S-100B is superior to NSE, BDNF and GFAP in predicting outcome of resuscitation from cardiac arrest with hypothermia treatment

Objective

To conduct a pilot study to evaluate the blood levels of brain derived neurotrophic factor (BDNF), glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE) and S-100B as prognostic markers for neurological outcome 6 months after hypothermia treatment following resuscitation from cardiac arrest.

Design

Prospective observational study.

Setting

One intensive care unit at Uppsala University Hospital.

Patients

Thirty-one unconscious patients resuscitated after cardiac arrest.

Interventions

None.

Measurements and main results

Unconscious patients after cardiac arrest with restoration of spontaneous circulation (ROSC) were treated with mild hypothermia to 32-34 °C for 26 h. Time from cardiac arrest to target temperature was measured. Blood samples were collected at intervals of 1-108 h after ROSC. Neurological outcome was assessed with Glasgow-Pittsburgh cerebral performance category (CPC) scale at discharge from intensive care and again 6 months later, when 15/31 patients were alive, of whom 14 had a good outcome (CPC 1-2). Among the predictive biomarkers, S-100B at 24 h after ROSC was the best, predicting poor outcome (CPC 3-5) with a sensitivity of 87% and a specificity of 100%. NSE at 96 h after ROSC predicted poor outcome, with sensitivity of 57% and specificity of 93%. BDNF and GFAP levels did not predict outcome. The time from cardiac arrest to target temperature was shorter for those with poor outcome.

Conclusions

The blood concentration of S-100B at 24 h after ROSC is highly predictive of outcome in patients treated with mild hypothermia after cardiac arrest.     

The impact of social support on mental health service users’ sense of coherence: A longitudinal panel survey

Background

Social support is a crucial coping resource in the development of a strong sense of coherence. However, little is known about which components of social support are most important for the positive development of sense of coherence.

Objectives

The aim of this study is to investigate the ability of the six social provisions in Weiss's theory of social support to predict the positive development of sense of coherence among people with mental health problems.

Design

The study has a prospective design including a baseline assessment and one-year follow-up.

Settings

The community mental health care system in a large city in Norway.

Participants

The sample comprised 107 people with mental health problems. The inclusion criteria were: 18-80 years of age, living at home, mental health problems considered relatively stable, able to engage in dialogue, reliant on the mental health services and/or an activity centre, good orientation, mastery of the Norwegian language and no alcohol and/or drug problems. A total of 92 completed both measures.

Methods

Sense of coherence was measured by the Sense of Coherence questionnaire, mental symptoms by the revised Symptom Checklist-90-R and social support by The Social Provision Scale (all Norwegian versions).

Results

The results show that while social support predicted change in sense of coherence (standardized beta coefficient for social support was 0.32, P = 0.016), mental symptoms did not (standardized beta coefficient −0.07, P = 0.621). The social provision of opportunity for nurturance contributed most to the prediction (standardized beta coefficient 0.24, P = 0.019).

Conclusions

The results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems.     

Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study

Background

The episiotomy rate has declined worldwide but remains high in several countries such as Taiwan. The effects of episiotomy on women's health should be a constant concern. Few data are available on the effect of episiotomy by validated measures.

Objective

The present study examined the effect of episiotomy on pain, urinary incontinence, and sexual function up to 3 months postpartum.

Design, setting and participants

A prospective follow-up study of 243 women who completed the Taiwanese versions of the Short Form McGill Pain Questionnaire, International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form, Female Sexual Function Index, and a demographic questionnaire after vaginal delivery in a Taiwanese medical center.

Methods

Differences between those who did and did not have an episiotomy were tested using ANCOVA, adjusting for age, parity, newborn weight, and vacuum delivery. The reliability and validity of the measuring instruments were assessed using Cronbach's α coefficient and factor analysis.

Results

Women who delivered without an episiotomy had significantly lower perineal pain scores at weeks 1, 2 and 6 postpartum compared to women who had an episiotomy (p = 0.0065, 0.0391, 0.0497, respectively). Women in the no-episiotomy group had significantly lower non-localized pain scores at week 2 postpartum compared to women in the episiotomy group (p = 0.0438). The mean urinary incontinence score was significantly higher in the episiotomy group 3 months postpartum (p = 0.0293). No significant difference in sexual function score was found between groups.

