Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

BACKGROUND: Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. METHODS: We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000). Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection) were examined. RESULTS: Shoulder pain was associated with an injury in one third (33.2% (230/692)) of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52) more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202)) of visits. An x-ray was performed in 29.0% (164/566) of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound) was infrequently performed (6.5%, 37/566). Physiotherapy was ordered in 23.9% (135/566) of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. CONCLUSION: These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices

Chiropractic and self-care for back-related leg pain: design of a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Back-related leg pain (BRLP) is a common variation of low back pain (LBP), with lifetime prevalence estimates as high as 40%. Often disabling, BRLP accounts for greater work loss, recurrences, and higher costs than uncomplicated LBP and more often leads to surgery with a lifetime incidence of 10% for those with severe BRLP, compared to 1-2% for those with LBP.</p> <p>In the US, half of those with back-related conditions seek CAM treatments, the most common of which is chiropractic care. While there is preliminary evidence suggesting chiropractic spinal manipulative therapy is beneficial for patients with BRLP, there is insufficient evidence currently available to assess the effectiveness of this care.</p> <p>Methods/Design</p> <p>This study is a two-site, prospective, parallel group, observer-blinded randomized clinical trial (RCT). A total of 192 study patients will be recruited from the Twin Cities, MN (n = 122) and Quad Cities area in Iowa and Illinois (n = 70) to the research clinics at WHCCS and PCCR, respectively.</p> <p>It compares two interventions: chiropractic spinal manipulative therapy (SMT) plus home exercise program (HEP) to HEP alone (minimal intervention comparison) for patients with subacute or chronic back-related leg pain.</p> <p>Discussion</p> <p>Back-related leg pain (BRLP) is a costly and often disabling variation of the ubiquitous back pain conditions. As health care costs continue to climb, the search for effective treatments with few side-effects is critical. While SMT is the most commonly sought CAM treatment for LBP sufferers, there is only a small, albeit promising, body of research to support its use for patients with BRLP.</p> <p>This study seeks to fill a critical gap in the LBP literature by performing the first full scale RCT assessing chiropractic SMT for patients with sub-acute or chronic BRLP using important <b>patient-oriented </b>and <b>objective biomechanical </b>outcome measures.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00494065">NCT00494065</a></p

Emotion Coregulation in Mother-Child Dyads: A Dynamic Systems Analysis of Children with and without Autism Spectrum Disorder

Few studies have investigated patterns of emotion coregulation in families of children with Autism Spectrum Disorder (ASD) or contrasted the ways in which their emotion coregulation patterns differ from families of typically developing (TD) children. To address this gap, we used a dynamic systems approach to compare flexible structure and emotional content of coregulation between mothers and children (3-7&nbsp;years) with ASD (n&nbsp;=&nbsp;47) and TD children (n&nbsp;=&nbsp;26). Mother-child play interactions in the home were videotaped and emotion-engagement states were coded in micro-level 5-s intervals based on behavioral and affective expressions. Analyses indicated that mother-child dyads in the ASD group spent more time than dyads in the TD group in mismatched emotion-engagement states (e.g., child negative/mother positive), and children with ASD spent more time than TD children engaged exclusively with objects. Mother-child dyads in the TD group stayed longer in mutual positive engagement states. Compared to dyads in the TD group, mother-child dyads in the ASD group exhibited greater flexibility (i.e., a wider range of emotional-engagement states, more frequent changes in states, and less time in each state). These findings suggest that mothers and their children with ASD do not sustain dyadic positive engagement patterns in a low-stress environment. Findings confirmed the preference of children with ASD for objects over social partners, even when they are at home with their mothers, and elucidated a challenging mother-child interactional style. Results have implications for mother-child interventions aimed at regulating negative emotional states and sustaining positive ones in families raising children with ASD

Patient-reported outcomes of brentuximab vedotin in Hodgkin lymphoma and anaplastic large-cell lymphoma

