Long-term follow up of a physical therapy programme for patients with fibromyalgia syndrome

The purpose of this study was to evaluate, in a long-term perspective, the impact of a physical therapy-based educational programme on patients with fibromyalgia syndrome (FMS). The programme includes information about the syndrome, information about pain and muscle physiology, training in warm water, stretching, body awareness therapy and relaxation in groups of 15 patients twice weekly, 2 hours during 10 weeks. A total of 240 patients with FMS participated in the study before and immediately after the programme and at a follow up with a mean of 35 months after the programme. Health status as measured with the Fibromyalgia Impact Questionnaire was answered by the patients at all three measurement points. Questionnaires concerning self-care, self-motivation and sense of coherence (SOC) were distributed at the follow up. The results showed a significant improvement on several symptoms when comparing before and after the programme, and at the time of follow up the patients' rated well-being was still improved. The results also showed that the patients' pretreatment perception of symptoms, well-being and SOC are predictors to the perception of general health at the follow up of a physical therapy programme. The conclusion is that a physical therapy programme for patients with FMS may have a positive impact on patients' general well-being but not on other symptoms.     

Sense of coherence and psychiatric morbidity in terms of anxiety and depression in patients with major depression before and after electric convulsive treatment

The specific aim of this study was to explore if the Sense of Coherence (SOC) Scale reflects and overlaps with standardized psychiatric assessments of depression and anxiety leading to the main hypothesis that the degree of depression decreases while the SOC scores remain stable. Fifteen patients with a diagnosis of major depression according to Axis I in DSM-IV and planned electric convulsive treatment (ECT) participated in the study. The clinician-rated instruments, Montgomery Åsberg Depression Rating Scale (MADRS) and Global Assessment of Function (GAF), and the self-assessment instruments such as SOC and the Comprehensive Psychopathological Rating Scale-Self Rating Scale for Affective Syndromes (CPRS-S-A) were used before and after the treatment. The patients showed statistically significant improvements in clinician-rated depression (p < 0.001) and functional status (p < 0.001), and in self-rated anxiety (p = 0.001) and depression (p = 0.003). There was no significant improvement in SOC (p = 0.213). No significant correlations were found between the SOC scores and any of the measures except for GAF after treatment (r = 0.57, p = 0.039); the lower the SOC scores the greater was the functional dysfunction. In conclusion, the SOC Scale seems not to be a measure of psychopathology in terms of depression or anxiety merely.     

Sleep,psychological distress,and stress arousal in women with fibromyalgia

The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in α-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an eitiologic factor but, contrary to several literature assertions, α-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 247–257, 1997     

Sense of coherence: quality of life before and after coronary artery bypass surgery--a longitudinal study

The attention to patient outcome has nowadays extended from morbidity and mortality to an aspect of patients' benefits in terms of quality of life. One factor crucial for quality of life is coping capacity, in this study represented by the sense of coherence concept. Physical status and emotional state (often measured by comprehensive instruments not always suitable for clinical use) are also additionally used to reflect quality of life. The purpose was therefore to study sense of coherence and emotional state as indirect measures of quality of life in relation to coronary artery bypass grafting surgery. One hundred and eleven patients were studied by a developed questionnaire on five occasions in relation to the surgery: the week before the angiography, the day before surgery and then at 3, 6, and 12 months post-operatively. The main findings were: (1) The sense of coherence was changed (more than +/-10%) from before to 1 year after surgery in 41% of the patients, which is contrary to the theory of sense of coherence as a stable personality characteristic in adults. (2) Experience of depressed mood, stress, and anxiety decreased significantly from before to after surgery. (3) Beneficial outcome with regard to sense of coherence was significantly related to less experience of loneliness, depressed mood, stress and anxiety, and to less experience of chest pain 1 year after surgery. In conclusion, sense of coherence and emotional state variables, are suggested to be valuable as measurements of quality of life in relation to coronary artery bypass grafting surgery.     

2型糖尿病患者心理-致感、应对方式与生存质量关系的研究

目的：探讨2型糖尿病患者心理-致感、应对方式与生存质量的关系。方法：采用一般资料调查表、心理-致感量表、医学应对方式问卷及糖尿病生存质量特异性量表对某三级甲等医院511例2型糖尿病患者进行问卷调查。结果：心理一致感总分与面对呈显著正相关,与回避、屈服、生存质量总分及其各维度呈显著负相关;面对与生存质量总分及其各维度呈显著负相关,回避及屈服与生存质量总分呈显著正相关,且三种应对方式在心理一致感和生存质量之间具有中介作用（P〈0．05）。结论：护理人员应加强患者心理状态的评估与干预,提高患者心理-致感水平及使用积极应对方式的能力,从而改善患者的生存质量。     

Efficacy of the whole-body vibration for pain,fatigue and quality of life in women with fibromyalgia: a systematic review

Purpose: To determine the quality of evidence on the use of whole-body vibration (WBV) in controlling pain, fatigue and quality of life in women with fibromyalgia.

