The Experts below are selected from a list of 21123 Experts worldwide ranked by ideXlab platform
Susan Solymoss - One of the best experts on this subject based on the ideXlab platform.
-
Graduated compression stockings to treat acute Leg Pain associated with proximal DVT
Thrombosis and Haemostasis, 2020Co-Authors: Stan Shapiro, Thierry Ducruet, Philip Wells, Marc Rodger, Michael Kovacs, David Anderson, Vicky Tagalakis, David Morrison, Susan Solymoss, Marie-josé MironAbstract:SummaryAcute deep venous thrombosis (DVT) causes Leg Pain. Elastic compression stockings (ECS) have potential to relieve DVT-related Leg Pain by diminishing the diameter of distended veins and increasing venous blood flow. It was our objective to determine whether ECS reduce Leg Pain in patients with acute DVT. We performed a secondary analysis of the SOX Trial, a multicentre randomised placebo controlled trial of active ECS versus placebo ECS to prevent the post-thrombotic syndrome.The study was performed in 24 hospital centres in Canada and the U.S. and included 803 patients with a first episode of acute proximal DVT. Patients were randomised to receive active ECS (knee length, 30–40 mm Hg graduated pressure) or placebo ECS (manufactured to look identical to active ECS, but lacking therapeutic compression). Study outcome was Leg Pain severity assessed on an 11-point numerical Pain rating scale (0, no Pain; 10, worst possible Pain) at baseline, 14, 30 and 60 days after randomisation. Mean age was 55 years and 60% were male. In active ECS patients (n=409), mean (SD) Pain severity at baseline and at 60 days were 5.18 (3.29) and 1.39 (2.19), respectively, and in placebo ECS patients (n=394) were 5.38 (3.29) and 1.13 (1.86), respectively. There were no significant differences in Pain scores between groups at any assessment point, and no evidence for subgroup interaction by age, sex or anatomical extent of DVT. Results were similar in an analysis restricted to patients who reported wearing stockings every day. In conclusion, ECS do not reduce Leg Pain in patients with acute proximal DVT.
-
graduated compression stockings to treat acute Leg Pain associated with proximal dvt a randomised controlled trial
Thrombosis and Haemostasis, 2014Co-Authors: Susan R Kahn, Stan Shapiro, Thierry Ducruet, Marc Rodger, Vicky Tagalakis, Philip S Wells, Michael J Kovacs, David C Anderson, David R Morrison, Susan SolymossAbstract:Acute deep venous thrombosis (DVT) causes Leg Pain. Elastic compression stockings (ECS) have potential to relieve DVT-related Leg Pain by diminishing the diameter of distended veins and increasing venous blood flow. It was our objective to determine whether ECS reduce Leg Pain in patients with acute DVT. We performed a secondary analysis of the SOX Trial, a multicentre randomised placebo controlled trial of active ECS versus placebo ECS to prevent the post-thrombotic syndrome.The study was performed in 24 hospital centres in Canada and the U.S. and included 803 patients with a first episode of acute proximal DVT. Patients were randomised to receive active ECS (knee length, 30–40 mm Hg graduated pressure) or placebo ECS (manufactured to look identical to active ECS, but lacking therapeutic compression). Study outcome was Leg Pain severity assessed on an 11-point numerical Pain rating scale (0, no Pain; 10, worst possible Pain) at baseline, 14, 30 and 60 days after randomisation. Mean age was 55 years and 60% were male. In active ECS patients (n=409), mean (SD) Pain severity at baseline and at 60 days were 5.18 (3.29) and 1.39 (2.19), respectively, and in placebo ECS patients (n=394) were 5.38 (3.29) and 1.13 (1.86), respectively. There were no significant differences in Pain scores between groups at any assessment point, and no evidence for subgroup interaction by age, sex or anatomical extent of DVT. Results were similar in an analysis restricted to patients who reported wearing stockings every day. In conclusion, ECS do not reduce Leg Pain in patients with acute proximal DVT.
Danielle A W M Van Der Windt - One of the best experts on this subject based on the ideXlab platform.
-
Prognosis of sciatica and back-related Leg Pain in primary care: the ATLAS cohort.
