Neck pain and disability: A cross-sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinic

This hospital-based cross-sectional cohort study examines the clinical and demographic features of neck pain, disability (using the Northwick Park neck pain questionnaire) and relationships to handicap in employment. Of 173 consecutive referrals to a rheumatology clinic with neck pain, 70% had neck/arm pain without neurological involvement, 13% other conditions, 11% nerve involvement and 5% other spinal pain. 141 patients (mean age 50 years) had mechanical or degenerative neck pain, of which 13% was probably work-related and 13% was trauma-related. 44 had taken sickness absence for an average of 30 weeks. Comorbidities were frequent (lumbar pain 51%). Those in work were significantly less disabled than those not working (p = 0.001) and those off sick (p < 0.01). Those reporting sleep disturbance, tearfulness and crying were significantly more disabled (p = 0.0001) than those who did not. Neck pain in secondary care is complicated by physical and emotional comorbidities. Comprehensive management requires a biopsychosocial model of care

Conservative management of low back pain

Back pain is prevalent worldwide, but back pain disability has reached epidemic proportions in many industrialised societies. Few patients have serious medical pathology or direct neurological involvement requiring surgery. Although the causes remain unclear, physical stress and its consequences on discs, facet joints and supporting soft tissues at work or leisure are important, sometimes aggravated by adverse psychosocial factors. Modern management emphasises the role of self-care, beginning in primary care with the first episode. Without root compression, bed rest should not exceed 48 hours. Emphasis is on encouraging a rapid return to physical fitness and other activities, including employment, acknowledging that returning to a normal life may require working through pain. Medication facilitates this. No one should remain in pain beyond six weeks without being referred to a specialist service for a physical and psychosocial assessment by appropriately trained professionals and with consultant support for investigation, pain management and rehabilitation when needed

Changes in the quality of life in severely disabled people following provision of powered indoor/outdoor chairs

Purpose:To determine the benefits for patients who received an Electric Powered Indoor/outdoor Chair (EPIOC) and to quantify their perceived changes to their quality of life. Method: Community-based cohort study of all patients provided with an EPIOC over 4 months; and followed up about 3 months later in a community served by a regional wheelchair service in North West London (population about 3.1 million) using the EuroQol EQ-5D with visual analogue scales for each of the 5 dimensions of the EQ-5D. Results: Sixty-four wheelchair users were assessed initially and 51 completed follow up. Chair users showed no significant improvement in health state as measured by the EQ-5D after EPIOC provision. The visual analogue scales (VASs) indicated that, although perceived overall health state, independence and social life did not appear to improve, the dimensions of mobility, quality of life and pain/discomfort improved significantly on provision of an EPIOC. Conclusion: EPIOC users reported significant improvements in several important aspects of their lives; not just in mobility (as expected) but also in reduction of pain and discomfort. The use of VASs provided a more holistic set of outcome measures that demonstrate quality of life benefits beyond that of health state alone

Young people’s experiences using electric powered indoor-outdoor wheelchairs (EPIOCs): Potential for enhancing users’ development?

Purpose: To examine the experiences of severely physically disabled young people using electric powered indoor/outdoor chairs (EPIOCs). Methods: A priori interview questions examined young people’s functioning with EPIOCs, pain and discomfort with EPIOC use and accidents or injuries resulting from EPIOC use. Eighteen young people (13 males and 5 females) aged 10 -18 (mean 15) years were interviewed by telephone using a qualitative framework approach. Participants were interviewed 10 -19 (mean 14.5) months after delivery of the chair. Diagnoses included muscular dystrophy (n = 10), cerebral palsy (n = 5), and ‘other’ (n =3). Results: Many children reported positive functioning following EPIOC use, including increased independence and social activities like wheelchair football. However, EPIOC use was also associated with pain and discomfort, as well as perceived lack of safety, and minor accidents. Most young people and their families were fairly satisfied with the service and provision of their wheelchairs. Conclusions: The findings suggest that disabled children’s development may benefit from the use of electric powered indoor/outdoor wheelchairs, although the advantages may come at certain costs to young people’s perceived and real safety. Recommendations to powered wheelchair providers include the demonstrated need for additional driving training as these young people mature

Using geographical information systems for management of back-pain data

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2002 MCB UP LtdIn the medical world, statistical visualisation has largely been confined to the realm of relatively simple geographical applications. This remains the case, even though hospitals have been collecting spatial data relating to patients. In particular, hospitals have a wealth of back pain information, which includes pain drawings, usually detailing the spatial distribution and type of pain suffered by back-pain patients. Proposes several technological solutions, which permit data within back-pain datasets to be digitally linked to the pain drawings in order to provide methods of computer-based data management and analysis. In particular, proposes the use of geographical information systems (GIS), up till now a tool used mainly in the geographic and cartographic domains, to provide novel and powerful ways of visualising and managing back-pain data. A comparative evaluation of the proposed solutions shows that, although adding complexity and cost, the GIS-based solution is the one most appropriate for visualisation and analysis of back-pain datasets

Determination of biomembrane bending moduli in fully atomistic simulations.

