Recovery priorities in degenerative cervical myelopathy: a cross-sectional survey of an international, online community of patients

ObjectivesTo establish the recovery priorities of individuals suffering with degenerative cervical myelopathy (DCM).DesignA cross-sectional, observational study.SettingPatients from across the world with a diagnosis of DCM accessed the survey over an 18-month period on Myelopathy.org, an international myelopathy charity.Participants481 individuals suffering from DCM completed the online survey fully.Main outcome measuresFunctional recovery domains were established through qualitative interviews and a consensus process. Individuals were asked about their disease characteristics, including limb pain (Visual Analogue Scale) and functional disability (patient-derived version of the modified Japanese Orthopaedic Association score). Individuals ranked recovery domains (arm and hand function, walking, upper body/trunk function, sexual function, elimination of pain, sensation and bladder/bowel function) in order of priority. Priorities were analysed as the modal first priority and mean ranking. The influence of demographics on selection was analysed, with significancep<0.05.ResultsOf 659 survey responses obtained, 481 were complete. Overall, pain was the most popular recovery priority (39.9%) of respondents, followed by walking (20.2%), sensation (11.9%) and arm and hand function (11.5%). Sexual function (5.7%), bladder and bowel (3.7%) and trunk function (3.5%) were chosen less frequently. When considering the average ranking of symptoms, while pain remained the priority (2.6±2.0), this was closely followed by walking (2.9±1.7) and arm/hand function (3.0±1.4). Sensation ranked lower (4.3±2.1). With respect to disease characteristics, overall pain remained the recovery priority, with the exception of patients with greater walking impairment (p<0.005) who prioritised walking, even among patients with lower pain scores.ConclusionsThis is the first study investigating patient priorities in DCM. The patient priorities reported provide an important framework for future research and will help to ensure that it is aligned with patient needs.

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Provision and Perception of Physiotherapy in the Nonoperative Management of Degenerative Cervical Myelopathy (DCM): A Cross-Sectional Questionnaire of People Living With DCM

Global Spine Journal ◽

10.1177/2192568220961357 ◽

2020 ◽

pp. 219256822096135

Author(s):

Max B. Butler ◽

Oliver D. Mowforth ◽

Abdul Badran ◽

Michelle Starkey ◽

Timothy Boerger ◽

...

Keyword(s):

Cervical Myelopathy ◽

Nonoperative Management ◽

Japanese Orthopaedic Association ◽

Multivariate Logistic Regression Analysis ◽

Demographic Characteristics ◽

Symptom Duration ◽

Cross Sectional Survey ◽

Cross Sectional ◽

International Guidelines ◽

Degenerative Cervical Myelopathy

Study Design: Cross-sectional survey. Objectives: Degenerative cervical myelopathy (DCM) is a common syndrome of acquired spinal cord impairment caused by canal stenosis secondary to arthritic changes of the spine. International guidelines consider physiotherapy an option for mild, stable DCM; however, few studies have been conducted on nonoperative management. The objective was to determine current usage and perceptions of nonoperative physiotherapy for DCM. Methods: Persons with DCM were recruited to a web-based survey. Participants with complete responses that had not received surgery were included (n = 167). Variables included symptom duration, treatment history, current disability, and demographic characteristics. Results: Disease and demographic characteristics were equivalent between those who did and did not receive physiotherapy. In all, 19.5% of physiotherapy recipients reported subjective benefit from physiotherapy. Those perceiving benefit had significantly higher mJOA (modified Japanese Orthopaedic Association) scores, lower neck pain scores, and shorter symptom duration. In multivariate logistic regression analysis, those with mild DCM were more likely to perceive benefit than those with severe DCM, as were those with moderate DCM (to a lesser extent). Individuals whose diagnosis was delayed 1 to 2 years were less likely to perceive benefit than those that waited 0 to 6 months. Conclusions: The provision of nonoperative physiotherapy in the management of DCM is inconsistent and appears to differ from international guidelines. Few patients perceived benefit from physiotherapy; however, this was more likely in those with mild DCM and in those with shorter symptom durations. Further work is needed to establish the appropriate role of physiotherapy for this population.

