured. These findings are consistent with the long half-life of piroxicam and suggest that non-compliance leading to omission of piroxicam for two days is of less clinical importance than omission of naproxen for two days.

Adult↗

Rheumatic pain in a Philippine village. A WHO-ILAR COPCORD Study.

In initiating a community oriented programme for the control of rheumatic disease (COPCORD), 1685 people of all ages from a rural area in the Philippines were questioned by primary health care workers (PHW) for limb and spinal rheumatic pain and disability. The total complaint rate was 15.3% for men and 18.5% for women. For those 15 years and older the age adjusted rheumatic pain rates for pain present at the time of survey were 28.4% for the Philippines and 22.6% for Lawrence's UK population. The most common rheumatic pain sites in this community were knee, lumbar spine, neck and the trapezius muscle. The disability rate was 4.5% for those 15 years and older. One quarter of those with pain had received medical attention and the remainder, herbal treatment, massage, various faith and/or self-treatment methods.

Adolescent↗

The analgesic effects of transcutaneous electrical nerve stimulation and placebo in chronic pain patients. A double-blind non-crossover comparison.

The analgesic effects of high frequency transcutaneous electrical nerve stimulation (TNS), "acupuncture-like" TNS and placebo TNS were evaluated in 33 patients with rheumatoid arthritis and chronic hand pain using a randomized, double-blind, non-crossover design. An oscilloscope was employed to monitor the stimulator output in the TNS treatment groups and to provide strong suggestion and a focus of attention in the placebo treatment group. The two forms of TNS were applied at the highest intensity that could be tolerated by patients. Assessments of resting pain, joint tenderness, grip strength and grip pain were made before and after treatment. The pain and joint tenderness measurements showed high frequency TNS, "acupuncture-like" TNS and placebo TNS to be equally effective in producing analgesia of similar degree and trend over time. The grip strength measurements showed no significant change. The results obtained with placebo are probably due to the suggestion and attention effects of the visual stimulus. The implications of these results in respect to pain control pathways are discussed. Although TNS given at high intensity was shown to be no better than placebo applied with strong suggestion, this does not preclude its use as a method of pain control in rheumatoid arthritis.

Acupuncture Therapy↗

Proximal dissection of the olecranon bursa in rheumatoid arthritis.

A patient with rheumatoid arthritis and a distended olecranon bursa, which subsequently dissected subcutaneously in a proximal direction over the triceps muscle, is reported. Dissection of the olecranon bursa in a distal direction is not uncommon, but proximal dissection has not been reported.

Arthritis, Rheumatoid↗

Transcutaneous electrical nerve stimulation in rheumatoid arthritis.

The therapeutic effect of once weekly transcutaneous electrical nerve stimulation in patients with rheumatoid arthritis was compared with placebo in a randomised, double-blind, non-crossover study lasting three weeks. Thirty-two patients with classic or definite rheumatoid arthritis and wrist involvement were evaluated. Transcutaneous electrical nerve stimulation was better than the placebo in relieving pain at rest and while gripping. In addition, grip strength, measured as power and work done, immediately improved following transcutaneous electrical nerve stimulation but returned almost to initial values between assessments. No significant improvement was shown for the placebo group.

Adult↗

A simple pressure dolorimeter for the quantification of joint tenderness in inflammatory arthritis.

A simple pressure dolorimeter for the detection and quantification of joint tenderness is described and evaluated. The pressure dolorimeter was more sensitive than a modified Ritchie Index in measuring degree of joint tenderness and as sensitive in detecting tender joints. The interobserver error of the pressure dolorimeter was low, and in a drug withdrawal study, the pressure dolorimeter was able to detect change in joint tenderness whereas the conventional Ritchie Index was not. These results suggest that the pressure dolorimeter is a simple, reliable and sensitive instrument for measuring joint tenderness in patients with inflammatory joint disease. It is also inexpensive and readily available.

Arthritis, Rheumatoid↗

Observations on rheumatic disease in Polynesia and the Philippines.

Two different types of study of rheumatic disease in the southwest Pacific are outlined. The Philippines study of a rural developing population is primarily oriented to intervention rather than causation, but before intervention can be effectively planned, information on the frequency and causes of rheumatic complaints is necessary. The Tokelauan investigation is a comprehensive prospective study of the total population with full medical examination of each subject allowing hypotheses to be tested concerning genetic and environmental variables.

Adolescent↗

The activities of daily living index in rheumatoid arthritis: an observer variation study.

The Northwick Park activities of daily living (ADL) index was used to assess functional disability in rheumatoid arthritis patients. Assessments were carried out by two pairs of observers and inter-observer variation was studied. No significant differences were found between observers for the total independence score and the total time taken to complete individual tasks. A significant difference was found between observers in Pair A with regard to the total assessment time, as one member from this pair took consistently longer to complete the assessment than the other. Although this trend was also apparent in Pair B, this was not significant. The modified ADL index is recommended for routine assessment in the general treatment and rehabilitation of patients with rheumatoid arthritis.

Activities of Daily Living↗

Popliteal cysts: variations on a theme of Baker.

Adams in 1840 was the first to describe popliteal cysts, "the enlarged bursa is normally situated beneath the inner head of the gastrocnemius and communicates with the joint by a species of valvular opening." Baker whose name has been given to the cysts suggested in 1877 that the cyst may be a distended bursa related to the semimembranosus tendon. He also suggested that the cyst was connected with the knee synovium and pointed out that the fluid could not return to the joint. He considered that rupture could occur with the formation of calf cysts and that the leak could come from the popliteus bursa. He also commented (Case 1) on difficulty in distinguishing this syndrome from venous thrombosis. He quotes Foucher (1856) who described a typical history of a recurrent cyst with rupture. "An officer first noticed a small swelling in the inner side of the popliteal space, three days after a forced march on a rough road. The tumour only very gradually increased. About eighteen months after its first appearance a sudden effort at extending the leg caused a rupture of the wall of the cyst, the tumour disappearing at the same time that the calf of the leg began to swell. A bandage was applied, but the patient was not laid up. Two years afterwards the cyst was larger than ever; and for a short time the patient was obliged to lie up, as part of the fluid contents of the cyst, after a tight bandaging, had extended on both sides of the knee. Ultimately the disease disappeared." Foucher described 6 cases, but did not observe the communication of the cyst with the knee. Thus, though much of what we know today has been known for over a century, medical text books give scant attention to the subject. The varied clinical patterns derived from popliteal cysts still lead to misdiagnosis with undesirable if not disastrous consequences. Current knowledge of this subject is brought together in this review.

Cysts↗

Acupuncture.

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Acupuncture Therapy↗