Chronicity Of Complaints Research Articles

Self-management behaviour and knowledge of patients with musculoskeletal complaints attending an Australian osteopathy clinic: A consecutive sampling design

BackgroundMusculoskeletal complaints present a substantial disease burden worldwide and account for nearly 8% of the total disease burden in Australia. Like other chronic diseases, self-management plays a significant role in the overall management plan for musculoskeletal complaints. ObjectiveEvaluate the self-management behaviours of patients seeking care for a primary musculoskeletal complaint in an Australian osteopathy clinic. DesignConsecutive sampling design. SettingVictoria University Osteopathy Clinic (Melbourne, Australia). MethodsPatients were invited to complete a health information and demographic questionnaire in addition to the Partners in Health (PiH) scale prior to their initial consultation. The PiH subscales and total score were evaluated to ascertain their relationship with gender, age, and other health demographic variables. ParticipantsConsecutive patients attending the Victoria University Osteopathy Clinic. ResultsData from 331 patients was available for analysis. The PiH total score mean was 70.9 (±14.3). Reliability estimations for the PiH subscales were acceptable (McDonald's omega > 0.75). PiH total and subscale scores were not associated with age, and not significantly different for gender and chronicity of complaint. Significant differences for other health behaviours (smoking, blood pressure assessment) were identified. ConclusionsThe current study provides support for the use of the PiH in a patient population seeking osteopathy care for primary acute or chronic musculoskeletal complaint, and also in younger populations seeking care. The results of the study suggest that osteopathy patients seeking care for a primary musculoskeletal complaint demonstrated a relatively high disposition towards the self-management of their health complaints.

Effects of passive‐active movement training on upper limb motor function and cortical activation in chronic patients with stroke: a pilot study

To determine which individual and work-related factors are associated with performing modified work and to evaluate the influence of modified work on the duration of sick leave and health-related outcomes among employees with musculoskeletal complaints. A prospective study with 12 months follow-up. In this prospective study a total of 164 employees on sick leave for 2-6 weeks due to musculoskeletal complaints completed 2 questionnaires. At baseline we gathered information about individual characteristics, physical and psychosocial workload, and disease specific and general health. The follow-up questionnaire, sent to respondents who returned to their original job on full duty, collected information about having performed modified work, and disease-specific and general health. Employees were less likely to perform modified work when their regular work was characterized by frequent lifting and their relationship with colleagues was less than good. Employees were more likely to return to modified work when they had a better mental health, had prolonged periods of standing in their regular job and had less skill discretion. Duration of sick leave was influenced by chronicity of complaints and disability, but not by modified work. Modified work, as the only advice given by a occupational health physician, did not influence the total duration of sick leave nor the improvement in health during sick leave for employees on sick leave due to musculoskeletal complaints.

“INTERMED”: a method to assess health service needs: II. Results on its validity and clinical use

The validity and clinical use of a recently developed instrument to assess health care needs of patients with a physical illness, called INTERMED, is investigated. The INTERMED combines data reflecting patients’ biological, psychological, and social characteristics with information on health care utilization characteristics. An example of a patient population in which such an integral assessment can contribute to the appropriateness of care, are patients with low back pain of degenerative or unknown origin. It supports the validity and the clinical usefulness of the INTERMED when clinically relevant subgroups in this heterogeneous population can be identified and described based on their INTERMED scores. The INTERMED was utilized in a group of patients ( N = 108) having low back pain who vary on the chronicity of complaints, functional status, and associated disability. All patients underwent a medical examination and responded to a battery of validated questionnaires assessing biological, psychological, and social aspects of their life. In addition, the patients were assessed by the INTERMED. It was studied whether it proved to be possible to form clinically meaningful groups of patients based on their INTERMED scores; for this, a hierarchical cluster analysis was performed. In order to clinically describe them, the groups of patients were compared with the data from the questionnaires. The cluster analysis on the INTERMED scores revealed three distinguishable groups of patients. Comparison with the questionnaires assessing biological, psychological, and social aspects of disease showed that one group can be characterized as complex patients with chronic complaints and reduced capacity to work who apply for a disability compensation. The other groups differed explicitly with regard to chronicity, but also on other variables. By means of the INTERMED, clinically relevant groups of patients can be identified, which supports its use in clinical practice and its use as a method to describe case mix for scientific or health care policy purposes. In addition, the INTERMED is easy to implement in daily clinical practice and can be of help to ease the operationalization of the biopychosocial model of disease. More information on its validity in different patient populations is necessary.