Conclusions

The results indicate that episiotomy increased pain at weeks 1, 2 and 6 postpartum, and urinary incontinence at 3 months postpartum. Awareness of the relationship between episiotomy and women's health will help health care professionals develop policy and promote the application of restrictive episiotomy.     

Physical activity and pain following total hip arthroplasty

Objectives

To determine types and levels of physical activities and hip pain in patients who had a total hip arthroplasty 5-7 years previously.

Participants

Ninety-eight men with a mean age of 61 years (standard deviation 9 years) and 134 women with a mean age of 61 years (standard deviation 6 years).

Methods

Patients reported current physical activities and activity 2 years after surgery. Patients were also asked about pain in the operated hip associated with specific activities, and reduction of activities due to pain.

Results

Ninety-five patients reported hip pain during physical activity, most frequently during bending and lifting activities and least frequently during non-weight-bearing activities. Climbing stairs was also associated with pain. Of 137 patients who decreased their level of activity between the two time points, 57 did so because of hip pain. Their average reduction in activity was 9.1 hours/week (95% confidence interval 6.8 to 11.4 hours/week). These 57 patients reported higher levels of activity 2 years after surgery than those who did not decrease their activity because of pain.

Conclusions

This study provides important information on the types of physical activity in which total hip arthroplasty patients participate, and their association with hip pain and reduction of activity due to pain. There is a need for future research to assess a wide variety of types and levels of activities, and to determine their association with pain and revision surgery.     

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

The association between nursing diagnoses, resource utilisation and patient and caregiver outcomes in a nurse-led home care service: longitudinal study

Background

The information generated by nurses through standardised nursing languages is insufficiently evaluated and exploited, mainly in home care services, as is its potential impact on outcomes.

Objectives

To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation with use of resources, mortality, institutionalisation and satisfaction.

Design

Observational, longitudinal follow-up study.

Settings

Home care services delivered by Primary Healthcare Districts in Málaga, Costa del Sol, Almería and Granada, in Spain.

Participants

Patients and caregivers who initiated the Home Care Programme.

Methods

The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made by nurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use of resources, mortality, institutionalisation and satisfaction.

Results

Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8 diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p = 0.033). Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregivers were, in 78% of cases, due to the recipient’s baseline functional status. No relation was detected for institutionalisation or for patient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk for mortality (RR: 2.08 CI 95%: 1.26-3.42) (p = 0.012).

Conclusions

These data confirm results from other studies which find nursing diagnoses to be sound predictors of resources use. Their synergy with other case-mix systems in home care should be investigated.     

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: A randomised controlled trial

Background

In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans.

Objective

The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences.

Design

A randomised, single-blind controlled trial study design was used.

Settings

This study involved seven hospitals and 10 obstetricians in Taiwan.

Participants

Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n = 155) or control (n = 141) groups.

Methods

The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations.

Results

The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t = 2.48, p = 0.01). The experimental group also showed a higher degree of childbirth control (t = 9.60, p < 0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t = 2.63, p = 0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t = 3.74, p < 0.001) in the experimental group than in the control group.

Conclusions

The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.     

Influence of reduction in the elution times on HPLC glycohaemoglobin results

Objectives

To compare HPLC methods with short and long elution times for HbA1c measurement in blood.

Methods

Comparison between G7-Tosoh (1.2 min); Bio-Rad-Variant-II-Turbo (1.3 min) and Arkray-HA-8160 (2.9 min).

Results

Passing-Bablok regression equations were: Y = 0.17 + 0.96X; Y = − 0.39 + 1.01X; Y = − 0.40 + 1.0X and the means of the differences using Bland-Altman Plot were 0.02; − 0.34; 0.32 for HA-8160/G7-Tosoh, HA-8160/Variant-II-Turbo and G7-Tosoh/Variant-II-Turbo, respectively.

Conclusions

Faster elution methods had no problems on reproducibility of results obtained by slower elution methods.     