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Characteristics of Upper Limb Impairment Related to Degenerative Cervical Myelopathy: Development of a Sensitive Hand Assessment (Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy)

Neurosurgery ◽

10.1093/neuros/nyz499 ◽

2019 ◽

Vol 86 (3) ◽

pp. E292-E299 ◽

Cited By ~ 1

Author(s):

Sukhvinder Kalsi-Ryan ◽

Lauren E Riehm ◽

Lindsay Tetreault ◽

Allan R Martin ◽

Florentina Teoderascu ◽

...

Keyword(s):

Upper Limb ◽

Functional Impairment ◽

Cervical Myelopathy ◽

Hand Function ◽

Intraclass Correlation ◽

Japanese Orthopaedic Association ◽

Neurological Impairment ◽

Cord Compression ◽

Manual Dexterity ◽

Degenerative Cervical Myelopathy

Abstract BACKGROUND Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyperreflexia, focal weakness, and sensory impairment. The modified Japanese Orthopaedic Association (mJOA) score relies on the patients’ subjective perceptions, whereas existing objective measures such as strength and sensory testing do not capture subtle changes in dexterity and function. OBJECTIVE 1) To characterize arm and hand function in DCM; and 2) To develop and validate Graded Redefined Assessment of Strength, Sensibility, and Prehension Version-Myelopathy (GRASSP-M), a clinical assessment that quantifies upper limb impairment. METHODS A total of 148 DCM patients (categorized into mild, moderate, and severe based on mJOA grade) and 21 healthy subjects were enrolled. A complete neurological exam, the mJOA, the QuickDASH, grip dynamometry, and the GRASSP-M were administered. RESULTS Strength, sensation, and manual dexterity significantly declined with increasing DCM severity (P ≤ .05). Impairment in hand dexterity showed better discrimination between mild, moderate, and severe DCM categories than strength or sensation. The GRASSP-M was found to be both a reliable (intraclass correlation coefficient >0.75 for intra- and inter-rater reliability) and valid (with both concurrent and construct validity) tool. CONCLUSION These results demonstrate that patients’ subjective reporting of functional status, especially in the mild DCM category, may underrepresent the extent of functional impairment. The GRASSP-M is an objective tool designed to characterize patients’ functional impairment related to the upper limb, which proves useful to diagnose and quantify mild dysfunction, monitor patients for deterioration, and help determine when patients should be treated surgically.

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P78 Recovery priorities for patients with degenerative cervical myelopathy

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.137 ◽

2019 ◽

Vol 90 (3) ◽

pp. e42.3-e43

Author(s):

Benjamin M Davies ◽

Oliver D Mowforth ◽

Iwan Sadler ◽

Bizhan Aarabi ◽

Brian K Kwon ◽

...

Keyword(s):

Cervical Myelopathy ◽

Hand Function ◽

Research Priorities ◽

Bowel Function ◽

Upper Body ◽

Functional Domains ◽

Patient Interviews ◽

Disease Characteristics ◽

Lower Pain ◽

Degenerative Cervical Myelopathy

ObjectivesThe misalignment of patient and researcher objectives has been shown to contribute to research inefficiency and wastage. The patient research priorities in degenerative cervical myelopathy [DCM] are unknown. The present study aimed to establish relevant functional domains and their recovery priority to DCM sufferers.DesignFunctional domains were established from qualitative patient interviews (n=4), and the recovery priority through an e-survey (n=659).SubjectsDCM Patients recruited via a DCM charity [Myelopathy.org] and Google Adwords.MethodsSeven functional domains were identified: arm and hand, walking, upper body/trunk, sexual, elimination of pain, normal sensation and bladder/bowel function. Patients were asked to rank these domains. The influence of disease characteristics on selection was analysed.Results481 complete responses were analysed. Overall, pain was the most popular recovery priority (39.9%), followed by walking (20.2%), sensation (11.9) and arm and hand function (11.5%). Sexual function (5.7%), bladder and bowel (3.7%) or trunk function (3.5%) were chosen less frequently. With respect to disease characteristics, overall pain remained the recovery priority [with the exception of patients with greater walking impairment (p<0.005) who prioritised walking] even amongst patients with lower pain scores.ConclusionsPain is a recovery priority for DCM patients, even amongst those reporting low levels of pain.

