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1.
Background
Similar to other countries worldwide, Scotland lacked a national view of whether the quality of the physiotherapy management of low back pain was compliant with national guidelines. Anecdotal evidence suggested that standards of care varied considerably despite the wide availability of clinical guidelines to clinicians.Aim
To develop a framework that supports National Health Service (NHS) Scotland in providing consistently applied high-quality physiotherapy assessment and management of low back pain in line with guideline recommendations.Design
Prospective, multicentred national study, data collection and improvement phase.Setting
All NHS boards in Scotland (n = 14) plus two private provider sites.Participants
One hundred and eighty-six individual NHS sites and two private providers of services to patients with low back pain.Method
A national dataset was developed from evidence- and consensus-based guideline sources. All sites collected data (two 5-week periods) over 1 year (2008-2009) using a web-based database. This was interspersed by an improvement phase during which required improvements were considered and implemented. Issues were shared through a national network and national meeting.Results
Data from 2147 patients showed improvements in the documented physiotherapy management of low back pain over the two cycles. All participants developed and implemented remedial action plans based on the results of the first cycle.Conclusion
It is possible to implement a framework, which is led nationally but driven and owned locally, supporting physiotherapists in an active programme of locally determined improvement. However, although process and outcome are linked, the direct impact of this initiative on patient outcome is not known. 相似文献2.
Objectives
Acquired brain injury (ABI) requires an extended recovery time and residual signs may be observed years after discharge. Supervised home-based motor training may present a viable option for continuing treatment of adult patients, but little information is available on home-based treatment in children. This study assessed the feasibility of home practice in children with ABI (1 or more years post-trauma). The efficacy of the programme was also evaluated.Design
A non-randomised, self-control study with control and intervention periods.Setting
Home-based exercise programme.Participants
Nineteen children (mean age 12.5 ± 3.1 years).Interventions
A 4-week daily training programme of step-up and sit-stand-sit exercises.Main outcome measures
Feasibility was assessed by the number of participants who completed the programme. Efficacy was evaluated at different stages using 10-metre walking and 2-minute walking tests, and the balance subitems of the Bruininks-Oseretsky Test of Motor Proficiency. An energy expenditure index was calculated for walking. Performance scores were used to assess balance.Results
Nine participants completed the study. The mean number of training sessions was 22 ± 8 of the 30 sessions originally scheduled. Major differences were noted between the experimental stages. Walking speed, endurance and balance improved significantly during the intervention period.Conclusions
Continuing exercising at home may be a feasible and efficient option for a considerable proportion of ABI children who are compliant with a simple but challenging exercise programme. A randomised controlled trial with a larger sample is now required. 相似文献3.
4.
Objectives
To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.Design
Cross-sectional, correlation study.Setting
Orthopaedic outpatient setting in a tertiary hospital.Participants
One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.Measures
Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.Results
The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.Conclusions
This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes. 相似文献5.
Audrey L. Nelson Shirley Groer Polly Palacios Douglas Mitchell Sunil Sabharwal R. Lee Kirby Deborah Gavin-Dreschnack Gail Powell-Cope 《Archives of physical medicine and rehabilitation》2010,91(8):1166-1173
Nelson AL, Groer S, Palacios P, Mitchell D, Sabharwal S, Kirby RL, Gavin-Dreschnack D, Powell-Cope G. Wheelchair-related falls in veterans with spinal cord injury residing in the community: a prospective cohort study.
Objectives
(1) To determine the incidence of wheelchair falls and fall-related injuries in persons with spinal cord injury (SCI) living in the community. (2) To predict wheelchair-related falls and associated injuries from specific parameters including characteristics of the wheelchair user, wheelchair type and features, health care practices, wheelchair activities, and physical environment.Design
This prospective cohort study followed participants monthly over 1 year; data were collected through surveys, interviews, performance testing, observation, and medical records.Setting
Three Veterans' Administration hospitals.Participants
Convenience sample of community-dwelling persons with SCI who used a wheelchair as their primary means of mobility (N=702).Interventions
Not applicable.Main Outcome Measures
Self-reports of wheelchair falls and fall-related injuries, Wheelchair User Characteristics Survey, Health Status Checklist, Health-Related Behaviors, Zuckerman Sensation Seeking Scale, Wheelchair and Equipment-Related Behaviors, Wheelchair Characteristics, Wheelchair Skills Test, and Physical Environment Assessment.Results
Of the 659 subjects who completed the study, 204 participants (31%) reported 553 fall events, and 95 subjects (14%) were injured as a result of wheelchair falls. A logistic regression model for predicting wheelchair falls identified 6 significant risk factors: pain in previous 2 months, alcohol abuse, greater motor function, history of previous fall, fewer SCI years, and shorter length of wheelchair. Eighty-two percent of the variance for wheelchair fall events was explained by these 6 variables. A logistic regression model for predicting injurious falls identified 4 significant risk factors: pain in previous 2 months, greater motor function, history of previous fall, and inaccessible home entrance. These 4 factors were able to explain 81% of the variance for injurious falls.Conclusions
This is the first study to determine the incidence of wheelchair-related falls in community-dwelling people with SCI who use a wheelchair. Results indicate the incidence of falls was 31% and injurious falls was 14%. Those at greatest risk can be predicted from some readily available information regarding their clinical status, wheelchair features, and home environment. 相似文献6.
