Multimethod assessment of treatment process in chronic low back pain: comparison of reported pain-related anxiety with directly measured physical capacity

Although cognitive behavioural treatments (CBT) have proven efficacy in improving symptom management, pain-related distress, physical performance and return to work. few studies have examined the relationship between changes in behavioural process variables during treatment and improvement in outcome variables following treatment. We designed a multimethod assessment strategy to test the relative contribution of changes in physical capacity and pain-related anxiety to treatment outcome variables. Low back pain patients (n = 59) were treated with an intensive programme of physical exercise and CBT. Comparisons from pre- to post-treatment showed significant improvement in pain severity, interference, affective distress, activity level, and depression. Improvements in pain-related anxiety were associated with improvements in all outcome variables except interference. Of three physical capacity composite scores, improvement in only one (lumbar extension and flexion capacity) was associated with improvements in all outcome variables except interference. Further analyses demonstrated that the relationship between changes in pain-related anxiety and treatment outcome were independent of changes in physical capacity performance. Changes during treatment in pain-related anxiety may be more important than changes during treatment in physical capacity when predicting the effect of treatment on behavioural outcome measures. These results are discussed in the context of how to improve assessment of the chronic pain patient and improve the effectiveness of multidisciplinary CBT.     

Hypochondriasis Among Patients with Multiple Somatoform Symptoms—Psychopathology and Outcome of a Cognitive-Behavioral Therapy

As hypochondriasis often occurs with somatization, patients with somatization disorder plus hypochondriasis were compared to patients with somatization syndrome alone regarding psychopathology, patterns of physical symptoms and outcome of a cognitive-behavioral inpatient treatment. A sample of patients with DSM-IV hypochondriasis and multiple somatoform symptoms(N = 27) and a matched sample of patients with multiple somatoform symptoms but without hypochondriasis (N = 27) were assessed. All subjects obtained a cognitive-behavioral treatment for somatization and hypochondriasis. Assessment took place at admission and at one-year follow-up. Only a few differences between the groups were found: Hypochondriacs suffered more often from abdominal pain, and they reported a higher intolerance of bodily complaints. At follow-up, all outcome variables improved significantly. High effect sizes were found for the reduction of symptoms and the mean number of visits to the doctor. The specific effect on health care use highlights the socioeconomic relevance of these results.     

Sphincter of Oddi dysfunction: Does Psychosocial Distress Play a Role?

Sphincter of Oddi dysfunction (SOD) is a functional gastrointestinal disorder characterized by pancreatobiliary-type of pain in the absence of organic abnormalities. The aim of this study was to investigate specific psychosocial predictors of functional outcome in a group of patients consecutively referred to a gastroenterological department for biliary-type of pain. Based on medical examination patients were divided into functional (SOD) and organic groups. Self-administered questionnaires regarding demographic characteristics, psychological distress (Symptom Check-List-90–R, [SCL-90-R]), severity of acute and chronic stress, level of subjective well-being and satisfaction with health were completed. The analyses were based on the logistic regression approach. In this sample, SOD patients were older than organic patients and more likely female. Logistic regression analysis showed that higher acute stress (i.e., main effect) was associated with a decreased likelihood of functional (SOD) outcome, whereas the combination of acute stress with chronic stress and the combination of acute stress with higher severity of psychopathology (i.e., interaction effect) was associated with an increased likelihood of functional (SOD) outcome. These findings suggest stressful life events in combination with certain psychological symptoms can play a role in the symptom presentation of patients with sphincter of Oddi dysfunction.     

