Stephanie Davies - Academia.edu (original) (raw)
Papers by Stephanie Davies
Pain practice : the official journal of World Institute of Pain
... Eric J. Visser MBBS, FANZCA, FFPMANZCA,; Stephanie Davies MBBS, FANZCA, FFPMANZCA. ... Author... more ... Eric J. Visser MBBS, FANZCA, FFPMANZCA,; Stephanie Davies MBBS, FANZCA, FFPMANZCA. ... Author Information. Pain Medicine Unit Fremantle Hospital and Health Service Western Australia, Australia E-mail: eric.visser@health.wa.gov.au; stephanie.davies@health.wa.gov.au ...
Pain Practice, 2014
The aim of this study was to investigate the hypothesis that chronic widespread pain, (CWP) drawn... more The aim of this study was to investigate the hypothesis that chronic widespread pain, (CWP) drawn by patients on a body diagram, could be used as a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies. The triage questionnaires of 144 adults attending a chronic pain outpatients' clinic were audited and the percentage pain surface area (PPSA) drawn on their body diagrams was calculated using the "rule of nines" (RON) method for burns area assessment. Outcomes were measured using the painDETECT Questionnaire (PD-Q) and other indices and compared using a nonrandomized, case-control method. It was found that significantly more subjects with CWP (defined as a PPSA ≥ 20%) reported high (≥ 19) PD-Q scores (suggesting pain "sensitization" or neuropathic pain) (P = 0.0002), "severe" or "extremely severe" anxiety scores on the Depression, Anxiety and Stress Scale-21 Items Questionnaire (P = 0.0270), ≥ 5 psycho-social stressors (P = 0.0022), ≥ 5 significant life events (P = 0.0098), and used ≥ 7 pain management strategies (PMS) (P < 00001), compared to control subjects with a lower PPSA. A Widespread Pain Index score ≥ 7 (OR = 11.36), PD-Q score ≥ 19 (OR = 4.46) and use of ≥ 7 PMS (OR = 5.49) were independently associated with CWP. This study demonstrates that calculating PPSA on a body diagram (using the RON method) is a valid and convenient "snapshot" screening tool to identify patients with an increased likelihood of pain sensitization, psycho-social load, and utilizing pain management resources.
Survey of Anesthesiology, 1998
PLoS ONE, 2012
Background: Persistent non-specific low back pain (nsLBP) is poorly understood by the general com... more Background: Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policyinto-practice intervention developed for primary care physicians (PCPs).
Pain Medicine, 2011
Two Australian public hospital multidisciplinary pain centers (MPCs) situated on opposite sides o... more Two Australian public hospital multidisciplinary pain centers (MPCs) situated on opposite sides of the country. Restructuring our services to become patient-centred and patient-driven by enabling entry to our MPCs through an education portal, inclusive of both knowledge and self-management skills, and to then be free to select particular treatment options on the basis of evidence of known efficacy (risk/benefit). Group-based education to inform our patients of the current state of uncertainty that exists in Pain Medicine, both in regard to diagnostic and therapeutic practices. Using an interprofessional team approach, we aimed to present practical and evidence-based advice on techniques of pain self-management and existing traditional medical options. Early, resource efficient, group intervention provides many patients with sufficient information to make informed decisions and enables them to partner us in engaging a whole person approach to their care. We have implemented routine comprehensive audits of clinical services to better inform the planning and provision of health care across health services. System plasticity is as important to the process of integrated health care as it is to our understanding of the complexity of the lived experience of pain. Better-informed consumers partnered with responsive health professionals drive the proposed paradigm shift in service delivery. The changes better align the needs of consumers with the ability of health care providers to meet them, thus achieving the twin goals of patient empowerment and system efficiency.