Methods: The search involved MEDLINE/PubMed, LILACS, CINAHL, CENTRAL and PEDro, without temporal or language restriction. The terms “fibromyalgia” and “whole-body vibration” were used. Trials (randomized or quasi-randomized) that compared a group of women with fibromyalgia who received WBV to a control group with no intervention were included. The quality of evidence was assessed using the GRADE system. The quantitative evaluation by meta-analysis was also used, whenever possible.

Results: Three studies were included. Regarding the outcome pain, it has not been possible to assess the magnitude of effect of treatment. The result of the outcome fatigue showed no difference between the groups after the proposed intervention (Mean Difference: 0.01; 95% CI: ?0.11 to 0.09). The meta-analysis for the outcome quality of life showed a small difference between groups, favoring the WBV group (Standard Mean Difference: 0.4943; p?=?0.05; 95% CI: 0.0045 to 0.9841).

Conclusions: The results, based on very low quality of evidence, were inconclusive regarding pain, and showed no clinically important effects on the control of fatigue and improvement of quality of life.

• Implications for rehabilitation

• There is no evidence to support the use of whole-body vibration for pain treatment of women with fibromyalgia.

• The use of whole-body vibration in women with fibromyalgia showed no clinically important effects in the control of fatigue and improvement of quality of life.

     

Well-being, sense of coherence, and burnout in stroke victims and spouses during the first few months after stroke

Ten stroke victims, who had recently suffered their first manifest stroke with lasting neurological symptoms, participated, together with their spouses, in a study aimed at elucidating the well-being, sense of coherence (SOC), and burnout during the first few months after discharge. The stroke victims had no substantial speech disturbances, and showed no evidence of significant cognitive impairment, signifying they were mildly to moderately impaired by their stroke. All subjects were investigated at 1 and 3 months after homecoming. The methods used in this study were open-ended interviews with all research participants, performed at two different appointments, and three self-reporting questionnaires: the well-being measure (WM), the SOC scale, and the burnout measure (BM). The instruments suit each other well, broaden the picture of living with stroke and give an attuned comprehensive understanding. The most striking finding was the substantial differences in the results, both regarding the stroke victims and their spouses, clearly indicating the limited value current generalizations have. The results also pointed to considerable distress both in stroke victims and spouses, although individuals with a weak SOC clearly displayed more difficulties in coping with the situation and risk of burnout, than did those with a strong SOC.     

Sense of Coherence,Parenting Attitudes and Stress among Mothers of Children with Autism in Hong Kong

Background The moderating and mediating relationships among sense of coherence, parental attitudes and parenting stress for caregiving parents of children with autism were tested. Materials and Methods One hundred and fifty‐seven mothers of children with autism recruited from representative community service centres in Hong Kong completed the Chinese versions of Sense of Coherence Scale (SOC), Confidence and Acceptance subscales of Parent‐Attitude Survey Scales and Parenting Stress Index Short Form. Results Accounting for mothers’ demographic background, SOC showed a moderating effect with child's symptoms and parenting stress. Mothers with a strong SOC perceived lower stress than their counterparts even when their children presented with more severe autistic symptoms. Two proximal factors in parenting, parental confidence and acceptance of the child, were found to partially mediate SOC and stress. Conclusions The stress experience of mothers of children with autism is related strongly to a global sense of coherence as well as more specific parenting attitudes.     

Sense of coherence and suicidality in suicide attempters: a prospective study

The usefulness of the Sense of Coherence (SOC) scale in the nursing setting is well-established, and an association between SOC and suicidality has been suggested. The aim was to test whether low SOC at index attempt is an independent predictor of suicidality at 2-month follow-up and of risk for repeat attempt. The study, which had a prospective cross-sectional design, included patients admitted to hospital after a suicide attempt. They were interviewed by means of Structured Clinical Interview for DSM-IV. Participants (n=155) completed the SOC scale and the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. Suicidality was rated with the Suicide Assessment Scale. Instruments were employed again at follow-up. Non-fatal/fatal repetition within 3 years was determined by review of hospital records. Low SOC at baseline predicted high suicidality at follow-up. The association remained after adjustment for major depression and affective symptom burden. Repeat attempts were made by 54 persons. Low baseline SOC was associated with repeat attempt, but the association did not remain after adjustment for major depression and symptom burden. Low SOC ratings could be a marker of risk for high suicidality in the aftermath of a suicide attempt. The SOC scale could be incorporated in nursing assessments of suicide attempters.     

