Prognostic factors for neck pain in general practice

Prognostic studies on neck pain are scarce and are typically restricted to short-term follow-up only. In this prospective cohort study, indicators of short- and long-term outcomes of neck pain were identified that can easily be measured in general practice. Patients between 18 and 70 years of age, suffering for at least 2 weeks from neck pain were recruited by 42 general practitioners (GPs). Perceived recovery, pain intensity and neck dysfunction after 7 and 52 weeks were considered as outcome measures. Indicators of prognosis were identified by means of logistic regression analyses (perceived recovery) and linear regression analyses (pain intensity and neck dysfunction). In total, 183 patients were included. After 1 year, 63% had recovered. The prognostic models showed differences between short- and long-term indicators. At the short term, besides the baseline values of the respective outcome measurements, only older age (≥40) and concomitant low back pain and headache were associated with poor outcome. At the long term, in addition to age and concomitant low back pain, previous trauma, a long duration of neck pain, stable neck pain during the 2 weeks prior to baseline measurement, and previous neck pain predicted poor prognosis. The predictive power of the models was weak: the explained variance (R²) varied from 24 to 36%. Patient history and physical examination give GPs little handholds to predict the prognosis for patients with sub-acute and chronic neck pain. A few indicators of a less favourable prognosis of neck pain were identified, of which older age and concomitant low back pain was the most consistent.     

Early predictors of long-term disability after injury.

BACKGROUND: Improving outcomes after serious injury is important to patients, patients' families, and healthcare providers. Identifying early risk factors for long-term disability after injury will help critical care providers recognize patients at risk. OBJECTIVES: To identify early predictors of long-term disability after injury and to ascertain if age, level of disability before injury, posttraumatic psychological distress, and social network factors during hospitalization and recovery significantly contribute to long-term disability after injury. METHODS: A prospective, correlational design was used. Injury-specific information on 63 patients with serious, non-central nervous system injury was obtained from medical records; all other data were obtained from interviews (3 per patient) during a 2 1/2-year period. A model was developed to test the theoretical propositions of the disabling process. Predictors of long-term disability were evaluated using path analysis in the context of structural equation modeling. RESULTS: Injuries were predominately due to motor vehicle crashes (37%) or violent assaults (21%). Mean Injury Severity Score was 13.46, and mean length of stay was 12 days. With structural equation modeling, 36% of the variance in long-term disability was explained by predictors present at the time of injury (age, disability before injury), during hospitalization (psychological distress), or soon after discharge (psychological distress, short-term disability after injury). CONCLUSIONS: Disability after injury is due partly to an interplay between physical and psychological factors that can be identified soon after injury. By identifying these early predictors, patients at risk for suboptimal outcomes can be detected.     

Exploring Associations of Preoperative Physical Performance With Postoperative Outcomes After Lumbar Spinal Fusion: A Machine Learning Approach

ObjectiveTo explore the association between preoperative physical performance with short- and long-term postoperative outcomes in patients undergoing lumbar spinal fusion (LSF).DesignRetrospective cohort.SettingUniversity hospital.ParticipantsSeventy-seven patients (N=77) undergoing elective LSF were preoperatively screened on patient demographics, patient-reported outcome measures, and physical performance measures (movement control, back muscle endurance strength and extensor strength, aerobic capacity, flexibility).InterventionsNot applicable.Main Outcome MeasuresAssociations between preoperative variables and inpatient functional recovery, hospital length of stay (LOS), and 1- to 2-year postoperative pain reduction were explored using random forest analyses assessing the relative influence of the variable on the outcome.ResultsAerobic capacity was associated with fast functional recovery <4 days and prolonged functional recovery >5 days (median z scores=7.1 and 12.0). Flexibility (median z score=4.3) and back muscle endurance strength (median z score=7.8) were associated with fast functional recovery <4 days. Maximum back extensor strength was associated with prolonged functional recovery >5 days (median z score=8.6). Flexibility (median z score=5.1) and back muscle endurance strength (median z score=13.5) were associated with short LOS <5 days. Aerobic capacity (median z score=8.7) was associated with prolonged LOS >7 days. Maximum back extensor strength (median z score=3.8) was associated with 1- to 2-year postoperative pain reduction and aerobic capacity (median z score=2.8) was tentative.ConclusionsPhysical performance measures were associated with both short- and long-term outcomes after LSF. Adding these measures to prediction models predicting outcomes after LSF may increase their accuracy.     

Social support, personal control, and psychosocial recovery following heart transplantation

To study the influence of psychosocial resources on psychological recovery after heart transplantation, 28 patients were surveyed during their hospitalization after transplant surgery and 6 months posttransplantation. Scales from the Coping With Serious Illness Battery were used to measure psychosocial resources (social support and personal control) and psychological and functional outcomes. Psychosocial resources assessed during hospitalization were associated with recovery outcomes at 6 months posttransplantation. Personal control was positively correlated with optimism, well-being, and satisfaction with life (r = .41 to .49) and negatively correlated with anger (r = -.57) and depression (r = -.52). Social support network helpfulness and attachment with others were correlated with psychological outcomes (r = .41 to .59) and functional outcome (r = .42 to .47). Efforts directed toward enhancing perceptions of personal control, social support network helpfulness, and attachment may be useful for promoting psychosocial recovery.     