Pain Medicine, 2011
To assess the effects of preclinic group education sessions and system redesign on tertiary pain ... more To assess the effects of preclinic group education sessions and system redesign on tertiary pain medicine units and patient outcomes. Prospective cohort study. Two public hospital multidisciplinary pain medicine units. People with persistent pain. A system redesign from a "traditional" model (initial individual medical appointments) to a model that delivers group education sessions prior to individual appointments. Based on Patient Triage Questionnaires patients were scheduled to attend Self-Training Educative Pain Sessions (STEPS), a two day eight hour group education program, followed by optional patient-initiated clinic appointments. Number of patients completing STEPS who subsequently requested individual outpatient clinic appointment(s); wait-times; unit cost per new patient referred; recurrent health care utilization; patient satisfaction; Global Perceived Impression of Change (GPIC); and utilized pain management strategies. Following STEPS 48% of attendees requested individual outpatient appointments. Wait times reduced from 105.6 to 16.1 weeks at one pain unit and 37.3 to 15.2 weeks at the second. Unit cost per new patient appointed reduced from 1,805AustralianDollars(AUD)toAUD1,805 Australian Dollars (AUD) to AUD1,805AustralianDollars(AUD)toAUD541 (for STEPS). At 3 months, patients scored their satisfaction with "the treatment received for their pain" more positively than at baseline (change score=0.88; P=0.0003), GPIC improved (change score=0.46; P<0.0001) and mean number of active strategies utilized increased by 4.12 per patient (P=0.0004). The introduction of STEPS was associated with reduced wait-times and costs at public pain medicine units and increased both the use of active pain management strategies and patient satisfaction.
Pain Medicine, 2006
Michael S. Kaplan, PhD, MD, Leah R. Kaplan, BA Rehabilitation Team West, PA, Baltimore, Maryland,... more Michael S. Kaplan, PhD, MD, Leah R. Kaplan, BA Rehabilitation Team West, PA, Baltimore, Maryland, USA It has been our observation that our chronic pain adult patients often fit the characteristic of ADHD. Inatten-tion, Hyperactivity, and Impulsivity. Our evidence now demonstrates ...
The Medical Journal of Australia, 2013
European Journal of Pain Supplements, 2011
A questionnaire survey of cancer inpatients from the Oncology clinic of the Lithuanian University... more A questionnaire survey of cancer inpatients from the Oncology clinic of the Lithuanian University of Health Sciences Hospital has been conducted. Patients were administered a validated scale to measure perceived pain communication, the Lithuanian versions of the Barriers Questionnaire -II and the Brief Pain Inventory. Statistical analyses included descriptive and correlation analyses. Results: Responses from 30 cancer patients were analysed. The average (SD) level of self-reported perceived pain communication was 3.1 (0.95) on a scale 0-5, with higher score indicating better pain communication. The biggest patients' concerns were about physiological consequences of opioid use: 3.9 (0.10) on a scale 0-5, with higher score indicating larger barriers. Reported average (SD) pain intensity was 3.9 (1.30) on a scale 0-10, with higher score indicating more intense pain. In correlation analyses, perceived pain communication was negatively related with age (r = −0.37, p < 0.05), the belief that "good" patients do not complain about pain (r = −0.39, p < 0.05), and the concerns about physiological consequences of opioid use (r = −0.42, p < 0.05). Conclusions: Cancer patients, especially older ones, should be specifically informed about the importance of honest pain report. The physiological effects of opioid use should be explained to those patients in more detail.
BMC Musculoskeletal Disorders, 2012
Background: In Western Australia (WA), health policy recommends encouraging the use of active sel... more Background: In Western Australia (WA), health policy recommends encouraging the use of active self-management strategies as part of the co-care of consumers with persistent low back pain (LBP). As many areas in WA are geographically isolated and health services are limited, implementing this policy into practice is critical if health outcomes for consumers living in geographically-isolated areas are to be improved.
BMC Health Services Research, 2012
Background: Coordinated, interdisciplinary services, supported by self-management underpin effect... more Background: Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. Methods: Fourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals' access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes. Results: Five key themes were identified that affected individuals' experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP. Conclusions: Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.