The effect of a physiotherapy education compared with a non-healthcare education on the attitudes and beliefs of students towards functioning in individuals with back pain: An observational, cross-sectional study

Objectives

To investigate the difference in attitudes: (1) between first and fourth year physiotherapy students towards functioning in individuals with back pain; and (2) between physiotherapy students and non-healthcare students towards functioning in individuals with back pain.

Design

Observational, cross-sectional study.

Setting

Glasgow Caledonian University, Scotland, UK.

Participants

First year physiotherapy (n = 61) and non-healthcare students (n = 61), and fourth year physiotherapy (n = 62) and non-healthcare students (n = 62).

Main outcomes

All participants completed the Health Care Providers’ Pain and Impairment Relationship Scale (range 15 to 105). This questionnaire measures attitudes towards functioning in individuals with back pain.

Results

Fourth year physiotherapy students had more positive attitudes towards functioning in individuals with back pain than first year physiotherapy students [57.4 vs 66.6 (mean difference −9.2, 95% confidence interval −12.2 to −6.1, P < 0.01)]. Similarly, fourth year non-healthcare students had more positive attitudes towards functioning in individuals with back pain compared with first year non-healthcare students [69.2 vs 65.3 (mean difference −3.9, 95% confidence interval −7.2 to −0.5, P = 0.03)]. Physiotherapy students had more positive attitudes than non-healthcare students in the first year [66.6 vs 69.2 (mean difference −2.6, 95% confidence interval −5.5 to 0.4, P = 0.08)] and the fourth year [57.4 vs 65.3 (mean difference −7.9, 95% confidence interval −11.4 to −4.4, P < 0.01)] of study.

Conclusion

These findings suggest that physiotherapy education brings about positive student attitudes towards functioning in individuals with back pain. This may be partly attributable to receiving a university degree education, but would appear to be further enhanced by specifically receiving a physiotherapy degree. This may facilitate students to become more evidence-based practitioners following qualification.     

Effectiveness of an informative video on reducing anxiety levels in patients undergoing elective coronarography: An RCT

Background

Anxiety levels have a considerable effect on patients during hospitalization. Cardiology Departments are characterized by a high turn-over of patients and it is necessary to give clear and exhaustive information routinely in compliance with legal and deontological requirements.

Aims

The aim of the study was to evaluate the effectiveness of an informative video, devised for patients undergoing coronarography, on reducing anxiety levels and getting more satisfaction from the received information.

Methods

A two arm RCT design was chosen.The patients in both study arms received standard care while the informative video was shown in the treatment group. The Spielberger scale was used to measure anxiety levels before the procedure while satisfaction as to the received information was measured using a scale with semantic indications.

Results

Ninety-three patients accepted to take part in the study. The weighted mean difference (WMD) between the anxiety levels of the treated and controlled groups was − 8.24 (CI 95%: − 12.04/− 4.44; p < 0.00001).The WMD of the level of satisfaction for the received information was + 22.23 (CI 95%: + 12.73 /+ 31.73; p < 0.00001).

Conclusions

The use of the informative video in Cardiology Departments proves to be highly recommended as an instrument to lower anxiety levels and increase significantly the level of satisfaction deriving from the received information.     

Distrust, predisposition to use health services and breast cancer screening: Results from a multicultural community-based survey

Purpose

To examine whether and how distrust of the health system and predisposition to use healthcare services influence frequency of mammograms and Clinical Breast Exams (CBEs).

Methods

A community-based survey recruited 184 women (age 47 ± 12); 49% were college-educated, 77% had health insurance, and 57% were non-white. Distrust was measured with a four-item scale (Cronbach α = 0.71); predisposition to use health services with an 11-item scale (Cronbach α = 0.84). Ordinal regression analysis was used to test two models examining “time since last mammogram” and “time since last CBE.” The later model had a better goodness-of-fit, as indicated by a non-significant, Pearson coefficient.