Body language reading of emotion in schizophrenia: Associations with symptoms and functional outcome

Our aim was to explore how body language reading of emotion relates to neurocognition, symptoms and functional outcome in schizophrenia. Fifty‐four individuals with schizophrenia and eighty‐four healthy controls participated in the study. Emotion perception was assessed with a point‐light display (PLD) task, the Emotion in Biological Motion (EmoBio) test, neurocognition was measured with the MATRICS Consensus Cognitive Battery (MCCB), and functioning was indexed by one measure of functional capacity and by one self‐report questionnaire. Clinical symptoms were assessed with a five factor Positive and Negative Syndrome Scale (PANSS) symptoms model. Participants with schizophrenia had impaired body language reading of emotions compared to healthy controls (Cohen's d = 0.69). In participants with schizophrenia, emotion perception was associated with neurocognition (r = 0.42), functional capacity (r = 0.27) and disorganization symptoms (r = –0.27). Mediation analyses showed that disorganization symptoms mediated the effects of emotion perception and neurocognition, respectively, on social functional capacity. These results suggest that in individuals with schizophrenia, reduced emotion perception from body movements has negative consequences for functional outcome, but that the effect is mediated through disorganization symptoms.     

Physical recovery in Arthroscopic knee surgery: unique contributions of coping behaviors to clinical outcomes and stress reactivity

Few studies have examined whether certain coping behaviors are associated with physical outcomes following surgery. This prospective, longitudinal study investigated the effect of active and avoidant coping behaviors on two physical outcomes over time, pain and knee function, in a group of patients experiencing knee arthroscopic surgery (n = 81). Structured interviews and physician clinical assessments were conducted preoperatively and at 3 and 24 weeks postoperatively. Coping behavior was assessed during the preoperative interview, and patients were divided into high and low avoidant and active coping groups. Using repeated measures MANCOVA/ANCOVA, avoidant coping was significantly associated with knee pain and active coping was associated with knee function. Serum cortisol levels were available for a patient subset (n = 16); higher cortisol was related to both avoidant coping and poorer functioning during early recovery. Results suggest that these divergent coping behaviors are differentially associated with stress reactivity and physical outcomes in healthy patients undergoing minor knee surgery.     

Distinct performance profiles on the Brixton test in frontotemporal dementia

The Brixton Spatial Anticipation Test is a well-established test of executive function that evaluates the capacity to abstract, follow, and switch rules. There has been remarkably little systematic analysis of Brixton test performance in the prototypical neurodegenerative disorder of the frontal lobes: behavioural variant frontotemporal dementia (bvFTD) or evaluation of the test’s ability to distinguish frontal from temporal lobe degenerative disease. We carried out a quantitative and qualitative analysis of Brixton performance in 76 patients with bvFTD and 34 with semantic dementia (SD) associated with temporal lobe degeneration. The groups were matched for demographic variables and illness duration. The bvFTD group performed significantly more poorly (U = 348, p < .0001, r = .58), 53% of patients scoring in the poor–impaired range compared with 6% of SD patients. Whereas bvFTD patients showed problems in rule acquisition and switching, SD patients did not, despite their impaired conceptual knowledge. Error analysis revealed more frequent perseverative errors in bvFTD, particularly responses unconnected to the stimulus, as well as random responses. Stimulus-bound errors were rare. Within the bvFTD group, there was variation in performance profile, which could not be explained by demographic, neurological, or genetic factors. The findings demonstrate sensitivity and specificity of the Brixton test in identifying frontal lobe degenerative disease and highlight the clinical value of qualitative analysis of test performance. From a theoretical perspective, the findings provide evidence that semantic knowledge and the capacity to acquire rules are dissociable. Moreover, they exemplify the separable functional contributions to executive performance.     

The psychosocial predictors of long-term distress in partners of patients with acute coronary syndrome

Objective: Partners of acute coronary syndrome (ACS) patients are at risk of experiencing long-term distress and the purpose of this study was to identify its predictors.

Design: Using an observational design, 80 partners of ACS patients completed validated questionnaires at three time points. The predictor variables, marital satisfaction and optimism were assessed three weeks after patient hospital discharge (T1). The outcomes, depressive symptoms and physical health status (from a quality of life scale) were measured 6 (T2) and 12 (T3) months post-discharge, and scores were combined to indicate the long-term response.

Main outcome measures: Depressive symptoms and physical health status.