Anesthesia & Analgesia, 1997
Epidural anesthesia (EA) and combined spinalepidural anesthesia (CSEA) are popular anesthetic tec... more Epidural anesthesia (EA) and combined spinalepidural anesthesia (CSEA) are popular anesthetic techniques for elective cesarean section. A randomized, blind study was conducted to compare maternal experiences during these regional anesthetics. EA was established using alkalinized 2% lidocaine with epinephrine and fentanyl, whereas spinal anesthesia was performed using 2.5 mL hyperbaric 0.5% bupivacaine and fentanyl via a single-space CSEA approach. Both patients and observers were blinded to the anesthetic technique allocation. One hundred twenty patients were enrolled; 6 were withdrawn (Group EA, n = 55; Group CSEA, n = 59). Of the two techniques, CSEA was associated with earlier onset times (P < O.OOl), more intense motor block (P < 0.05), and greater ephedrine use (P < 0.01). Anxiety was significantly lower (P < 0.05) and satisfaction was higher (P < 0.05) before starting surgery with CSEA. Pain scores were lower pre-and intraoperatively with CSEA, a difference that became significant during block placement and at delivery (P < 0.05). There were no differences between groups in the incidence or severity of hypotension and nausea or analgesic supplementation rate; or for postoperative assessments of intraoperative pain, anxiety and satisfaction, and postpartum backache and headache. We conclude that maternal conditions and experience were good with both methods, although CSEA conferred several minor advantages.
Acta Orthopaedica, 2002
We designed a prospective study to examine the influence of graft type (hamstring or patella tend... more We designed a prospective study to examine the influence of graft type (hamstring or patella tendon) on thigh muscle torque recovery after anterior cruciate ligament reconstruction. 60 patients undergoing ACL reconstruction, using a hamstring or patella tendon graft, were studied and 45 were followed up to 1 year. Concentric and eccentric quadriceps and hamstring torque were recorded, using an isokinetic dynamometer preoperatively, 6 and 12 months after ACL reconstruction. We found an improvement in all muscle functions in both the operated and unoperated legs during the recovery period. Graft type had no effect on recovery. During the first 6 months, torque was restored to preoperative levels and continued to improve in all muscles and actions between 6 months and 1 year.
Pain Medicine, 2014
To provide access to professional development opportunities for health care professionals, especi... more To provide access to professional development opportunities for health care professionals, especially in rural Australian regions, consistent with recommendations in the Australian National Pain Strategy and state government policy. A preliminary prospective, single-cohort study design, which aligned health policy with evidence-informed clinical practice, evaluated the implementation and effectiveness of an interprofessional, health care provider pain education program (hPEP) for management of nonspecific low back pain (nsLBP) in rural Western Australia. The 6.5-hour hPEP intervention was delivered to 60 care providers (caseload nsLBP 19.8% ± 22.5) at four rural WA regions. Outcomes were recorded at baseline and 2 months post-intervention regarding attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale [HC-PAIRS]), Back Pain Beliefs Questionnaire [BBQ]), and self-reported evidence-based clinical practice (knowledge and skills regarding nsLBP, rated on a 5-point Likert scale with 1 = nil and 5 = excellent). hPEP was feasible to implement. At 2 months post-hPEP, responders&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (response rate 53%) improved evidence-based beliefs were indicated by HC-PAIRS scores: baseline mean (SD) [43.2 (9.3)]; mean difference (95% CI) [-5.9 (-8.6 to -3.1)]; and BBQ baseline [34.3 (6.8)]; mean difference [2.1 (0.5 to 3.6)]. Positive shifts were observed for all measures of clinical knowledge and skills (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and increased assistance with planning lifestyle changes (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), advice on self-management (P = 0.010), and for decreased referrals for spinal imaging (P = 0.03). This policy-into-practice educational program is feasible to implement in rural Western Australia (WA). While preliminary data are encouraging, a further randomized controlled trial is recommended.