The bilayer bending modulus (Kc) is one of the most important physical constants characterizing lipid membranes, but precisely measuring it is a challenge, both experimentally and computationally. Experimental measurements on chemically identical bilayers often differ depending upon the techniques employed, and robust simulation results have previously been limited to coarse-grained models (at varying levels of resolution). This Communication demonstrates the extraction of Kc from fully atomistic molecular dynamics simulations for three different single-component lipid bilayers (DPPC, DOPC, and DOPE). The results agree quantitatively with experiments that measure thermal shape fluctuations in giant unilamellar vesicles. Lipid tilt, twist, and compression moduli are also reported

Clinical features of those using powered indoor/outdoor wheelchairs (EPIOCs) with a muscular dystrophy: disease features, comorbidities and complications of disability.

Objective To describe the clinical features of EPIOC users with a muscular dystrophy (MD) and explore the complexities of comorbidities, clinical features and conditions secondary to disability influencing prescription. Method Cross-sectional survey of a clinic population. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic and clinical profiles and wheelchair factors. Results Sixty five users (mean age 23.7, range 10-67, sd 12.95 years) had a diagnosis of a MD and 39 had additional clinical features (ACFs). Fifty-one were men (mean age 22.6, range 10-67, sd 12.9 years) and 14 women (mean age 27.7, range 10-49, sd 12.9 years). The majority had Duchenne MD (n=40). ACFs influencing prescription were scoliosis (n=20), problematic pain (n=14), ventilatory failure (n=4), pressure sores (n=2), dependent oedema/cellulitis (n=2). Tilt-in-space (TIS) was provided to 48 users and specialised seating (SS) to 35 (30 having both SS and TIS). Complex controls were provided to 17 users including tray mounted (n=14), non-standard (n=7) and interfacing issues (n=6). Bespoke seating was provided to 12 users: carved foam (n=4), Scott systems (n=4), Matrix (n=3) and moulded seat insert (n=1). Pressure relieving cushions prescribed were Jay 2 (n=14), Qbitus (n=10), Vicaire (n=4), RoHo (n=3) and other (n=9). Thirteen had standard cushions. Conclusion Management of posture is critical in MD and is complicated by growth and disease progression. Complex, individually tailored, EPIOC prescription requires clinical expertise from experienced multidisciplinary teams

Problematic clinical features of children and adults with cerebral palsy who use electric powered indoor/outdoor wheelchairs: A cross-sectional study

Aim: To describe the clinical features of electric powered indoor/outdoor wheelchair (EPIOC) users with cerebral palsy (CP) that are problematic to optimal prescription; and explore the complexities of comorbidities, features of CP and conditions secondary to disability impacting on equipment provision for children and adults. Method: Cross-sectional study of EPIOC users (n=102) with a primary diagnosis of CP. Retrospective review of electronic and case note records. Records were reviewed by a rehabilitation consultant. Data were extracted under three themes; demographic, diagnostic/clinical and wheelchair factors. Further data were entered from clinical records (charts). Results: There were 48 males mean age 27.5 (range 8-70 sd 13.9) years and 54 females, mean age 29.5 (range 7-68 sd 14.6) years with CP. Sixteen comorbidities, nine features of CP and five features of disability influenced wheelchair prescription. Sixty-four users were provided with specialised seating (SS) and 47 with tilt-in-space (TIS) seats. Complex controls were provided to 16 users, 12 tray-mounted. The majority of users had both SS and TIS. Conclusions: Powered wheelchair prescription has important therapeutic roles in clinical management in addition to enhancing mobility, independence and participation. Clinical features such as spasticity and problematic pain appeared less well managed in adults than in children

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

This article is made available through the Brunel Open Access Publishing Fund. Copyright @ 2014 Informa UK Ltd.Purpose: The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. Method: Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. Results: Records of 28 men mean age 57 (range 37–78, SD 12) years and 63 women mean age 57 (range 35–81, SD 11) years with MS were reviewed a mean of 64 (range 0–131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. Conclusions: Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions

Describing race, ethnicity, and culture in medical research. Self defined ethnicity is unhelpful

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - 1996 Copyright BMJ Publishing Group