Findings

Distrust to the health system was significantly correlated with age (r = −0.19*), income (r = −0.16*), and predisposition to use health services (r = −0.26**). Distrust predicted time since last CBE (B: 0.37, SE: 0.19*), which in turn was significantly correlated with time since last mammogram (r = 0.44**). Predisposition to use health services predicted time since last CBE (B: −0.78, SE: 0.19**) and time since last mammogram (B: −0.47, SE: 0.22**). Insurance predicted time since last CBE (B: −0.94, SE: 0.44*), while age (B: −0.21, SE: 0.03**) and income (B: −0.19, SE: 0.09*) predicted time since last mammogram.

Conclusion

Distrust of the healthcare system and predisposition to use health services influence breast cancer screening directly. Distrust interferes with behavioral patterns that favor recurrent breast cancer screening.

Practice implications

Trustworthiness in the healthcare system and positive attitudes for the use of, health services enhance routine breast cancer screening. *p < 0.05, **p < 0.001.     

Ankle positioning and knee perturbation affect temporal recruitment of the vasti muscles in people with patellofemoral pain

Objectives

To compare the temporal recruitment of the vastus medialis obliquus (VMO) and vastus lateralis (VL) during voluntary ankle movements and perturbed standing in people with patellofemoral pain, and to determine the effects of different reflex and voluntary postural exercise tasks on VMO facilitation.

Design

Repeated-measures design.

Participants

Twenty-three subjects with patellofemoral pain.

Interventions

Quadriceps reflex contraction in response to postero-anterior knee perturbations was measured with three crural muscle contraction conditions and three postural exercises (semi-squatting, tip-toeing and heel standing).

Main outcome measures

The electromyographic (EMG) onset time of the VMO and VL during each task was measured and compared across the different tasks.

Results

The mean EMG onset time of the VMO was later than that of the VL in the voluntary tasks such as tip-toeing (VMO 95.3 ms vs VL 36.4 ms, mean difference 58.9 ms, 95% confidence interval −33.7 to 151.5 ms), whereas earlier VMO activation was found in the perturbation tests such as toe standing (VMO 17.6 ms vs VL 22.9 ms, mean difference −5.3 ms, 95% confidence interval −25.3 to 14.7 ms).

Conclusion

These findings suggest the potential benefits of unexpected perturbation activities for facilitating VMO activation. The clinical applications of perturbation tasks in rehabilitation exercise programmes and the underlying mechanisms warrant further investigation.     

The effects of providing pre-gastrointestinal endoscopy written educational material on patients’ anxiety: A randomised controlled trial

Background

Endoscopy is a frequently applied operation in health institutions which may cause anxiety in patients.

Objective

The objective of this study is to determine the effects of written educational material related to the endoscopy procedure on the anxiety level of the patient before gastrointestinal endoscopy.

Design

A randomised controlled trial design with two groups: case and control groups.

Participants

140 patients assigned randomly who applied for gastrointestinal endoscopy.

Methods

Intervention: the control group in our study consisted of 70 people who were briefly informed by the relevant unit about pre-endoscopy preparation. The case group consisted of 70 people who were also given brief information about the pre-endoscopy preparation by the relevant unit. Only the case group were also given written educational material and told orally by the researcher about the content. Measurements: for the collection of the data, a questionnaire form and Spielberger's State-Trait Anxiety Inventory were used.

Results

A significant difference in the average state anxiety scores was found between the case and the control group (p < 0.05). An important difference was found in the average state anxiety scores between the case and the control group who had not undergone endoscopy before our study (p < 0.05).

Conclusions

Use of written material including detailed information to inform the patient before endoscopy was useful in lessening their anxiety level. Health professionals should evaluate the anxiety level of patients before endoscopy and educational material should be given to them to read.     

The effect of health visitors' postpartum home visit frequency on first-time mothers: cluster randomised trial

Background

Postpartum home visiting by nurses can benefit higher-risk families. Yet, little is known about the effects of universal services which provide care for all families including those at lowest risk (e.g. provision by health visitors-United Kingdom specialist community public health nurses).

Objective

It was to determine the effect of frequency of health visitors’ home visits on ‘low-risk’ first-time families’ outcomes to 8 weeks postpartum and 7 months follow-up.

Design

A cluster randomised controlled trial.

Setting

Within one health and social care managerial area in Northern Ireland.