Pain practice : the official journal of World Institute of Pain
... Eric J. Visser MBBS, FANZCA, FFPMANZCA,; Stephanie Davies MBBS, FANZCA, FFPMANZCA. ... Author... more ... Eric J. Visser MBBS, FANZCA, FFPMANZCA,; Stephanie Davies MBBS, FANZCA, FFPMANZCA. ... Author Information. Pain Medicine Unit Fremantle Hospital and Health Service Western Australia, Australia E-mail: eric.visser@health.wa.gov.au; stephanie.davies@health.wa.gov.au ...
Pain Practice, 2014
The aim of this study was to investigate the hypothesis that chronic widespread pain, (CWP) drawn... more The aim of this study was to investigate the hypothesis that chronic widespread pain, (CWP) drawn by patients on a body diagram, could be used as a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies. The triage questionnaires of 144 adults attending a chronic pain outpatients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinic were audited and the percentage pain surface area (PPSA) drawn on their body diagrams was calculated using the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;rule of nines&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (RON) method for burns area assessment. Outcomes were measured using the painDETECT Questionnaire (PD-Q) and other indices and compared using a nonrandomized, case-control method. It was found that significantly more subjects with CWP (defined as a PPSA ≥ 20%) reported high (≥ 19) PD-Q scores (suggesting pain &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;sensitization&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or neuropathic pain) (P = 0.0002), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;severe&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;extremely severe&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; anxiety scores on the Depression, Anxiety and Stress Scale-21 Items Questionnaire (P = 0.0270), ≥ 5 psycho-social stressors (P = 0.0022), ≥ 5 significant life events (P = 0.0098), and used ≥ 7 pain management strategies (PMS) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 00001), compared to control subjects with a lower PPSA. A Widespread Pain Index score ≥ 7 (OR = 11.36), PD-Q score ≥ 19 (OR = 4.46) and use of ≥ 7 PMS (OR = 5.49) were independently associated with CWP. This study demonstrates that calculating PPSA on a body diagram (using the RON method) is a valid and convenient &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;snapshot&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; screening tool to identify patients with an increased likelihood of pain sensitization, psycho-social load, and utilizing pain management resources.
Survey of Anesthesiology, 1998
PLoS ONE, 2012
Background: Persistent non-specific low back pain (nsLBP) is poorly understood by the general com... more Background: Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policyinto-practice intervention developed for primary care physicians (PCPs).
Pain Medicine, 2011
Two Australian public hospital multidisciplinary pain centers (MPCs) situated on opposite sides o... more Two Australian public hospital multidisciplinary pain centers (MPCs) situated on opposite sides of the country. Restructuring our services to become patient-centred and patient-driven by enabling entry to our MPCs through an education portal, inclusive of both knowledge and self-management skills, and to then be free to select particular treatment options on the basis of evidence of known efficacy (risk/benefit). Group-based education to inform our patients of the current state of uncertainty that exists in Pain Medicine, both in regard to diagnostic and therapeutic practices. Using an interprofessional team approach, we aimed to present practical and evidence-based advice on techniques of pain self-management and existing traditional medical options. Early, resource efficient, group intervention provides many patients with sufficient information to make informed decisions and enables them to partner us in engaging a whole person approach to their care. We have implemented routine comprehensive audits of clinical services to better inform the planning and provision of health care across health services. System plasticity is as important to the process of integrated health care as it is to our understanding of the complexity of the lived experience of pain. Better-informed consumers partnered with responsive health professionals drive the proposed paradigm shift in service delivery. The changes better align the needs of consumers with the ability of health care providers to meet them, thus achieving the twin goals of patient empowerment and system efficiency.