7.
Serge S. Colson Michaël Benchortane Véronique Tanant Jean-Paul Faghan Manuela Fournier-Mehouas Charles Benaïm Claude Desnuelle Sabrina Sacconi 《Archives of physical medicine and rehabilitation》2010,91(5):697-101
Colson SS, Benchortane M, Tanant V, Faghan J-P, Fournier-Mehouas M, Benaïm C, Desnuelle C, Sacconi S. Neuromuscular electrical stimulation training: a safe and effective treatment for facioscapulohumeral muscular dystrophy patients.
Objective
To investigate the feasibility, safety, and effectiveness of neuromuscular electrical stimulation (NMES) strength training in facioscapulohumeral muscular dystrophy (FSHD) patients.Design
Uncontrolled before-after trial.Setting
Neuromuscular disease center in a university hospital and a private-practice physical therapy office.Participants
FSHD patients (N=9; 3 women, 6 men; age 55.2±10.4y) clinically characterized by shoulder girdle and quadriceps femoris muscle weakness.Interventions
Patients underwent 5 months of strength training with NMES bilaterally applied to the deltoideus, trapezius transversalis, vastus lateralis, and vastus medialis muscles for five 20-minute sessions per week.Main Outcome Measures
Plasma creatine kinase (CK) activity; scores for pain and fatigue on visual analog scales (VAS), manual muscle testing (MMT), maximal voluntary isometric contraction (MVIC), 6-minute walking tests (6MWT), and self-reported changes in daily living activities.Results
NMES strength training was well tolerated (CK activity and pain and fatigue scores on VAS were not modified). Most of the muscle functions (shoulder flexion and extension and knee extension) assessed by MMT were significantly increased. MVIC of shoulder flexion and abduction and the 6MWT distance were also improved.Conclusions
In FSHD, NMES strength training appears to be safe with positive effects on muscle function, strength, and capacity for daily activities. 相似文献8.
Kirpalani D, Mitra R. Cervical facet joint dysfunction: a review.
Objective
To review the relevant literature on cervical facet joint dysfunction and determine findings regarding its anatomy, etiology, prevalence, clinical features, diagnosis, and treatment.Data Sources
A computer-aided search of several databases was performed, including Medline (1966 to present), Ovid (1966 to present), and the Cochrane database (1993 to present).Study Selection
Selected articles had the following criteria: (1) all articles analyzed cervical facet joint pain—anatomy, prevalence, etiology, diagnosis, treatment; (2) only full, published articles were studied, not abstracts; and (3) all articles were published in English.Data Extraction
All articles were critically evaluated and included the following categories: randomized controlled trials, meta-analyses, uncontrolled clinical trials, uncontrolled comparison studies, nonquantitative systematic reviews, and literature-based reviews.Data Synthesis
We examined 45 references that consisted of 44 journal articles and relevant sections from 1 textbook. Cervical facet joints have been well established in the literature as a common nociceptive pain generator, with an estimated prevalence that ranges from 25% to 66% of chronic axial neck pain. No studies have reported clinical examination findings that are diagnostic for cervical facet mediated pain.Conclusions
Overall the literature provides very limited information regarding the treatment of this condition, with only radiofrequency neurotomy showing evidence of effectively reducing pain from cervical facet joint dysfunction. 相似文献9.