Results: Partner depressive symptoms increased and physical health status deteriorated over the months following the patients’ ACS. After controlling for demographics, clinical severity of ACS and T1 levels of the outcome variable, partners’ long-term depressive symptoms were predicted by poor marital satisfaction and low optimism at T1, and poor physical health status was predicted by low T1 optimism.

Conclusion: Psychosocial factors are predictors of long-term distress for ACS partners. Partners in an unhappy marriage or with low optimism after ACS are at an increased risk of depression and low physical health status, and should be the target of additional support.     

The correlations of socioeconomic status,disease activity,quality of life,and depression/anxiety in Chinese patients with rheumatoid arthritis

This study aimed (i) to investigate the relationships among socioeconomic status, disease activity, quality of life, and the psychological status in Chinese rheumatoid arthritis (RA) patients; (ii) to explore the possible risk factors of anxiety and depression. A total of 160 RA patients underwent standardized laboratory examinations and completed several questionnaires. Independent samples t-tests, χ² analyses, and logistic regression modeling were used to analyze the data. We found 30.6% RA patients were anxiety, and 27.5% had depression, which were significantly higher than the control group (7.8 and 11.7%, respectively). And there were significant correlations among education, pain, disease activity, medication adherence, functional capacity, quality of life, and anxiety/depression. Meanwhile, logistic regression analysis revealed that poor quality of life and low education level were significantly associated with anxiety/depression in RA patients. In conclusion, there were significant relationships among education, quality of life, and anxiety/depression in Chinese RA patients.     

Negative perfectionism increases the risk of fatigue following a period of stress

Abstract

There is a considerable amount of research concerning (he relationship between psychological variables and the postoperative outcome of surgery. However, little attention has been paid to the potential influence of psychological factors on infra-operative variables, most notably on anaesthetic requirement. The present study investigates the influence of surgery-related trail and slate anxiety as well as of dispositional and surgery-related actual coping on several indicators of intra- and postoperative adjustment. In addition, a possible mediating effect of stress-induced analgesia on the relationships between anxiety, coping, and intraoperative anaesthetic requirements was evaluated. Sixty-one patients undergoing elective lumbar iniclcotomy completed questionnaires regarding anxiety and coping variables one day before surgery. Intraoperative adjustment was assessed by measuring EEG-controlled anaesthetic requirements for induction and maintenance of anaesthesia, β-endorphin plasma concentration was collected preoperatively in the induction room. Postoperative outcome was assessed on the third day after surgery by questionnaires regarding pain experience, physical condition and emotional state. For preoperative anxiety as well as vigilant coping behaviour, there were opposite relationships with subjective measures of adjustment (e.g. self-reported postoperative pain experience), on the one side, and objective measures on the other (e.g., intraoperative anaesthetic requirement). Stress-induced analgesia was found for the subgroup of high-anxious patients. The results indicate that psychological programmes aimed at facilitating patients' perioperative adjustment should consider the different effects of anxiety and coping on subjective and objective measures.     

Trauma history as a resilience factor for patients recovering from total knee replacement surgery

Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills).

Objective: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR).

Design: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure.

Results: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (β = ?.259, p = .006) and three-month follow-up assessments (β = ?.187, p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients’ trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance: β = ?.200, p = .037).

Conclusion: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery.     

Extent and nature of anxiety experienced during physical examination of chronic low back pain

There is strong evidence to suggest that anxiety is a common problem for many chronic pain patients and can exacerbate a patient's pain condition. Notwithstanding, there is little information about the extent and nature of anxiety experienced during physical examination of pain, or the primary factors associated with anxiety in this context. In the present study, 45 chronic low back pain patients completed a questionnaire battery at the time of intake to an interdisciplinary treatment program. After approximately four weeks on program, patients underwent a routine standardized physiotherapy review of their condition following which they completed a second questionnaire battery. The examination was videotaped and coded for pain behavior. Physiotherapists provided objective scoring of non-organic signs and physical impairment. Results suggested that participants experienced substantial anxiety at the point of examination with scores on the Beck Anxiety Inventory (M = 30.47, S.D. = 6.96) comparable to scores that have been found with DSM-IV panic disorder patients. Regression analyses revealed that catastrophic cognitions, behavioral displays of pain and somatic sensations measured during examination uniquely predicted anxiety experienced during examination. Demographic, injury-related, personality, and patient-practitioner variables did not significantly contribute to explaining examination anxiety. Findings support cognitive-behavioral formulations of anxiety and strongly suggest that anxiety may complicate the assessment process. Implications for the assessment and treatment of pain are presented along with future research directions.     