The Spine Journal, 2017Co-Authors: Kika Konstantinou, Kate M. Dunn, Martyn Lewis, Reuben Ogollah, Danielle A W M Van Der WindtAbstract:BACKGROUND CONTEXT: Evidence is lacking on the prognosis and prognostic factors of back-related Leg Pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions. PURPOSE: The present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related Leg Pain and sciatica. STUDY DESIGN: This is a prospective cohort study. PATIENT SAMPLE: The present study included adults visiting their family doctor with back-related Leg Pain in the United Kingdom. OUTCOME MEASURES: Information about Pain, function, psychological, and clinical variables, was collected. Good outcome was defined as 30% or more reduction in disability (Roland-Morris Disability Questionnaire). METHODS: Participants completed the questionnaires, underwent clinical assessments, received a magnetic resonance imaging scan, and were followed-up 12 months later. Mixed-effects logistic regression evaluated the prognostic value of six a priori defined variable sets (Leg Pain duration, Pain intensity, neuropathic Pain, psychological factors, clinical examination, and imaging variables). A combined model, including variables from all models, examined independent effects. The National Institute for Health Research funded the study. There are no conflicts of interest. RESULTS: A total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group. For the whole cohort, longer Leg Pain duration (odds ratio [OR] 0.41; confidence interval [CI] 0.19-0.90), higher identity score (OR 0.70; CI 0.53-0.93), and patient's belief that the problem will last a long time (OR 0.27; CI 0.13-0.57) were the strongest independent prognostic factors negatively associated with improvement. These last two factors were similarly negatively associated with improvement in the sciatica subgroup. CONCLUSIONS: The present study provides new evidence on the prognosis and prognostic factors of back-related Leg Pain and sciatica in primary care. Just over half of patients improved at 12 months. Patient's belief of recovery timescale and number of other symptoms attributed to the Pain are independent prognostic factors. These factors can be used to inform and direct decisions about timing and intensity of available therapeutic options.
-
clinical outcomes among low back Pain consulters with referred Leg Pain in primary care
Spine, 2011Co-Authors: Jonathan C Hill, Kika Konstantinou, Kate M. Dunn, Martyn Lewis, Bolaji E Egbewale, Danielle A W M Van Der WindtAbstract:STUDY DESIGN: Merged data from two primary care prospective cohort studies. OBJECTIVE: To compare the clinical course of low back Pain (LBP) consulters to primary care with and without self-reported referred Leg Pain. SUMMARY OF BACKGROUND DATA: In patients with LBP, the presence of Leg Pain/sciatica is considered a poor prognostic indicator, associated with more severe Pain, disability, and time off work. However, questions remain about how best to identify sciatica in primary care and whether self-reported referred Leg Pain provides a distinct classification for primary care. METHODS: Data from two large prospective cohort studies of consecutive patients consulting with LBP in 13 general practices were merged. Using self-report data patients were divided into three subgroups: (1) those with LBP alone, (2) LBP with referred Pain above the knee (LBP + above-knee), and (3) LBP with referred Pain below the knee (LBP + below-knee). Unadjusted and adjusted baseline and 6-month follow-up scores on physical, psychological, and social indicators were compared between the groups using multiple regression analysis. RESULTS: Among 1247 consulters the baseline prevalence of cases with LBP alone was 465 (37%), LBP + above-knee was 308 (25%), and LBP + below-knee was 474 (38%). Baseline severity and 6-month outcomes in the consulters with referred Leg Pain were significantly worse compared to those with LBP alone across a wide range of clinical characteristics, although differences diminished after adjusting for baseline characteristics. CONCLUSION: The clinical course for LBP with self-reported referred Leg Pain is much worse. However, the fact that differences in outcome were not worse after adjustment suggests that baseline differences in severity and duration of back Pain, demographic, and psychological characteristics largely explain the poorer outcomes in patients with referred Leg Pain. Future research needs to establish if similar results are observed among patients with clinically determined sciatica.
Susan R Kahn - One of the best experts on this subject based on the ideXlab platform.
-
graduated compression stockings to treat acute Leg Pain associated with proximal dvt a randomised controlled trial
Thrombosis and Haemostasis, 2014Co-Authors: Susan R Kahn, Stan Shapiro, Thierry Ducruet, Marc Rodger, Vicky Tagalakis, Philip S Wells, Michael J Kovacs, David C Anderson, David R Morrison, Susan SolymossAbstract:Acute deep venous thrombosis (DVT) causes Leg Pain. Elastic compression stockings (ECS) have potential to relieve DVT-related Leg Pain by diminishing the diameter of distended veins and increasing venous blood flow. It was our objective to determine whether ECS reduce Leg Pain in patients with acute DVT. We performed a secondary analysis of the SOX Trial, a multicentre randomised placebo controlled trial of active ECS versus placebo ECS to prevent the post-thrombotic syndrome.The study was performed in 24 hospital centres in Canada and the U.S. and included 803 patients with a first episode of acute proximal DVT. Patients were randomised to receive active ECS (knee length, 30–40 mm Hg graduated pressure) or placebo ECS (manufactured to look identical to active ECS, but lacking therapeutic compression). Study outcome was Leg Pain severity assessed on an 11-point numerical Pain rating scale (0, no Pain; 10, worst possible Pain) at baseline, 14, 30 and 60 days after randomisation. Mean age was 55 years and 60% were male. In active ECS patients (n=409), mean (SD) Pain severity at baseline and at 60 days were 5.18 (3.29) and 1.39 (2.19), respectively, and in placebo ECS patients (n=394) were 5.38 (3.29) and 1.13 (1.86), respectively. There were no significant differences in Pain scores between groups at any assessment point, and no evidence for subgroup interaction by age, sex or anatomical extent of DVT. Results were similar in an analysis restricted to patients who reported wearing stockings every day. In conclusion, ECS do not reduce Leg Pain in patients with acute proximal DVT.