Xue-Ling Yang Huan-Huan Li Ming-Huang Hong 《International journal of nursing studies》2010,47(5):550-559
Background
Chinese calligraphy handwriting is the practice of traditional Chinese brush writing, researches found calligraphy had therapeutic effects on certain diseases, some authors argued that calligraphy might have relaxation effect.Objectives
This study was to compare the effects of calligraphy handwriting with those of progressive muscle relaxation and imagery training in Chinese Nasopharyngeal Carcinoma patients.Design and participants
This study was a randomized controlled trial. Two hundred and eighty-seven Nasopharyngeal Carcinoma patients were approached, ninety (31%) patients were recruited and randomized to one of the three treatment groups: progressive muscle relaxation and guided imagery training group, Calligraphy handwriting group, or a Control group. Seventy-nine (87.8%) completed all of the outcome measures.Outcome measures
The primary treatment outcome was the changes of physiological arousal parameters measured by pre- and post-treatment differences of heart rate, blood pressure and respiration rate. The secondary outcomes included: modified Chinese version of Symptom Distress Scale, Profile of Mood State-Short Form, and Karnofsky Performance Status measured at baseline, during treatment (after the 2-week intervention), post-treatment (after the 4-week intervention) and after a 2-week follow-up. Effectiveness was tested by repeated measure ANOVA analyses.Setting
Cancer centre of a major university hospital in Guangdong, China.Results
Results showed that both of calligraphy and relaxation training demonstrated slow-down effects on physiological arousal parameters. Moreover, calligraphy practice gradually lowered participants’ systolic blood pressure (simple main effect of time at pre-treatment measure, p = .007) and respiration rate (p = .000) at pre- and post-treatment measures as the intervention proceeded, though with a smaller effect size as compared to relaxation. Both of calligraphy and relaxation training had certain symptom relief and mood improvement effects in NPC patients. Relaxation was effective in relieving symptom of insomnia (p = .042) and improving mood disturbance, calligraphy elevated level of concentration (p = .032) and improved mood disturbance.Conclusions
Similar to the effects of relaxation training, calligraphy demonstrated a gradually build-up physiological slow-down, and associated with heightened concentration and improved mood disturbance. Calligraphy offered a promising approach to improved health in cancer patients. 相似文献10.
Bürge E Kupper D Finckh A Ryerson S Schnider A Leemann B 《Archives of physical medicine and rehabilitation》2008,89(10):1857-1862
Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.
Objective
To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.Design
Randomized trial.Setting
Rehabilitation center.Participants
Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.Intervention
The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.Main Outcome Measures
Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.Results
At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.Conclusions
Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery. 相似文献11.
Tao W Haley SM Coster WJ Ni P Jette AM 《Archives of physical medicine and rehabilitation》2008,89(6):1046-1053
Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach.
Objectives
To develop and explore the feasibility of a functional staging system (defined as the process of assigning subjects, according to predetermined standards, into a set of hierarchic levels with regard to their functioning performance in mobility, daily activities, and cognitive skills) based on item response theory (IRT) methods using short forms of the Activity Measure for Post-Acute Care (AM-PAC) and to compare the criterion validity and sensitivity of the IRT-based staging system to a non-IRT-based staging system developed for the FIM instrument.Design
Prospective, longitudinal cohort study of patients interviewed at hospital discharge and 1, 6, and 12 months after inpatient rehabilitation.Setting
Follow-up interviews conducted in patients' homes.Participants
Convenience sample of 516 patients (47% men; sample mean age, 68.3y) at baseline (retention at the final follow-up, 65%) with neurologic, lower-extremity orthopedic, or complex medical conditions.Interventions
Not applicable.Main Outcome Measures
AM-PAC basic mobility, daily activity, and applied cognitive activity stages; FIM executive control, mobility, activities of daily living, and sphincter stages. Stages refer to the hierarchic levels assigned to patients' functioning performances.Results
We were able to define IRT-based staging definitions and create meaningful cut scores based on the 3 AM-PAC short forms. The IRT stages correlated as well or better to the criterion items than the FIM stages. Both the IRT-based stages and the FIM stages were sensitive to changes throughout the 6-month follow-up period. The FIM stages were more sensitive in detecting changes between baseline and 1-month follow-up visits. The AM-PAC stages were more discriminant in the follow-up visits.Conclusions
An IRT-based staging approach appeared feasible and effective in classifying patients throughout long-term follow-up. Although these stages were developed from short forms, this staging methodology could also be applied to improve the meaning of scores generated from IRT-based computerized adaptive testing in future work. 相似文献12.