Robert Chen,1 Suzanne Allibone,2 Nancy L Bartlett,3 Pauline Brice,4 Andy Chen,5 Katrina Pose,6 Lynn Rich,7 Vijay Bonthapally,8 Phillip M Garfin,9 Michelle Fanale10 1Department of Hematology &amp; Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA; 2The Lymphoma Service of the Christie NHS Foundation Trust, Manchester, UK; 3Department of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA; 4Department of Hemato-Oncology, H&ocirc;pital Saint-Louis, Paris, France; 5Knight Cancer Institute, Oregon Health &amp; Science University, Portland, OR, 6Lymphoma and Cancer Survivorship Stanford Comprehensive Cancer Center, Stanford, CA, 7Lymphoma Program, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 8Millennium Pharmaceuticals Inc., Cambridge, MA, 9Seattle Genetics, Inc., Bothell, WA, 10Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Background: Patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) or R/R systemic anaplastic large-cell lymphoma (sALCL) treated with brentuximab vedotin (BV) experienced high remission rates in two Phase II trials. With increased response rates and survival times, patient-reported outcomes (PROs) and health-related quality of life (HRQoL) are becoming increasingly important and can help inform treatment decisions to enhance care of cancer patients.Objective: The objective was to qualitatively assess HRQoL in long-term survivors treated with BV.Methods: An eight-question survey assessing PRO-related aspects was developed and fielded to a subset of patients with HL or sALCL who remained in long-term follow-up after completing BV treatment in the two pivotal studies.Results: The survey was completed by 25 of 38 patients (12 with HL, 13 with sALCL). The majority of patients reported that their energy level, outlook on life, difficulties with daily activities, ability to participate in physical activities, and overall HRQoL improved compared to those before BV treatment.Limitations: Small sample size and lack of a baseline questionnaire or validated assessment instrument limit broad applicability of these findings to large populations of patients with HL or sALCL.Conclusion: This is the first report of BV PRO data in R/R HL and sALCL. Given the patients&rsquo; poor prognostic outcomes before stem cell transplant, these encouraging results warrant formal evaluation of PRO end points in BV trials. Keywords: patient well-being, brentuximab vedotin, health-related quality of life, pilot study, activities of daily livin

Dor e funcionalidade na atenção básica à saúde Pain and functionality in primary health care

A dor osteoarticular e a funcionalidade são elementos ligados à saúde dos indivíduos e, portanto, influenciam o modo de interação entre si e entre eles e o meio ambiente que os cerca. Contudo, não são muitos os estudos que levantam essas questões de saúde na população em geral, sobretudo quando aproximamos o olhar da atenção básica sobre elas. Este artigo tem o objetivo de fornecer dados iniciais sobre dor e funcionalidade nos indivíduos com queixa osteoarticular em uma população adscrita a uma unidade básica de saúde (UBS) e suscitar o debate sobre integralidade da atenção nesse serviço. O trabalho descritivo foi realizado na UBS (n1=64) e nos domicílios (n2=48), entre indivíduos a partir dos 20 anos de idade. Foi aplicado um instrumento de avaliação de funcionalidade e a Escala Visual Analógica de dor, e foram exploradas questões sociodemográficas. Com esses instrumentos, buscou-se avaliar o perfil dos indivíduos em relação ao seu grau de dor musculoesquelética, o grau de funcionalidade nas atividades da vida diária, idade e ocupação. Nos resultados, encontramos uma predominância do sexo feminino nos dois grupos, 84,37% e 81,25%, respectivamente. Quase metade das pessoas com dor musculoesquelética eram donas de casa, e a média de idade entre os grupos estava acima dos 55 anos.<br>Musculoskeletal pain and functionality are linked to the individual health and, thus, influence the mode of interaction between individuals and between them and the environment that surrounds them. However, there are not many studies that question such health issues concerning the population in general, especially when we look at these issues from the basic care point of view. The aim of this article is to present initial data on the subject of pain and functionality in individuals with musculoskeletal complaints enrolled in a primary care unit and prompt a discussion on how complete the services provided by these units are. This study was carried out in a primary care unit and various households, among subjects aging 20 years or older. A functionality assessment tool and a Visual Analogue Scale were applied, and social and demographic issues were also considered. By using these tools, it was made an attempt to evaluate the profile of individuals in association with their degree of musculoskeletal pain and the degree of functionality in the activities of their daily lives, ages and occupations. We found a predominance of women in both groups: 84.37% and 81.25%, respectively. Nearly half of all people with musculoskeletal pain were housewives, and the average age between groups was over 55