Participants

First-time ‘low risk’ mothers who had given birth during 2002-2004 and were visited by a health visitor who had agreed to take part in the study, were invited to participate. In total, n = 39 health visitors were allocated to ‘intervention’ and n = 41 to ‘control’. Of n = 295 ‘low-risk’ first-time mothers who agreed to take part, n = 136 with intervention health visitors were offered six home visits 2-8 weeks postpartum and n = 159 within the control group were offered one planned visit.

Methods

Self-completed measures of parenting, maternal wellbeing and service use were gathered pre-intervention, 8 weeks and 7 months postpartum. The main outcome was the Edinburgh Postnatal Depression Scale (EPDS). At 8 weeks and 7 months postpartum, n = 129 and n = 115 intervention mothers, also n = 151 and n = 141 control mothers completed outcome measures.

Results

An intention to treat analysis was performed using multilevel modelling analysis which statistically controlled for pre-home visit outcomes, clinic attendance and antenatal contact. The intervention had no impact on most outcomes, however, it was associated with an increased EPDS score (after adjustment: 0.16, 2.36 95%CI) at 8 weeks (before accounting for outliers) but not at 7 months (−0.62,1.65 95%CI). Intervention mothers had higher service satisfaction (7.7, 21.28, 95%CI 8 weeks; 4.69, 22.71, 7 months) and were less likely to have used emergency medical services for their infants to 8 weeks (OR: 0.15, 0.85, 95%CI).

Conclusion

Weekly postpartum visits to ‘low-risk’ mothers had variable effects, therefore, practitioners and researchers should consider further development and application of effective, evidence based home visiting content.     

Correspondence of diagnosis to initial treatment for neck pain

Objectives

A patient care model has been proposed linking patient assessment to diagnosis to treatment to outcomes. Validation of this method is required. McKenzie developed the mechanical diagnosis and therapy (MDT) process to diagnose neck pain and direct its treatment. No study known to the authors has determined the link between MDT diagnosis and treatment for neck pain. The objective of the current study was to determine inter-rater agreement on the link between MDT diagnosis and treatment for neck pain.

Setting

Outpatient physical therapy clinics.

Participants

Fifty-four clinician raters, 20 patients with neck pain.

Design

Clinicians, MDT-trained for neck pain, viewed videotaped examinations of adult patients with neck pain and rated diagnosis and initial treatment.

Main outcomes measures

Inter-rater agreement on the MDT diagnosis-treatment link and derangement-directional preference link.

Results

Inter-rater agreement on the diagnosis-treatment link of derangement-directional preference and not derangement-no directional preference of treatment was with moderate clinical and statistical significance (κ = 0.46, 95% confidence interval 0.45-0.47; P < 0.001; 86% agreement). There was moderate agreement on derangement-directional preference for the ‘derangement-extension’ link (κ = 0.40, 95% confidence interval 0.38-0.41; P < 0.001) and ‘derangement-lateral’ link (κ = 0.45, 95% confidence interval 0.44-0.46; P < 0.001), but with poor agreement for the ‘derangement-flexion’ link (κ = 0.04, 95% confidence interval 0.02-0.05; P < 0.001).

Conclusions

Clinicians trained in MDT for neck pain link diagnosis to initial treatment of patients with neck pain with moderate reliability, specifically using extension or laterally directed preference for treatment. The current study contributes towards validation of the diagnosis-treatment link of the MDT patient care model for neck pain.     

Pain in persons with postpolio syndrome: frequency, intensity, and impact

Stoelb BL, Carter GT, Abresch RT, Purekal S, McDonald CM, Jensen MP. Pain in persons with postpolio syndrome: frequency, intensity, and impact.

Objective

To describe the frequency, intensity, and impact of pain in persons with postpoliomyelitis syndrome (PPS).

Design

Retrospective, cross-sectional survey.

Setting

Community-based survey.

Participants

Convenience sample of people with PPS.

Interventions

Not applicable.

Main Outcome Measures

Overall intensity and duration of pain, pain sites, pain interference, pain treatments, and relief provided by pain treatments.