震区医务工作者的心理一致感与创伤后应激障碍的相关研究

目的:探讨震区医务工作者心理一致感(SOC)水平及与创伤后应激障碍(PTSD)的相互关系。方法:以706名四川震区医务工作者为被试,采用德国埃森创伤问卷(ETI)及心理一致感问卷(SOC-13)为研究工具,运用描述统计、差异检验、相关分析方法统计数据。结果:①女性SOC总分和意义感维度得分明显高于男性。女性PTSD高激惹症状得分明显高于男性。②年龄≥30岁的群体意义感得分、高激惹得分显著高于年龄30岁的群体。③非PTSD组的SOC总分及其各个维度得分均显著高于PTSD组。④SOC及各维度与PTSD及各维度间显著负相关。结论:震区医务工作者SOC的意义感维度与PTSD的高激惹症状均与性别和年龄有关;确诊PTSD组医务工作者的SOC得分显著低于与非PTSD组;SOC与PTSD显著负相关,提示SOC对PTSD起到缓冲、调节和预测作用。     

Characteristics of disabilities in patients with subacutemyelo-optico-neuropathy living at home: Satisfaction in daily life and short form-36

Purpose. The aim of this study was to investigate the characteristics of disabilities in patients with subacute myelo-optico-neuropathy (SMON), and to reveal whether the satisfaction in daily life (SDL) or short form-36 (SF-36) correlated with these disabilities.

Method. The subjects consisted of 97 patients with SMON living at home, who were mailed a questionnaire concerning the patient's profile, SMON severity (disability scale for SMON), basic activities of daily living (self-rating Barthel Index, SR-BI), lifestyle (self-rating Frenchay Activities Index, SR-FAI), SDL and SF-36. A relationship with SDL, SF-36 and disabilities was analysed by using Spearman's rank correlation coefficient.

Results. Fifty-eight out of 97 patients with SMON responded, and their mean age was 76.1 years. The mean of SMON severity was 8.0; SR-BI, 70.8; SR-FAI, 11.1; SDL, 27.3; physical component summary of SF-36 (PCS), 26.3; mental component summary of SF-36 (MCS), 39.5. The SMON group had significantly lower scores for SDL than those for the age- and sex ratio- matched elderly persons. With respect to SDL, a significant correlation was observed with SMON severity, SR-BI, SR-FAI, SDL, and PCS and MCS of SF-36, but no significant correlation was observed regarding SMON severity and either the PCS or MCS.

Conclusions. The subjective domains of the quality of life in patients with SMON were observed to have decreased. SDL was considered to closely reflect the characteristics of the disabilities observed in patients with SMON.     

The process leading to affirmation of life with cleft lip and cleft palate: The importance of acquiring coherence

Aims: The objectives of this study were to understand the experiences of people with cleft lip and cleft palate (CLCP) and to describe the processes and factors leading to the acquisition of high self‐esteem. Methods: Semi‐structured interviews were conducted of 19 subjects with CLCP recruited via hospitals and through snowball sampling, and the results were analyzed qualitatively, comparing high and low self‐esteem groups. Results: Participants with high self‐esteem had gone through the phases of “noticing their difference from others”, “knowing about and deepening their understanding of CLCP”, “no denial of their life with CLCP” and “affirmation of life with CLCP”. Seven factor categories including “received sufficient explanation of CLCP condition (from parents) in the early stage”, “have not received negative messages about CLCP” and “feeling the presence of someone who accepts their feelings and supports them” were extracted as factors promoting these processes. Conclusions: Knowing about and understanding CLCP enables individuals to acquire a sense of coherence in their lives, which may be related to gaining a feeling of control over their cleft condition, acquiring a sense of autonomy, and finding a meaning for their lives. Thus, medical professionals should provide explanations that enable patients to understand CLCP, and also facilitate interaction between patients with the same condition.     

Quality of life in old age described as a sense of well-being, meaning and value

The purpose of the study was to present a model of quality of life and related factors, to study quality of life in a group of elderly subjects, and to do preliminary testing of the model. Quality of life was defined as a sense of well-being, meaning and value. The model includes health, functional capacity, and coping mechanisms as intra-individual conditions for quality of life, while factors in the biophysical and sociocultural environment are described as external conditions. The study sample consisted of 300 subjects, aged 75 or older and living in Finland. Data were gathered by means of structured personal interviews. The participants' quality of life was generally quite good. The correlations among the variables related to quality of life were significant, but the results of the regression analyses showed that the individual aspects of quality of life did not have identical explanatory models. The internal consistency of the instruments was good. The results give preliminary support to the model, but in future studies more attention must be paid to the conceptual and theoretical validity. In order to achieve results that can be applied in gerontological nursing practice, different groups and contexts must be investigated.