Maynard Williams

The reliability of selected pain provocation tests for sacroiliac joint pathology

Objective. To assess the inter‐rater reliability of seven pain provocation tests for pain of sacroiliac origin in low back pain patients. Summary of Background Data. Previous studies on the reliability of such tests have produced inconclusive and conflicting results. Methods. Fifty‐one patients with low back pain, with or without radiation into the lower limb, were assessed by one examiner and another drawn from a pool of five. Percent agreement and the Kappa statistic were used to evaluate the reliability of the seven tests. Results. Percent agreement and the Kappa statistic ranged in value from 78% and 0.52 (P < 0.001) to 94% and 0.88 (P < 0.001), respectively, when results for all examiner pairs were pooled. However, two tests demonstrated only marginal reliability when performed by one pair of assessors that examined 43% of the patients. Conclusions. Five of seven tests employed in this study were reliable, the other two were potentially reliable. These tests may be used to detect a sacroiliac source of low back pain, although sensitivity and specificity studies are needed to determine their diagnostic power. [Key words: backache, evaluation studies, reproducibility of results, sacroiliac joint] Spine 1994;19: 1243–1249

A comparison of the effects of two sitting postures on back and referred pain.

This study compared the effects of sitting with portable supports in either a kyphotic or lordotic posture on low-back and referred pain. Two hundred ten patients with low-back and/or referred pain were randomly assigned to either a kyphotic posture or lordotic posture group. The kyphotic and lordotic postures were facilitated by the use of a flat foam cushion or lumbar roll, respectively. Pain location, back pain, and leg pain intensity were assessed over a 24–48-hour period under both standardized clinical settings and general sitting environments. When sitting with a lordotic posture, back and leg pain were significantly reduced and referred pain shifted towards the low back. This study demonstrates that in general sitting environments a lumbar roll results in: 1) reductions in back and leg pain; and 2) centralization of pain. These findings do not apply to patients with stenosis or spondylolisthesis, whose symptoms may be aggravated by use of a lumbar roll.

The effects of repetitive motion on lumbar flexion and erector spinae muscle activity in rowers

OBJECTIVE The purpose of this study was to investigate changes in lumbar flexion together with the pattern and level of muscle activity of selected erector spinae during a rowing trial.Design. Cross-sectional repeated measures design. BACKGROUND Low back pain is a common problem in rowers. The amount of lumbar flexion occurring during rowing might influence the possibility of injury. METHODS Sixteen young adult school rowers participated in the study. Changes in lumbar flexion and muscle activity were recorded across the drive phase, at three stages of an ergometer based rowing trial. Lumbar flexion was calculated by computerised motion analysis of surface markers attached to the spinous processes of L1 and S1. Surface electromyography techniques were used to examine the magnitude of activity from three erector spinae muscles. The median frequency of the electromyographic signal was examined to quantify fatigue in the erector spinae muscles during isometric maximal effort muscle activation prior to and after the rowing trial. RESULTS Lumbar flexion increased significantly (P<0.05) during the rowing trial, as did the magnitude of electromyographic activity from sites over the lumbar multifidus, iliocostalis lumborum and longissimus thoracis muscles. The median frequency decreased significantly (P<0.05) in each muscle examined. CONCLUSIONS The findings showed that rowers attain relatively high levels of lumbar flexion during the rowing stroke, and these levels are increased during the course of the rowing trial. Indirect evidence of muscle fatigue in erector spinae muscles was also apparent, and this observation may in part be responsible for the increased levels of lumbar flexion observed. RELEVANCE Excessive lumbar flexion may influence the potential for injury to spinal structures. An awareness of increased lumbar flexion and muscle fatigue in the erector spinae muscles may be important for injury prevention programs for rowers.

A Prospective Study of Problem and Regular Nonproblem Gamblers Living in the Community

Little is known about the life course of gambling problems and there have been no prospective studies of problem gambling. This article describes a study of 77 problem gamblers and 66 nonproblem gamblers recruited from a national prevalence survey in New Zealand in 1991 and reassessed in 1998. While most 1991 problem gamblers were nonproblematic at follow-up, a significant minority had developed more serious problems. Multiple logistic regression analysis identified more severe gambling problems, hazardous drinking, and a preference for track betting as the strongest independent predictors of subsequent problem gambling. These findings contradict conventional notions that pathological gambling is invariably a chronic or chronically relapsing disorder. The findings have implications for the interpretation of previous research, conduct of future research, and problem gambling policy and treatment.

Chinese migrants’ mental health and adjustment to life in New Zealand

Objective: The purpose of this study was to identify and assess the relative importance of predictors of the self-rated adjustment and psychiatric morbidity of recent Chinese migrants. Method: Chinese migrants (n = 271) living in Auckland and aged 15 years or older completed a postal questionnaire that included the Chinese Health Questionnaire (CHQ). The majority of respondents came from Hong Kong and Taiwan. Results: Most respondents did not report major adjustment problems. The psychiatric morbidity rate was 19%. Major predictors of experiencing problems included rejection by locals, being aged 26–35 years or over 45 years and low English proficiency. Major predictors of poor adjustment included unemployment, low English proficiency, lack of university education, younger age, shorter residency, expectations not met and regrets about coming to New Zealand. Predictors of minor mental disorder included regretting coming, female gender and younger age. For migrants resident 2 years or less, unemployment and underemployment were additional risk factors. Mothers with absent husbands and young people with absent parents also had elevated rates of mental disorder. Conclusions: Although the overall prevalence of mental disorder for this sample of recent migrants appears to be similar to that of the general population, significant risk factors were identified. The findings extend knowledge of the adjustment and the mental health of migrants and provide potential focal points for primary and secondary prevention interventions.