Pain Medicine, 2011
To assess the effects of preclinic group education sessions and system redesign on tertiary pain ... more To assess the effects of preclinic group education sessions and system redesign on tertiary pain medicine units and patient outcomes. Prospective cohort study. Two public hospital multidisciplinary pain medicine units. People with persistent pain. A system redesign from a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;traditional&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; model (initial individual medical appointments) to a model that delivers group education sessions prior to individual appointments. Based on Patient Triage Questionnaires patients were scheduled to attend Self-Training Educative Pain Sessions (STEPS), a two day eight hour group education program, followed by optional patient-initiated clinic appointments. Number of patients completing STEPS who subsequently requested individual outpatient clinic appointment(s); wait-times; unit cost per new patient referred; recurrent health care utilization; patient satisfaction; Global Perceived Impression of Change (GPIC); and utilized pain management strategies. Following STEPS 48% of attendees requested individual outpatient appointments. Wait times reduced from 105.6 to 16.1 weeks at one pain unit and 37.3 to 15.2 weeks at the second. Unit cost per new patient appointed reduced from 1,805AustralianDollars(AUD)toAUD1,805 Australian Dollars (AUD) to AUD1,805AustralianDollars(AUD)toAUD541 (for STEPS). At 3 months, patients scored their satisfaction with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;the treatment received for their pain&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; more positively than at baseline (change score=0.88; P=0.0003), GPIC improved (change score=0.46; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) and mean number of active strategies utilized increased by 4.12 per patient (P=0.0004). The introduction of STEPS was associated with reduced wait-times and costs at public pain medicine units and increased both the use of active pain management strategies and patient satisfaction.
Pain Medicine, 2006
Michael S. Kaplan, PhD, MD, Leah R. Kaplan, BA Rehabilitation Team West, PA, Baltimore, Maryland,... more Michael S. Kaplan, PhD, MD, Leah R. Kaplan, BA Rehabilitation Team West, PA, Baltimore, Maryland, USA It has been our observation that our chronic pain adult patients often fit the characteristic of ADHD. Inatten-tion, Hyperactivity, and Impulsivity. Our evidence now demonstrates ...
The Medical Journal of Australia, 2013
European Journal of Pain Supplements, 2011
A questionnaire survey of cancer inpatients from the Oncology clinic of the Lithuanian University... more A questionnaire survey of cancer inpatients from the Oncology clinic of the Lithuanian University of Health Sciences Hospital has been conducted. Patients were administered a validated scale to measure perceived pain communication, the Lithuanian versions of the Barriers Questionnaire -II and the Brief Pain Inventory. Statistical analyses included descriptive and correlation analyses. Results: Responses from 30 cancer patients were analysed. The average (SD) level of self-reported perceived pain communication was 3.1 (0.95) on a scale 0-5, with higher score indicating better pain communication. The biggest patients' concerns were about physiological consequences of opioid use: 3.9 (0.10) on a scale 0-5, with higher score indicating larger barriers. Reported average (SD) pain intensity was 3.9 (1.30) on a scale 0-10, with higher score indicating more intense pain. In correlation analyses, perceived pain communication was negatively related with age (r = −0.37, p < 0.05), the belief that "good" patients do not complain about pain (r = −0.39, p < 0.05), and the concerns about physiological consequences of opioid use (r = −0.42, p < 0.05). Conclusions: Cancer patients, especially older ones, should be specifically informed about the importance of honest pain report. The physiological effects of opioid use should be explained to those patients in more detail.
BMC Musculoskeletal Disorders, 2012
Background: In Western Australia (WA), health policy recommends encouraging the use of active sel... more Background: In Western Australia (WA), health policy recommends encouraging the use of active self-management strategies as part of the co-care of consumers with persistent low back pain (LBP). As many areas in WA are geographically isolated and health services are limited, implementing this policy into practice is critical if health outcomes for consumers living in geographically-isolated areas are to be improved.
BMC Health Services Research, 2012
Background: Coordinated, interdisciplinary services, supported by self-management underpin effect... more Background: Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. Methods: Fourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals' access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes. Results: Five key themes were identified that affected individuals' experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP. Conclusions: Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.