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Walk and Run Test in Patients with Degenerative Compression of the Cervical Spinal Cord

Journal of Clinical Medicine ◽

10.3390/jcm10050927 ◽

2021 ◽

Vol 10 (5) ◽

pp. 927

Author(s):

Zdenek Kadanka ◽

Tomas Skutil ◽

Eva Vlckova ◽

Josef Bednarik

Keyword(s):

Cervical Spinal Cord ◽

Japanese Orthopaedic Association ◽

Cord Compression ◽

Cervical Cord ◽

Cross Sectional ◽

Severity Of Disability ◽

Degree Of Disability ◽

Degenerative Cervical Myelopathy ◽

Cardinal Symptoms ◽

Run Test

Impaired gait is one of the cardinal symptoms of degenerative cervical myelopathy (DCM) and frequently its initial presentation. Quantitative gait analysis is therefore a promising objective tool in the disclosure of early cervical cord impairment in patients with degenerative cervical compression. The aim of this cross-sectional observational cohort study was to verify whether an objective and easily-used walk and run test is capable of detecting early gait impairment in a practical proportion of non-myelopathic degenerative cervical cord compression (NMDCC) patients and of revealing any correlation with severity of disability in DCM. The study group consisted of 45 DCM patients (median age 58 years), 126 NMDCC subjects (59 years), and 100 healthy controls (HC) (55.5 years), all of whom performed a standardized 10-m walk and run test. Walking/running time/velocity, number of steps and cadence of walking/running were recorded; analysis disclosed abnormalities in 66.7% of NMDCC subjects. The DCM group exhibited significantly more pronounced abnormalities in all walk/run parameters when compared with the NMDCC group. These were apparent in 84.4% of the DCM group and correlated closely with disability as quantified by the modified Japanese Orthopaedic Association scale. A standardized 10-m walk/run test has the capacity to disclose locomotion abnormalities in NMDCC subjects who lack other clear myelopathic signs and may provide a means of classifying DCM patients according to their degree of disability.

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Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/2192568217710137 ◽

2017 ◽

Vol 7 (3_suppl) ◽

pp. 53S-69S ◽

Cited By ~ 21

Author(s):

Michael G. Fehlings ◽

Lindsay A. Tetreault ◽

Shekar Kurpad ◽

Darrel S. Brodke ◽

Jefferson R. Wilson ◽

...

Keyword(s):

Systematic Review ◽

Operative Treatment ◽

Functional Impairment ◽

Cervical Myelopathy ◽

Surgical Intervention ◽

Japanese Orthopaedic Association ◽

Duration Of Symptoms ◽

Degenerative Cervical Myelopathy ◽

The Impact

Study Design: Systematic review. Objectives: The primary objective of this systematic review was to define the change in impairment, disability, and pain following surgical intervention in patients with degenerative cervical myelopathy (DCM). Secondary objectives included to assess the impact of preoperative disease severity and duration of symptoms on outcomes and to summarize complications associated with surgery. Methods: A systematic literature search was conducted to identify prospective studies evaluating the effectiveness and safety of operative treatment in patients with DCM. Outcomes of interest were functional status, disability, pain, and complications. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Results: Of the 385 retrieved citations, 32 met inclusion criteria and are summarized in this review. Based on our results, pooled standard mean differences showed a large effect for improvement in Japanese Orthopaedic Association or modified Japanese Orthopaedic Association score from baseline at short-, medium-, and long-term follow-up: 6 to 12 months (1.92; 95% confidence interval [CI] = 1.41 to 2.43), 13 to 36 months (1.40; 95% CI = 1.12 to 1.67), and ≥36 months (1.92; 95% CI = 1.14 to 2.69) (moderate evidence). Surgery also resulted in significant improvements in Nurick, Neck Disability Index, and Visual Analogue Scale scores (low to very low evidence). The cumulative incidence of complications was low (14.1%; 95% CI = 10.1% to 18.2%). Conclusion: Surgical intervention for DCM results in significant improvements in functional impairment, disability, and pain and is associated with an acceptably low rate of complications.