Social cognitive theory and cancer patients' quality of life: a meta-analysis of psychosocial intervention components.

Social cognitive theory (SC) provides a theoretical framework to evaluate improved quality-of-life (QOL) outcomes through interventions with cancer patients To assess whether inclusion of SCT components predicted better outcomes, focused comparisons were used to integrate results from 38 randomized studies. Interventions with more SCT components had significantly larger effect sizes than studies with fewer or no SCT components for the overall analysis (Z = 3.72, p < .01). Subanalyses of affective, social, objective physical outcome, and specific QOL measures revealed that SCT-based interventions had significantly higher effect sizes; inclusion of SCT components resulted in significantly lower effect sizes on subjective physical and functional outcomes. Results suggest that using SCT-based interventions maximizes improvement in overall QOL outcomes for adult cancer patients.     

Authenticity as a Mediator of the Relation Between Child Maltreatment and Negative Outcomes for College Women

The goal of this cross-sectional study was to determine if authenticity in relationships mediated the relation between early childhood maltreatment and negative outcomes (depression, low self-esteem, and traumatic symptoms). An ethnically diverse sample of female college students (N = 257, M age = 19.74) completed self-report questionnaires related to early childhood maltreatment, negative outcomes, and authenticity in relationships. Approximately 30% of participants experienced childhood maltreatment including physical maltreatment, emotional maltreatment, or both. Results from multiple mediation analyses indicated that, when controlling for physical maltreatment, authenticity in close relationships significantly partially mediated the relation between emotional maltreatment and depression, self-esteem, and traumatic symptoms (p < .05). However, when controlling for emotional maltreatment, physical maltreatment did not significantly predict any of the outcome variables, so physical maltreatment was not significantly mediated by authenticity in relationships. These results have important clinical implications for women who experience negative mental health outcomes as a result of childhood maltreatment.     

Two alternative models of health behaviour and recovery from activity limitations due to acute injury: A prospective study

Cognitions influence recovery from activity limitations. In this study we aimed to independently test, compare and combine the common sense self-regulation model (CS-SRM) and social cognitive theory (SCT) in predicting recovery from activity limitations due to acute injury. Measures were gathered at two time points 5–6 weeks apart. The sample consisted of 146 university students (Mean age: 21.86, SD: 4.83, 62% female) with a heterogeneous range of injuries that limited their participation in physical activity. The dependent variable was recovery from activity limitations (Physical Functioning?–?Short Form-36). The predictor variables were measured using the Brief Illness Perception Questionnaire and SCT items designed according to theoretical recommendations. Time-line (TL) and self-efficacy (SE) were significant predictors of recovery in a multivariate analysis, controlling for reported pain at Time 1. A combined model including the best predictors from both models, TL (β = ?0.25, p < 0.05, R ² change = 0.17, p < 0.01) and SE (β =0.31, p < 0.05, R ² change = 0.05, p < 0.05), accounted for a significant amount of the variance in recovery from activity limitations. A combination of key variables from both models may be particularly useful for understanding the cognitive factors that influence recovery from activity limitations.     