Yoshiki Yamano - One of the best experts on this subject based on the ideXlab platform.
-
idiopathic spinal cord herniation in the thoracic spine as a cause of intractable Leg Pain case report and review of the literature
Journal of Spinal Disorders & Techniques, 2003Co-Authors: Ryuichi Sasaoka, Hiroaki Nakamura, Yoshiki YamanoAbstract:: We recently experienced a case of idiopathic spinal cord herniation in the upper thoracic spine with development of severe unilateral Leg Pain: a 57-year-old man who had suffered from severe Leg Pain for about 15 years with lack of abnormality in his lumbar spine. On MRI of the thoracic spine, however, the spinal cord at T2-T3 was bent forward with dilatation of the posterior subarachnoid space. In combination with the findings of computed tomographic myelography, we diagnosed idiopathic spinal cord herniation and performed a surgical treatment. Immediately after the operation, his Leg Pain disappeared. Therefore, we concluded that the cause of his Leg Pain was herniation of the thoracic spinal cord.
Kate M. Dunn - One of the best experts on this subject based on the ideXlab platform.
-
PREVALENCE AND CHARACTERISTICS OF NEUROPATHIC Pain IN PRIMARY CARE PATIENTS WITH LOW BACK-RELATED Leg Pain
2018Co-Authors: Harrisson Sa, Nadine E. Foster, Kate M. Dunn, Reuben Ogollah, Kika KonstantinouAbstract:Purpose of study and backgroundNeuropathic Pain is a challenging Pain syndrome to manage. Low back-related Leg Pain (LBLP) is clinically diagnosed as either sciatica or referred Leg Pain and sciatica is often assumed to be neuropathic. Our aim was to describe the prevalence and characteristics of neuropathic Pain in LBLP patients.MethodsAnalysis of cross-sectional data from a prospective, primary care cohort of 609 LBLP patients. Patients completed questionnaires, and received clinical assessment including MRI. Neuropathic characteristics (NC) were measured using the self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (SLANSS; score of ≥12 indicates Pain with NC).Results52% of the patients diagnosed with sciatica and 39% of those diagnosed with referred Leg Pain presented with Pain with NC. Irrespective of LBLP diagnosis, patients with NC reported significantly worse Leg Pain (mean 5.8 vs 4.7), back Pain intensity (0.0 vs 0.0), disability (RMDQ 15.2 vs 12.4), high risk of p...
-
Prognosis of sciatica and back-related Leg Pain in primary care: the ATLAS cohort.
The Spine Journal, 2017Co-Authors: Kika Konstantinou, Kate M. Dunn, Martyn Lewis, Reuben Ogollah, Danielle A W M Van Der WindtAbstract:BACKGROUND CONTEXT: Evidence is lacking on the prognosis and prognostic factors of back-related Leg Pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions. PURPOSE: The present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related Leg Pain and sciatica. STUDY DESIGN: This is a prospective cohort study. PATIENT SAMPLE: The present study included adults visiting their family doctor with back-related Leg Pain in the United Kingdom. OUTCOME MEASURES: Information about Pain, function, psychological, and clinical variables, was collected. Good outcome was defined as 30% or more reduction in disability (Roland-Morris Disability Questionnaire). METHODS: Participants completed the questionnaires, underwent clinical assessments, received a magnetic resonance imaging scan, and were followed-up 12 months later. Mixed-effects logistic regression evaluated the prognostic value of six a priori defined variable sets (Leg Pain duration, Pain intensity, neuropathic Pain, psychological factors, clinical examination, and imaging variables). A combined model, including variables from all models, examined independent effects. The National Institute for Health Research funded the study. There are no conflicts of interest. RESULTS: A total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group. For the whole cohort, longer Leg Pain duration (odds ratio [OR] 0.41; confidence interval [CI] 0.19-0.90), higher identity score (OR 0.70; CI 0.53-0.93), and patient's belief that the problem will last a long time (OR 0.27; CI 0.13-0.57) were the strongest independent prognostic factors negatively associated with improvement. These last two factors were similarly negatively associated with improvement in the sciatica subgroup. CONCLUSIONS: The present study provides new evidence on the prognosis and prognostic factors of back-related Leg Pain and sciatica in primary care. Just over half of patients improved at 12 months. Patient's belief of recovery timescale and number of other symptoms attributed to the Pain are independent prognostic factors. These factors can be used to inform and direct decisions about timing and intensity of available therapeutic options.