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Fashion designers' attitude-behaviour inconsistencies towards a sustainable business model: a neutralisation theory perspective

Journal of Fashion Marketing and Management ◽

10.1108/jfmm-05-2021-0128 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Asphat Muposhi ◽

Brighton Nyagadza ◽

Chengedzai Mafini

Keyword(s):

South Africa ◽

Online Survey ◽

Emerging Market ◽

Survey Study ◽

Future Research ◽

Cross Sectional ◽

Content Type ◽

Study Results ◽

Sustainable Fashion ◽

Fashion Designers

PurposeFashion designers in South Africa remain ambivalent in embracing sustainable fashion. This study examines the role of neutralisation techniques on attitude towards sustainable fashion. The study was conducted in South Africa, an emerging market known for water scarcity and pollution emanating from the textile industry.Design/methodology/approachA structured questionnaire was used to collect cross-sectional data from a sample of 590 fashion designers using a web-based online survey. Study constructs were drawn from the neutralisation theory and theory of planned behaviour.FindingsStandard multiple regression analysis results identified denial of injury, appeal to higher loyalties and external locus of control as the major rationalisation techniques influencing South African designers' negative attitudes towards sustainable fashion.Research limitations/implicationsResearch was conducted in South Africa where the concept of sustainable fashion is still at developmental stages. The generalisation of the study findings may be enhanced by extending the study to other markets with a fully developed market for sustainable fashion.Practical implicationsThe study results underscore the necessity of reducing social, structural and institutional barriers associated with the adoption of sustainable fashion. This study provides input towards efforts to develop attitude change strategies to stimulate designers to embrace sustainable fashion.Originality/valueThe research study contributes to theory, practice and future research.

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Predeath Grief, Resourcefulness, and Perceived Stress Among Caregivers of Partners With Young-Onset Dementia

Western Journal of Nursing Research ◽

10.1177/0193945918806689 ◽

2018 ◽

Vol 41 (7) ◽

pp. 973-989 ◽

Cited By ~ 2

Author(s):

Karie Ruekert Kobiske ◽

Abir K. Bekhet ◽

Mauricio Garnier-Villarreal ◽

Marilyn Frenn

Keyword(s):

Perceived Stress ◽

Online Survey ◽

Theoretical Framework ◽

Future Research ◽

Resilience Theory ◽

Moderating Effects ◽

Cross Sectional ◽

Young Onset ◽

Young Onset Dementia ◽

The Relationship

More than 200,000 Americans are currently diagnosed with young-onset dementia (YOD). YOD is dementia diagnosed prior to the age of 65. Most persons of YOD are cared for by their partners. Using the theoretical framework of Resilience Theory, this cross-sectional, correlational study examined the moderating effects of personal and social resourcefulness on the relationship between predeath grief and perceived stress among 104 YOD caregiving partners (life partners/spouses) using an online survey platform. Results indicated a large positive correlation between predeath grief and caregiver perceived stress ( r = .65; p < .001). Together predeath grief, personal resourcefulness and social resourcefulness explained 51.5% of the variance in perceived stress. Personal resourcefulness did not moderate the relationship. Social resourcefulness did positively moderate this relationship between predeath grief and perceived stress. These findings allow for a better understanding of the caregiving experience for a partner with YOD and creates opportunities for future research studies.

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Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists

BMJ Open ◽

10.1136/bmjopen-2019-030262 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030262 ◽

Cited By ~ 3

Author(s):

Rachel Stockley ◽

Rosemary Peel ◽

Kathryn Jarvis ◽

Louise Connell

Keyword(s):

Upper Limb ◽

Online Survey ◽

Current Therapy ◽

Future Research ◽

Evidence Based ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Constraint Induced Movement Therapy ◽

Therapy Interventions ◽

The Uk

ObjectivesTo survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK.DesignA cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much).SettingThe online survey was distributed via professional and social networks to UK-based therapists.ParticipantsRespondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6 week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists.ResultsRespondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29 min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments.ConclusionsThis study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.