Sumiko Shiba Hiroyuki Okawa Hiroyasu Uenishi Yumi Koike Katuya Yamauchi Ko Asayama Taro Nakamura Fumihiro Tajima 《Archives of physical medicine and rehabilitation》2010,91(8):1262-1266
Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.
Objective
To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).Design
Longitudinal study (20-y follow-up).Setting
Laboratory setting.Participants
Persons with SCI (N=7).Interventions
Not applicable.Main Outcome Measures
Maximum oxygen consumption V?o2max) measured in 1986-1988 and in 2006.Results
Subjects with SCI maintained stable V?o2max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o2max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o2max by 43% and 45% after 20 years.Conclusion
The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities. 相似文献13.
Objective
To define patient-centredness from the patient's perspective in the context of physiotherapy for chronic low back pain (CLBP).Design
Qualitative study using semi-structured interviews to explore perceptions of various aspects of physiotherapy management of CLBP.Setting
Physiotherapy departments in one geographical area of the UK National Health Service.Participants
Twenty-five individuals who had received physiotherapy for CLBP within the previous 6 months.Results
Six key themes emerged as the dimensions that the participants perceived to be important for patient-centred physiotherapy: communication; individual care; decision-making; information; the physiotherapist; and organisation of care. Communication was the most important dimension, underpinning the five other dimensions as well as being a distinct dimension of patient-centred physiotherapy.Conclusions
Physiotherapists should have an understanding of the six dimensions of patient-centred physiotherapy for CLBP. Improving physiotherapists’ communication skills may better facilitate patient-centred physiotherapy, and therefore enhance the experience of physiotherapy for this client group. 相似文献14.
Douglas C Wollin JA Windsor C 《Archives of physical medicine and rehabilitation》2008,89(10):1923-1932
Douglas C, Wollin JA, Windsor C. Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis.
Objective
To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS).Design
A cross-sectional survey and structured pain interview.Setting
Community.Participants
People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database.Interventions
Not applicable.Main Outcome Measures
Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques.Results
Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0±1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity.Conclusions
Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment. 相似文献15.
Courtney D. Hall Tanya Miszko Steven L. Wolf 《Archives of physical medicine and rehabilitation》2009,90(3):525-458
Hall CD, Miszko T, Wolf SL. Effects of Tai Chi intervention on dual-task ability in older adults: a pilot study.
Objective
To determine if a 12-week program of Tai Chi that has been shown to reduce falls incidence in older adults would improve the ability to allocate attention to balance under dual-task conditions.Design
Pre-/posttest experimental research design.Setting
Movement studies research laboratory.Participants
Community dwelling older adults (N=15; range, 62-85y) participated in either Tai Chi training or health education classes (controls) for 12 weeks.Interventions
Participants in the Tai Chi group attended a twice-weekly, 1.5-hour class taught by an experienced instructor. The control group attended a biweekly, 1-hour class for lectures on health-related topics.Main Outcome Measures
Two cognitive tasks (responding to auditory or visual stimulus as quickly as possible) were performed concurrently while maintaining static balance during the Sensory Organization Test (SOT) and while avoiding obstacles while walking. The percent change in performance relative to the single-task condition was calculated and defined as the dual-task cost. The dual-task cost was calculated for both the postural and cognitive measures.Results
There was no improvement in the performance of postural stability or cognitive task under dual-task conditions for the SOT for Tai Chi versus controls. There was no improvement in avoiding obstacles under dual-task conditions for Tai Chi versus controls.Conclusions
Contrary to our hypothesis, the findings of this study did not support a benefit of Tai Chi on the ability to allocate attention to balance under dual-task conditions. 相似文献16.
17.
Sheri P. Silfies Rupal Mehta Sue S. Smith Andrew R. Karduna 《Archives of physical medicine and rehabilitation》2009,90(7):1159-1169
Silfies SP, Mehta R, Smith SS, Karduna AR. Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain.