Other pain syndromes to be differentiated from fibromyalgia.

Several common chronic pain syndromes come to the attention of the rheumatologist demanding for differentiation from fibromyalgia (FM), although they are often associated with it. They may mimic FM by (1) the occurrence of wide spread pain, (2) the chronicity of complaints, (3) the preponderance of females in some of these, and (4) the lack of objective data to be derived from imaging techniques and laboratory tests. Pain is produced by the disturbance of normal function ("dysfunctional syndromes", MASI, ref. 6). Recognition requires examination of the locomotor system under biomechanical auspices both at rest and during movement in order to diagnose hyper- and hypomobility syndromes; treatment of these conditions is guided by principles to improve biomechanical function. In addition, the skin needs to be examined to detect panniculosis (also called "cellulitis"), which may be mixed up with FM due to its preferential occurrence in peri- or postmenopausal women. It is concluded that the aforementioned differential diagnosis needs to be considered appropriately in coinciding FM and all studies dealing with FM.

A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability.

A cross-sectional design was used to correlate cervical radiographic findings of spinal degeneration to neck pain and disability. The results were correlated to assess the clinical importance of radiographic spinal degeneration. Past investigations suggest little association between clinical findings and radiographic evidence of spinal degeneration. However, changes in activities of daily living and chronicity of complaint have not been investigated. Over a 5-month period, data were collected on 700 consecutive patients referred for cervical radiographic examination as part of their clinical evaluation. While in the radiology department, all subjects completed a visual analog pain scale, neck disability index, and short questionnaire, all of which quantified various aspects of any neck complaint. Relationships between indices of patient complaint and the number of cervical degenerative intervertebral discs were evluated using regression analysis. A significant relationship (P < 0.001) was noted between the number of levels of intervertebral disc degeneration and the chronicity of cervical complaint. No significant relationship was found between cervical degeneration and past trauma (P = 0.904) or gender (P = 0.213). Multiple-regression analysis of visual analog pain scale scores revealed a significant two-way interaction with chronicity and past trauma (P = 0.007) and a significant main effect with gender (P < 0.001). Cervical degeneration was not significant as a main effect or interaction with other factors. Multiple-regression analysis of neck disability index scores demonstrated a significant three-way interaction of chronicity, degeneration, and gender (P = 0.022) and a significant two-way interaction for chronicity and trauma (P = 0.025). No additional information was gathered by multivariate multiple-regression techniques. Increasing levels of spinal degeneration are related to increasing chronicity of patient complaints. Spinal degeneration is not related to past trauma or gender. Women, but not men, report higher disability with increasing levels of degeneration. Subjects with past trauma reported more intense pain and disability. Overall, men reported less neck pain and disability than women.

The primary double-contrast examination of the postoperative stomach.

Examination of the postoperative stomach is a difficult and often confusing procedure. Traditional methods of investigation have depended on using small amounts of barium as well as appropriate pressure and positioning. The authors feel that the well-established technique of double-contrast radiography of the upper gastrointestinal tract (with appropriate modifications) is both easier and more diagnostic; moreover, with the exception of suspected perforation or anastomotic rupture, there are no contraindications to the use of gastrointestinal hypotonia, distension, and barium coating of the mucosa regardless of the presenting symptomatology or the acuteness or chronicity of complaints.