Anesthesia & Analgesia, 1997
Epidural anesthesia (EA) and combined spinalepidural anesthesia (CSEA) are popular anesthetic tec... more Epidural anesthesia (EA) and combined spinalepidural anesthesia (CSEA) are popular anesthetic techniques for elective cesarean section. A randomized, blind study was conducted to compare maternal experiences during these regional anesthetics. EA was established using alkalinized 2% lidocaine with epinephrine and fentanyl, whereas spinal anesthesia was performed using 2.5 mL hyperbaric 0.5% bupivacaine and fentanyl via a single-space CSEA approach. Both patients and observers were blinded to the anesthetic technique allocation. One hundred twenty patients were enrolled; 6 were withdrawn (Group EA, n = 55; Group CSEA, n = 59). Of the two techniques, CSEA was associated with earlier onset times (P < O.OOl), more intense motor block (P < 0.05), and greater ephedrine use (P < 0.01). Anxiety was significantly lower (P < 0.05) and satisfaction was higher (P < 0.05) before starting surgery with CSEA. Pain scores were lower pre-and intraoperatively with CSEA, a difference that became significant during block placement and at delivery (P < 0.05). There were no differences between groups in the incidence or severity of hypotension and nausea or analgesic supplementation rate; or for postoperative assessments of intraoperative pain, anxiety and satisfaction, and postpartum backache and headache. We conclude that maternal conditions and experience were good with both methods, although CSEA conferred several minor advantages.
Acta Orthopaedica, 2002
We designed a prospective study to examine the influence of graft type (hamstring or patella tend... more We designed a prospective study to examine the influence of graft type (hamstring or patella tendon) on thigh muscle torque recovery after anterior cruciate ligament reconstruction. 60 patients undergoing ACL reconstruction, using a hamstring or patella tendon graft, were studied and 45 were followed up to 1 year. Concentric and eccentric quadriceps and hamstring torque were recorded, using an isokinetic dynamometer preoperatively, 6 and 12 months after ACL reconstruction. We found an improvement in all muscle functions in both the operated and unoperated legs during the recovery period. Graft type had no effect on recovery. During the first 6 months, torque was restored to preoperative levels and continued to improve in all muscles and actions between 6 months and 1 year.
Pain Medicine, 2014
To provide access to professional development opportunities for health care professionals, especi... more To provide access to professional development opportunities for health care professionals, especially in rural Australian regions, consistent with recommendations in the Australian National Pain Strategy and state government policy. A preliminary prospective, single-cohort study design, which aligned health policy with evidence-informed clinical practice, evaluated the implementation and effectiveness of an interprofessional, health care provider pain education program (hPEP) for management of nonspecific low back pain (nsLBP) in rural Western Australia. The 6.5-hour hPEP intervention was delivered to 60 care providers (caseload nsLBP 19.8% ± 22.5) at four rural WA regions. Outcomes were recorded at baseline and 2 months post-intervention regarding attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale [HC-PAIRS]), Back Pain Beliefs Questionnaire [BBQ]), and self-reported evidence-based clinical practice (knowledge and skills regarding nsLBP, rated on a 5-point Likert scale with 1 = nil and 5 = excellent). hPEP was feasible to implement. At 2 months post-hPEP, responders&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (response rate 53%) improved evidence-based beliefs were indicated by HC-PAIRS scores: baseline mean (SD) [43.2 (9.3)]; mean difference (95% CI) [-5.9 (-8.6 to -3.1)]; and BBQ baseline [34.3 (6.8)]; mean difference [2.1 (0.5 to 3.6)]. Positive shifts were observed for all measures of clinical knowledge and skills (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and increased assistance with planning lifestyle changes (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), advice on self-management (P = 0.010), and for decreased referrals for spinal imaging (P = 0.03). This policy-into-practice educational program is feasible to implement in rural Western Australia (WA). While preliminary data are encouraging, a further randomized controlled trial is recommended.