Results

A total of 91% (n=57) of the study participants (N=63) reported pain. The most frequently reported pain sites were the shoulders, lower back, legs, and hips. Participants reported pain intensity to be the greatest in the knees, legs, wrists, lower back, and head. Pain interfered most with sleep and with activities requiring a high level of musculoskeletal involvement. Respondents also reported pain problems that were more severe than those of the general population and than those of a sample of people with multiple sclerosis. Many treatments had been tried previously for pain, but continued use of treatments was reported by relatively few participants at the time of the survey.

Conclusions

The findings indicate that pain is a persistent and common problem in persons with PPS, highlighting the need for effective and accessible pain treatments for this population.     

Determinants of medication underuse and medication overuse in patients with chronic non-malignant pain: A multicenter study

Background

In chronic non-malignant pain, medication is often used as an important cornerstone of the treatment. Medication non-adherence is a frequent problem in chronic conditions. In patients with chronic non-malignant pain, medication non-adherence ranges between 8% and 53%. Two types of non-adherence can be identified: underuse and overuse of pain medication.

Objective

To examine determinants of both medication underuse and overuse non-adherence in patients with chronic non-malignant pain, with a focus on factors related to all five categories of determinants of medication non-adherence simultaneously, as proposed by the WHO.

Design

A multicenter cross-sectional study.

Settings

Three multidisciplinary outpatient pain centers in Flanders, Belgium.

Participants

A total of 265 patients with chronic non-malignant pain participated in the study.

Methods

Medication non-adherence was assessed by a self-report interview. Associations of socio-economic, treatment related, condition related, patient related and health care system related factors with medication underuse or overuse were determined by building two separate multivariable binary logistic regression models.

Results

Thirty eight percent of the patients were fully adherent. Based on multivariable analyses, underuse was significantly associated with more prescribed analgesics (OR = 2.303), self-medication (OR = 4.679), lower pain intensity (OR = 0.821), active coping strategies (OR = 1.132) and lack of information (OR = 0.268). Overuse of medication was associated with more prescribed analgesics (OR = 1.645) and current smoking (OR = 2.744).

Conclusion

Patients underusing or overusing their medication do have a different risk profile. The set of determinants of non-adherence, proposed by WHO, is suitable to study determinants of underuse, but the framework is less suitable to study determinants of medication overuse.     

Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: A cross-sectional observational study

Objective

To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash-associated disorder.

Design

Cross-sectional observation study.

Setting

Three secondary care physiotherapy departments in the Greater Manchester region of the UK.

Participants

All patients with chronic whiplash-associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study.

Main outcome measures

Pain and disability, as assessed by the Neck Disability Index.

Results

Cognitive factors were strongly related to levels of disability (R² change = 0.39, P < 0.001). Specifically, greater catastrophising (β = 0.41, P < 0.01) and lower functional self-efficacy beliefs (β = −0.47, P < 0.001) were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.

Conclusions

Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash-associated disorder.     

Effects of high frequency exercise in patients before and after elective percutaneous coronary intervention

Background

The aim of this study was to evaluate the effects of high frequency exercise for patients before and after an elective percutaneous coronary intervention (PCI), with special reference to maximal aerobic capacity, muscle function, health related quality of life (HRQoL), waist-hip ratio (WHR) and restenosis.

Methods

A randomised, controlled study was performed in Sweden between 2004 and 2006 in thirty-seven patients (five women) with stable coronary artery disease (CAD), age 63.6 ± 6.9 years, randomised to either high frequency exercise or control group. The patients in the training group performed three endurance resistance exercises and trained on a cycle ergometer 30 min, 5 times a week for 8 months at 70% of VO_2max.

Results

Patients in the training group significantly improved their maximal aerobic capacity (15 (9-46) vs. 8 (0-18)% p ≤ 0.05), shoulder flexion (p ≤ 0.01), shoulder abduction (p ≤ 0.01) and heel-lift (p ≤ 0.05) compared to the control group. There were no significant differences between the groups in HRQoL, WHR and restenosis.

Conclusion

High frequency exercise in patients treated with PCI seems to improve maximal aerobic capacity and muscle function, which may reduce the risks of further progression of atherosclerosis. However, further larger studies are needed to fully investigate the effects of exercise in patients with PCI.