The Role of Cardioprotective Avoidance Beliefs in Noncardiac Chest Pain and Associated Emergency Department Utilization

This study examined cardioprotective avoidance beliefs and general panic/agoraphobia variables among 45 Emergency Department patients with a primary complaint of noncardiac chest pain (NCCP) in the absence of coronary artery disease or other medical explanation. Cardioprotective beliefs about the dangerousness of work and physical activity were assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). Additional measures assessed complaints of cardiac distress and panic, anxiety sensitivity, panic-related beliefs, agoraphobic avoidance, and depressive symptoms. Hierarchical regression analysis indicated that cardiac distress symptoms are a function of panic symptoms and cardioprotective beliefs concerning both physical activity and work, with 62% of the total variance explained. The predictors also explained 57% of the variance in Emergency Department utilization, which was significantly related to cardiac distress symptoms, number of illnesses, and work-avoidance beliefs. Neither outcome was related to demographics, depression symptoms, general anxiety sensitivity, general panic cognitions, or agoraphobic avoidance. Results suggest that current behavioral understandings of NCCP might be advanced by further examination of cardiac-specific avoidance beliefs and behavior and the potential role these factors play in both symptom experience and medical utilization.     

Development and exploratory cluster-randomised opportunistic trial of a theory-based intervention to enhance physical activity among adolescents

This article reports the development and exploratory testing of a school-based intervention programme designed to enhance levels of physical activity in adolescents. The intervention is based on social cognitive theory (SCT), self-regulation theory (SRT) and planning as evidence-based mediators of physical activity changes. Two classes, paired on socio-economic variables, were selected from each of eight Portuguese schools and randomly assigned to an intervention or control group (N = 291). Primary outcome was ‘moderate to vigorous physical activity’ (International Physical Activity Questionnaire) measured pre and post intervention and at three and nine months follow-up. SCT, SRT and planning variables were secondary outcomes measured pre and post intervention. At post test, participants in the intervention group reported 18 min per week more physical activity (PA), adjusted for pre-intervention, age and sex, than those in the control group (95% confidence interval ?10 to 46; p = 0.249). This difference increased to 33 min (95% CI–4 to 71; p = 0.082) at three months and to 57 min (95% CI 13 to 101, p = 0.008) at nine month follow-up. Moreover, the intervention resulted in changes of some of the theoretical target variables, including outcome expectancies and coping planning. However, no evidence was found for the changes in theoretical moderators to mediate the intervention effects on behaviour. Implications for theory and for future research are discussed.     

Individual Versus Group Physical Therapy for Patients with Low Back Pain: Outcomes and Process (Therapeutic Factors)

ABSTRACT

Low back pain (LBP) is a common health problem usually treated individually, and requires costly physical therapy. Group treatment, besides being cost-effective, provides psychological support to the recovery of people who struggle with a physically disabling condition. The current study compares individual and group treatment of LBP, measuring differences in outcomes and process data (therapeutic factors). The study included 158 patients who participated in group (n = 71) and individual (n = 87) physical therapy, using a pre-post-follow-up design. Results indicated a significant improvement in all outcome measures at postintervention in both treatment settings, with no difference between them, which were sustained at follow-up. On a clinical level, a few differences were found: At postintervention, minimal clinically important improvement in perceived functioning and level of pain was greater among patients treated individually. On the other hand, at follow-up, only group participants gained additionally in perceived functioning and in fear avoidance. Therapeutic factors of other- versus self-focus and problem definition–change were more prevalent in group treatment.     

Transitioning from a hospital rehabilitation programme to home: Exploring the experiences of people with complex regional pain syndrome

Complex regional pain syndrome (CRPS) is difficult to diagnose and is characterised by burning pain in one or more limbs. Treatment is palliative not curative and focuses on improving function. This requires patients to make long-term changes to their behaviour. As with all such regimens, adherence is often poor. This study explored the lived experience of 10 patients who had returned home after completing a two-week in-patient treatment programme. The interviews focused on how they coped with the transition from hospital to home, and on the things that they considered had facilitated or hindered this transition. Battling for Control was an overarching theme that connected the four superordinate themes: ‘Gaining Momentum’ that facilitated the implementation of treatment advice, ‘Distance from the pool of expertise’ that detailed the barriers to adherence experienced; ‘It helped me realise it was not all in my head’ that detailed a facilitative process, and the ‘nag list’ that was a technique patients’ used to garner support. This article offers insights into the transition experience. A key outcome is the recognition of the need to better prepare patients for their transition back home.