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Age-related factors influence HIV testing within subpopulations: a cross-sectional survey of MSM within the Celtic nations

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053935 ◽

2019 ◽

Vol 95 (5) ◽

pp. 351-357

Author(s):

Jenny Dalrymple ◽

Kareena McAloney-Kocaman ◽

Paul Flowers ◽

Lisa M McDaid ◽

Jamie Scott Frankis

Keyword(s):

Hiv Testing ◽

Online Survey ◽

Future Research ◽

Sociocultural Factors ◽

Health Improvement ◽

Cross Sectional Survey ◽

Related Factors ◽

Cross Sectional ◽

Factors Influencing ◽

Age Related

ObjectivesDespite a recent fall in the incidence of HIV within the UK, men who have sex with men (MSM) continue to be disproportionately affected. As biomedical prevention technologies including pre-exposure prophylaxis are increasingly taken up to reduce transmission, the role of HIV testing has become central to the management of risk. Against a background of lower testing rates among older MSM, this study aimed to identify age-related factors influencing recent (≤12 months) HIV testing.MethodsCross-sectional subpopulation data from an online survey of sexually active MSM in the Celtic nations—Scotland, Wales, Northern Ireland and Ireland (n=2436)—were analysed to compare demographic, behavioural and sociocultural factors influencing HIV testing between MSM aged 16–25 (n=447), 26–45 (n=1092) and ≥46 (n=897).ResultsMultivariate logistic regression demonstrated that for men aged ≥46, not identifying as gay (OR 0.62, CI 0.41 to 0.95), location (Wales) (OR 0.49, CI 0.32 to 0.76) and scoring higher on the personalised Stigma Scale (OR 0.97, CI 0.94 to 1.00) significantly reduced the odds for HIV testing in the preceding year. Men aged 26–45 who did not identify as gay (OR 0.61, CI 0.41 to 0.92) were also significantly less likely to have recently tested for HIV. For men aged 16–25, not having a degree (OR 0.48, CI 0.29 to 0.79), location (Republic of Ireland) (OR 0.55, CI 0.30 to 1.00) and scoring higher on emotional competence (OR 0.57, CI 0.42 to 0.77) were also significantly associated with not having recently tested for HIV.ConclusionKey differences in age-related factors influencing HIV testing suggest health improvement interventions should accommodate the wide diversities among MSM populations across the life course. Future research should seek to identify barriers and enablers to HIV testing among the oldest and youngest MSM, with specific focus on education and stigma.

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EXPERIENCE OF LGBT PATIENTS AND FAMILY WITH HOSPICE AND PALLIATIVE CARE

Innovation in Aging ◽

10.1093/geroni/igz038.2323 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S623-S624

Author(s):

Gary L Stein ◽

Cathy Berkman

Keyword(s):

Palliative Care ◽

Staff Training ◽

Online Survey ◽

Research Policy ◽

Cross Sectional Study ◽

Care Staff ◽

Future Research ◽

Policy And Practice ◽

Cross Sectional ◽

Hospice And Palliative Care

Abstract This study examines the degree to which hospice and palliative care staff observe or perceive inadequate, disrespectful, or abusive care to LGBT patients and family members. A cross-sectional study using an online survey completed by 865 providers, including social workers, physicians, nurses, and chaplains. Among respondents, 55% reported that LGB patients were more likely to experience discrimination at their institution than non-LGB patients; 24% observed discriminatory care; 65% reported that transgender patients were more likely than non-transgender patients to experience discrimination; 20% observed discrimination to transgender patients; 14% observed the spouse/partner of LGBT patients having their treatment decisions disregarded or minimized; and 13% observed the spouse/partner being treated disrespectfully. Findings reported also include: institutional non-discrimination policy, staff training, intake procedures, and comfort in assessing LGBT status. Implications for future research, policy, and practice will be presented.

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