Postnatal depressive symptoms among Pacific mothers in Auckland: prevalence and risk factors

OBJECTIVE To assess the prevalence of and risk factors for postnatal depressive symptoms in a cohort of mothers of Pacific Island infants in Auckland, New Zealand. METHOD The data were gathered as part of the Pacific Island Families Study, in which 1376 mothers were interviewed when their babies were 6 weeks old. The interview included the Edinburgh Postnatal Depression Scale (EPDS). RESULTS 16.4% of mothers were assessed as probably experiencing depression. Prevalence rates varied from 7.6% for Samoans to 30.9% for Tongans. In addition to ethnicity, risk factors identified by stepwise multiple logistic regression included low Pacific Island acculturation, first birth, stress due to insufficient food, household income less than dollar 40,000, difficulty with transport, dissatisfaction with pregnancy, birth experience, babys sleep patterns, partner relationship and home. A large prevalence difference between Tongans and other groups remained when the effects of other risk factors were controlled statistically. CONCLUSIONS The prevalence of depressive symptoms among Pacific mothers is at the upper end of the range typically reported. Focus on the overall rate, however, obscures substantial variation between groups. Risk factors are generally similar to those identified in previous research. IMPLICATIONS The findings have implications for prevention and treatment and caution against assuming homogeneity within ethnic categories. Further research is required to explain differences in prevalence between Tongan and other Pacific Island groups.

Effects of a stress-management program on injury and stress of competitive gymnasts

20 competitive gymnasts (17 girls, 3 boys; mean age, 14.4 ± 3.4 yr.) were recruited from two clubs in Auckland, New Zealand. Gymnasts, who had competed at a national or international level, were divided into two groups to examine the effects of a longitudinal stress-management program on injury and stress. Those in the stress-management group took part in 12 1-hr. sessions over 24 weeks, while the control group took part in a placebo program of anthropometric measurements and lectures on nutrition. All participants completed the Life Experiences Survey and Athletic Experiences Survey at baseline, 3 mo., 6 mo. (end of intervention), and 9 mo. (3 mo. after completion of intervention). Injury data were collected prospectively by weekly self-report over the 9-mo. study. Repeated-measures analyses of covariance with age and, where applicable, the baseline measure of the dependent variable entered as covariates, indicated no significant group or group by time effects for the scores on the two surveys, or injury scores. However, given the small sample, the statistical power of the study to detect even large effects was low. Therefore, rather than concluding that the stress-management program had no effect on training hours lost to injury or on stress, upper limits were placed on the magnitude of any effects that might exist. Further research using larger samples is recommended.

Intimate Partner Violence Within a Cohort of Pacific Mothers Living in New Zealand

Maternal reports of intimate partner violence (IPV) were obtained from a cohort of Pacific mothers living in New Zealand. The Conflict Tactics Scale was completed by 1,095 women who had given birth in the past 12 months, and who were married or living with a partner as married. The 12-month prevalence of “victimization” through verbal aggression was 77%, 21% for “minor” physical violence, and 11% for “severe” physical violence. The 12-month prevalence of “perpetration” of verbal aggression against a partner was 90%, 35% for “minor” physical violence, and 19% for “severe” violence towards their partner. The experience of social inequality and acculturation are associated with IPV, albeit differentially across the experience of victimization and perpetration. Factors significantly associated with victimization are ethnicity, maternal education, social marital status and household income. Factors significantly associated with perpetration are ethnicity, cultural alignment, maternal birthplace and alcohol consumption since the birth of the child.

Recent Chinese migrants' health, adjustment to life in New Zealand and primary health care utilization

A community survey of 271 Chinese migrants aged 15 years and older living in Auckland was conducted to assess self-rated adjustment and health. The majority of respondents came from Hong Kong and Taiwan. Despite significant changes in their lives, including the absence of family members, unemployment and underemployment, most did not report major adjustment problems or regret having come to New Zealand. Few considered their health to be poor. Forty-two per cent reported having consulted a doctor within the past 12 weeks. Factors significantly associated with having experienced major problems included being aged 26-35 years, rejection from locals and having low English proficiency. Factors associated with poor adjustment included expectations not having been met, regretting coming, low proficiency in English, recent arrival in New Zealand, unemployment, younger age and lower levels of education. Self-rated fair or poor health was found to be associated with Chinese-only reading knowledge, residency of more than 5 years and regretting having come to New Zealand.

Traditional Gift Giving Among Pacific Families in New Zealand

The Pacific population in New Zealand is socially disadvantaged and over-represented in adverse social and health statistics. A cohort of 1,376 mothers of Pacific infants were asked about traditional gift commitments and the effect that these commitments had on the financial situation in their household. Sixty-two percent reported that they and/or their partner usually gave to their family or church, with 66.5% of this group giving to family in New Zealand, 58% to family in the Pacific Islands, and 75.9% to their church. Fifty-nine percent of these mothers reported that this gift commitment made their household financial situation more difficult. Factors significantly associated with gift giving are discussed, together with implications of these findings for Pacific families living New Zealand.