-
Classification of patients with low back-related Leg Pain: a systematic review
BMC Musculoskeletal Disorders, 2016Co-Authors: S Stynes, Kika Konstantinou, Kate M. DunnAbstract:Abstract Background The identification of clinically relevant subgroups of low back Pain (LBP) is considered the number one LBP research priority in primary care. One subgroup of LBP patients are those with back related Leg Pain. Leg Pain frequently accompanies LBP and is associated with increased levels of disability and higher health costs than simple low back Pain. Distinguishing between different types of low back-related Leg Pain (LBLP) is important for clinical management and research applications, but there is currently no clear agreement on how to define and identify LBLP due to nerve root involvement. The aim of this systematic review was to identify, describe and appraise papers that classify or subgroup populations with LBLP, and summarise how Leg Pain due to nerve root involvement is described and diagnosed in the various systems. Methods The search strategy involved nine electronic databases including Medline and Embase, reference lists of eligible studies and relevant reviews. Selected papers were appraised independently by two reviewers using a standardised scoring tool. Results Of 13,358 initial potential eligible citations, 50 relevant papers were identified that reported on 22 classification systems. Papers were grouped according to purpose and criteria of the classification systems. Five themes emerged: (i) clinical features (ii) pathoanatomy (iii) treatment-based approach (iv) screening tools and prediction rules and (v) Pain mechanisms. Three of the twenty two systems focused specifically on LBLP populations. Systems that scored highest following quality appraisal were ones where authors generally included statistical methods to develop their classifications, and supporting work had been published on the systems’ validity, reliability and generalisability. There was lack of consistency in how LBLP due to nerve root involvement was described and diagnosed within the systems. Conclusion Numerous classification systems exist that include patients with Leg Pain, a minority of them focus specifically on distinguishing between different presentations of Leg Pain. Further work is needed to identify clinically meaningful subgroups of LBLP patients, ideally based on large primary care cohort populations and using recommended methods for classification system development.
-
Reliability among clinicians diagnosing low back-related Leg Pain
European Spine Journal, 2015Co-Authors: S Stynes, Kika Konstantinou, Kate M. Dunn, Martyn LewisAbstract:Purpose To investigate agreement and reliability among clinicians when diagnosing low back-related Leg Pain (LBLP) in primary care consulters.
-
clinical outcomes among low back Pain consulters with referred Leg Pain in primary care
Spine, 2011Co-Authors: Jonathan C Hill, Kika Konstantinou, Kate M. Dunn, Martyn Lewis, Bolaji E Egbewale, Danielle A W M Van Der WindtAbstract:STUDY DESIGN: Merged data from two primary care prospective cohort studies. OBJECTIVE: To compare the clinical course of low back Pain (LBP) consulters to primary care with and without self-reported referred Leg Pain. SUMMARY OF BACKGROUND DATA: In patients with LBP, the presence of Leg Pain/sciatica is considered a poor prognostic indicator, associated with more severe Pain, disability, and time off work. However, questions remain about how best to identify sciatica in primary care and whether self-reported referred Leg Pain provides a distinct classification for primary care. METHODS: Data from two large prospective cohort studies of consecutive patients consulting with LBP in 13 general practices were merged. Using self-report data patients were divided into three subgroups: (1) those with LBP alone, (2) LBP with referred Pain above the knee (LBP + above-knee), and (3) LBP with referred Pain below the knee (LBP + below-knee). Unadjusted and adjusted baseline and 6-month follow-up scores on physical, psychological, and social indicators were compared between the groups using multiple regression analysis. RESULTS: Among 1247 consulters the baseline prevalence of cases with LBP alone was 465 (37%), LBP + above-knee was 308 (25%), and LBP + below-knee was 474 (38%). Baseline severity and 6-month outcomes in the consulters with referred Leg Pain were significantly worse compared to those with LBP alone across a wide range of clinical characteristics, although differences diminished after adjusting for baseline characteristics. CONCLUSION: The clinical course for LBP with self-reported referred Leg Pain is much worse. However, the fact that differences in outcome were not worse after adjustment suggests that baseline differences in severity and duration of back Pain, demographic, and psychological characteristics largely explain the poorer outcomes in patients with referred Leg Pain. Future research needs to establish if similar results are observed among patients with clinically determined sciatica.