Objective
To investigate alterations in trunk muscle timing patterns in subgroups of patients with mechanical low back pain (MLBP). Our hypothesis was that subjects with MLBP would demonstrate delayed muscle onset and have fewer muscles functioning in a feedforward manner than the control group. We further hypothesized that we would find differences between subgroups of our patients with MLBP, grouped according to diagnosis (segmental instability and noninstability).Design
Case-control.Setting
Laboratory.Participants
Forty-three patients with chronic MLBP (25 instability, 18 noninstability) and 39 asymptomatic controls.Interventions
Not applicable.Main Outcome Measures
Surface electromyography was used to measure onset time of 10 trunk muscles during a self-perturbation task. Trunk muscle onset latency relative to the anterior deltoid was calculated and the number of muscles functioning in feedforward determined.Results
Activation timing patterns (P<.01; η=.50; 1-β=.99) and number of muscles functioning in feedforward (P=.02; η=.30; 1-β=.83) were statistically different between patients with MLBP and controls. The control group activated the external oblique, lumbar multifidus, and erector spinae muscles in a feedforward manner. The heterogeneous MLBP group did not activate the trunk musculature in feedforward, but responded with significantly delayed activations. MLBP subgroups demonstrated significantly different timing patterns. The noninstability MLBP subgroup activated trunk extensors in a feedforward manner, similar to the control group, but significantly earlier than the instability subgroup.Conclusions
Lack of feedforward activation of selected trunk musculature in patients with MLBP may result in a period of inefficient muscular stabilization. Activation timing was more impaired in the instability than the noninstability MLBP subgroup. Training specifically for recruitment timing may be an important component of the rehabilitation program. 相似文献18.
Meachen SJ Hanks RA Millis SR Rapport LJ 《Archives of physical medicine and rehabilitation》2008,89(5):958-965
Meachen S-J, Hanks RA, Millis SR, Rapport LJ. The reliability and validity of the Brief Symptom Inventory−18 in persons with traumatic brain injury.
Objective
To investigate the psychometric properties of the Brief Symptom Inventory−18 (BSI-18) among persons with traumatic brain injury (TBI).Design
Inception cohort design with cross-sectional follow-up of 6 months to 15 years.Setting
Rehabilitation hospital.Participants
Adults (N=257) with moderate to severe TBI (81 inpatients and 176 follow-up participants, analyzed separately).Interventions
Not applicable.Main Outcome Measures
The BSI-18 is a brief screen of psychologic distress with a Global Severity Index (GSI), and 3 clinical subscales: somatization, anxiety, and depression.Results
Internal consistency of the GSI was high in both follow-up participants (α=.91) and inpatients (α=.84), whereas estimates for the somatization, anxiety, and depression subscales were more variable (α range, .61-.84). As would be expected for a measure of affective state, retest reliability estimates were only moderate. The BSI-18 GSI correlated with multiple measures of psychosocial adjustment. After accounting for demographics, injury severity, inpatient functional status, years since injury, and various psychosocial factors, the BSI-18 showed incremental validity in predicting concurrent functional, psychosocial, and psychologic status.Conclusions
The BSI-18 GSI had excellent reliability and validity among inpatients and follow-up participants. Modest reliability estimates may place an upper bound on the validity of the BSI-18 clinical subscales in inpatient TBI populations. 相似文献19.
Objectives
To investigate the attitudes of physiotherapy students to a variety of clinical interactions that have sexual connotations.Design
A questionnaire was distributed that required students to indicate their anticipated level of comfort in a variety of situations. Third and fourth year students were also asked whether they perceived that their degree programme had dealt with each of these issues adequately.Setting
One university in Australia.Participants
Three hundred and thirty-three first, second, third and fourth year students enrolled in an undergraduate physiotherapy degree programme.Main outcome measure
A modified version of Cohen's Comfort Scale Questionnaire.Results
Over half of the students anticipated that they would not feel comfortable in dealing with the issues raised in nine of the 19 sexually themed items. The three items that students endorsed as the least comfortable were ‘walking in on a patient/client who is masturbating’ (95%), ‘dealing with a patient/client who makes an overt sexual remark’ (74%) and ‘dealing with a patient/client who makes a covert sexual remark’ (68%). Significant gender differences were identified for five of the items. Over 90% of third and fourth year students considered that their degree programme had not dealt with five of the items. Although approximately one-third of senior students thought that their degree programme had covered dealing with overt (33%) and covert (32%) sexual comments adequately, these items were still rated as eliciting a high level of discomfort.Conclusions
Feelings of discomfort when interacting with clients can impact negatively on service provision and could be a major barrier to appropriate therapeutic intervention. Future research examining the nature and origin of discomfort in clinical settings and the role of undergraduate education in decreasing discomfort is warranted. 相似文献20.
Huizing AR Hamers JP Gulpers MJ Berger MP 《International journal of nursing studies》2009,46(4):459-469