Database

Specialists often assume that osteoarthritis is caused by heavy labouring work. But is it? If it is then defences should be explored as should potential case load. Evidence from: A Lievense et al. Journal of Rheumatology. November (2001) Vol. 28 #11 p 2520. Systematic review of research findings linking work with osteo arthritis of the Hip. 16 articles were selected in out of 2,921 on the grounds of study quality. All retained studies found hip OA associated with heavy vs. light workload. 12 of these were statistically significant but none were high quality cohort studies. That is they were snaphots. So the authors suspect recall bias as a possible explanation for the association. 10 of the 16 studies showed a dose response relationship. Comment This review is of an acceptable quality. The association and dose-response relationships could both be explained by the availability and seeking of medical assistance: Hip OA cases are more likely to seek treatment because pain hinders work hen

Elective surgery is not usually within the scope of this database. However, the current debate about implants illustrates a more general problem of medicalising a sense of low well-being and finding an identifiable event to blame. Any defect in the implant or defective surgery could heighten such concerns, but wouldn’t necessarily make them any more valid. Besides medical liability, product liability could be in the frame. Evidence from: P Tugwell et al. Arthritis and Rheumatism. November (2001) Vol. 44 # 11. p 2477. Links between silicone implants and rheumatological disease have been promoted for many years. This research paper is a review of all the evidence for such an association. 1773 relevant articles using any sort of connective tissue disease (CTD) (including rheumatoid arthritis etc.) outcome as the variable of interest. NO association was found between a new syndrome or established diagnoses. Full report available: http://www.fjc.gov/breimlit/science/report.htm Comment

If rehabilitation interventions are to be provided accurately it seems that adopting same approach for back and neck pain may be inappropriate. Evidence from: SZ George. Spine. October (2001) Vol. 26 #19 p 2139 A refinement of the role of fear avoidance in the course of chronic pain conditions is suggested by this research. The hypothesis being tested is that fear avoidance beliefs (FAB) would have different effects on the course of two very similar injuries located in different parts of the body, the lower back and, neck. FAB believed to be determined by stressful life events, personality, previous history of pain, and pain coping strategy? However it is not clear that the effect of each of these can be independently measured. The study made assessments of cases that had been referred to a chronic pain clinic. FAB were the same for both neck pain and back pain cases, however the associated disability was worse for back cases. Pain and disability were related for back cases but not nec

The work reported here describes a randomised control trial of a locally developed book on the self-management of back pain. Reductions in pain and disability were found during week one in the booklet group and in the advice to exercise group but not in the “both” group. There was no detectable difference between groups in pain/function scores at week three. Evidence from: P Little et al. Spine. October (2001) Vol. 26 #19 p 2065 The Radar report is available to subscribers: 1#11 7

It may be valid to apply a premium weighting on drivers who have recovered from TBI. Evidence from: BE Masel et al. Archives of Physical Medicine and Rehabilitation. November (2001) Vol. 82 #11. p 1526. A study of daytime sleepiness among TBI cases after apparently full recovery. Case series n = 71, 38 months after injury. Measured objectively in a live-in sleep laboratory. 47% hypersomnolance rate did not show up on self-report. That is, the hypersomnolant were unaware of their tendency to sleep during daytime. Comment It is generally held that motorists who fall asleep at the wheel would be aware that there was a risk in advance. This work suggests that former TBI cases (after 38 months) were unaware of their risk of daytime sleeping.

The bio mechanical model of whiplash promotes the orthodoxy that relative motions of head and torso, if eliminated, would eliminate whiplash neck injury. The novel device reported here would reduce relative motion, but its effect on claims would need to be validated. Evidence from: AF Tencer et al. Spine. November (2001) Vol. 26 #22 p 2432. A study of the relative motions of head and torso during rear end collision and the effectiveness of a head restraint air bag. New head restraint air bag was closer to the head, and absorbed some of the shock. Test speeds were below 10 kph. Relative motion was reduced. Comment If relative acceleration is important in causing injury at these speeds the new device would seem to offer some protection. Other studies have shown that even when torso and head are strapped firmly to the same rigid board, a rear end impact results in some deformation of neck alignment.