The role of spouse responses to disability and family environment in multiple sclerosis

Research in the area of family issues and multiple sclerosis has mainly focused on the impact of multiple sclerosis on the spouse. The aim of the current study was to examine the relationship between patients' ratings of their spouses' responses to multiple sclerosis patient disability behaviors and the impact on patient psychological and physical functioning. Multiple sclerosis patients were interviewed over the telephone using standardized questionnaires to assess patient physical and psychological functioning, spouse responses to patient disability and well behaviors (i.e., how does the spouse respond when you're having difficulties related to multiple sclerosis?), and family environment factors. The study was set in a large university-based Multiple Sclerosis Clinical Center. Forty-four of 64 patients approached with definite multiple sclerosis participated in the study. Physical functioning was assessed by the Kurtzke-EDSS, SIP, SF-36, and psychological functioning was assessed by the CES-D and SF-36. Scores on the SF-36 were generally lower compared with a normative sample of individuals with major medical problems; however, mean Kurtzke scores of 5.60 reflected moderate to severe impairment. Exploring spouse responses to disability, correlation analyses revealed that solicitous spouse responses to patient disability behaviors were significantly associated with greater multiple sclerosis-related physical disability. This relationship was stronger for patients who were more depressed. Spouse negative responses to patient disability behaviors were associated with poorer mental health, whereas spouses' encouragement of patient well behaviors was associated with lower emotional distress. Poorer psychological functioning was found in patients with families who were reported to have higher conflict and/or who were more controlling. Higher levels of independence in families were associated with better psychological and physical functioning in the patients. These preliminary findings suggest that patients' perceptions of their families' responses to disability and family environment factors may be important areas for further research. The findings may also provide potential targets for clinical intervention in the future.     

The effects of physical activity,fast-mimicking diet and psychological interventions on cancer survival: A systematic review and meta-analysis of randomized controlled trials

BackgroundHealth professionals are often asked if non-pharmacological interventions prolong life. This review aims to evaluate the effects of physical activity, fast-mimicking diet (FMD) and psychological interventions on survival in all cancers.MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs). Only RCTs of physical activity, FMD and psychological interventions (including counselling, cognitive and other psychotherapies) in cancer patients that reported survival outcomes were included.Data sourcesCENTRAL, MEDLINE, Embase, CINAHL, APA PsycINFO, Web of Science, ICTRP and ClinicalTrials.gov from inception to January 2020 were searched without language restrictions. The protocol was prospectively registered at PROSPERO (CRD42019160944).ResultsThirty-one RCTs (9 on physical activity and 22 on psychological interventions) were included in the final analysis after evaluation of 60,207 records from our initial search. No eligible RCT on FMD was reported. RCTs on group psychological interventions (41.9 %) and in patients with breast cancer (38.7 %) were the most common. Most evaluated short-term interventions and in primary or adjuvant settings. Only one of 9 (11 %) RCTs on physical activity and 8 of 22 (36 %) RCTs on psychological interventions were associated with improved overall survival. Only group psychological interventions in breast cancer had adequate number of RCTs to allow a meta-analysis to be performed. It demonstrated a trend towards improved overall survival (HR -0.20, 95 %CI -0.49 to 0.10), particularly in RCTs that evaluated long-term (>6 months) therapies (HR -0.29, 95 %CI -0.59 to 0.01).ConclusionLonger term interventions starting early in the patients’ care journey in primary and adjuvant settings have shown the most promise for improving survival. Better designed RCTs including survival outcomes are particularly needed in non-breast cancers.     

Can we achieve accountability for long-term outcomes?

Objective: To explore options for the development of a set of indicators to assess the long-term outcomes achieved by all people with a given disabling condition in a given population.Data Sources: The review draws on empirical studies of predictive indicators, theoretical literature on long-term recovery processes, and literature from administrative science on the use of indicators in accountability systems.Study Selection: Studies were selected that explicitly sought to relate short-term and long-term outcomes or that explored the mediating factors in the relationship between impairment, disability, and handicap.Data Extraction: The focus of the review is on (1) empirical evidence of the relationship between short- and long-term outcomes, particularly in causal claims, and (2) theoretical analyses of the factors that mediate this relationship.Data Synthesis: Evidence is presented that certain outcome states can be considered thresholds that make the outcome usable and, hence, sustainable or that create the opportunity for further improvement. Such thresholds could meet the construct validity criteria necessary for measures that are to be used as indicators in an accountability system. The interaction between psychological and physical factors in setting thresholds means that both objective and subjective indicators are required in an indicator system.Conclusions: It may well be possible to develop a parsimonious set of population-based outcome indicators for people with disabilities. The key safeguards required are construct validity and the involvement of people with disabilities in both the development and use of the indicators.     

Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

ObjectiveWhat are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer?Data SourcesFour electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020.Study SelectionRandomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer.Data ExtractionTwo independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools.Data SynthesisFourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, ?0.18; 95% confidence interval [CI], ?0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, ?0.61; 95% CI, ?1.19 to –0.02).ConclusionsHigh-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.     

Single-leg hop mechanics are correlated with self-reported knee function early after anterior cruciate ligament reconstruction

BackgroundBiomechanical changes that persist after anterior cruciate ligament (ACL) injury may impact short- and long-term outcomes. Understanding the relationship of biomechanics during a dynamic task and patient reported function can better identify patients who are most vulnerable to sub-optimal long-term outcomes, such as osteoarthritis (OA). The purpose of this study was to determine whether hip and knee biomechanics during single-leg hop landing were significantly correlated with the Knee injury and Osteoarthritis Outcome Score (KOOS), and whether symptomatic knees displayed altered biomechanics relative to asymptomatic knees.MethodsHip and knee biomechanics during the landing phase of a single-leg hop of thirty subjects with ACLR were analyzed. Subjects were also classified as symptomatic or asymptomatic based on their KOOS results. Correlation analyses and group comparisons between symptomatic and asymptomatic subjects were conducted.FindingsKOOS Symptoms, Pain, and Sport subscales were significantly correlated with frontal and sagittal plane hip and knee biomechanics. Furthermore, those with symptomatic knees demonstrated greater hip and knee flexion angles, and greater hip flexion moments.InterpretationThese results indicate that biomechanics associated with ACLR during a single-leg hop are correlated with worse KOOS outcomes. However, these correlations may be due to symptoms of the recovery from ACLR rather than those of OA. The results of this study may help to identify rehabilitation opportunities for patients at risk for worse long-term outcomes after ACLR.     

Cardiac rehabilitation program participation and outcomes after myocardial infarction.

Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.     

Specialized palliative care services are associated with improved short- and long-term caregiver outcomes

GOALS OF WORK: The goal of this study was to evaluate, at a population level, the association between specialized palliative care services (SPCS) and short- and long-term caregiver outcomes. PATIENTS AND METHODS: The Health Omnibus Survey, a face-to-face survey conducted annually in South Australia since 1991, collects health-related data from a rigorously derived, representative sample of 4,400 households. This study included piloted questions in the 2001, 2002, and 2003 Health Omnibus Survey on the impact of SPCS. Sample size was 9,088 individuals. "Unmet needs," a short-term outcome relevant to the caregiving period during a life-limiting illness, were tallied. "Moving on," a long-term caregiver-defined outcome reflecting the caregiver's adaptation and return to a new equilibrium after the death, was assessed with and without SPCS. RESULTS: Thirty-seven percent (3,341) indicated that someone close to them had died of a terminal illness in the preceding 5 years, of whom 949 (29%) reported that they provided care. SPCS were involved in caring for 60% of deceased patients. Day-to-day caregivers indicated fewer unmet needs when SPCS were involved (p = 0.0028). More caregivers were able to "move on" with their lives when SPCS were involved than when SPCS were not involved (86 vs 77%, p = 0.0016); this effect was greatest in the first 2 years after the loved one's death. CONCLUSION: At a population level, SPCS were associated with meaningful improvements in short-term ("unmet needs") and long-term ("moving on") caregiver-defined outcomes.     

Role of psychological factors in studying recovery from a transactional stress-coping approach: implications for mental health nursing practices

Over the last decade, the experience of recovering from psychiatric disabilities has received increased attention in mental health nursing. Recovery is a complex experience that can be understood in terms of construct, process, and outcomes. New theoretical frameworks are needed to better understand antecedents, process variables, and outcomes related to recovery. Considering that recovery is a stressful and challenging experience, the transactional stress-coping theory appears relevant to explore the appraisal and coping processes involved in recovery. Based on this theory, a new framework has been built to better understand the phenomenon of stress in recovery. More specifically, a review of the recovery literature had led to the identification of several key recovery concepts, which were then linked to major stress-coping concepts, namely contextual factors, potential stressors, primary and secondary appraisals, coping strategies, and short-term and long-term outcomes. This paper focuses on specific types of personal characteristics that are included in the broad category of contextual factors, namely psychological factors. These factors may act as coping resources, helping people to deal successfully with events interfering with the achievement of recovery goals. The main purpose of this paper is to offer a detailed discussion about how mental health nursing practices may promote the role of psychological factors within the stress-coping process. Three categories of psychological factors are discussed: views about oneself, psychological empowerment, and personal/philosophical orientations in life. A brief summary of the new framework is first offered to introduce its major concepts and basic mechanisms.     

Prognostic factors for poor recovery in acute whiplash patients

The objective of our prospective inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash-associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident. The study was carried out in a primary health care setting in The Netherlands and included 125 patients. The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use. The secondary outcome measures included neck pain intensity, work disability and sick leave. The outcomes were assessed at 4, 12 and 52 weeks after the accident. Prognostic factors were identified by logistic regression analyses. One year after the injury, 64% of the patients were recovered. Factors related to poor recovery were female gender, a low level of education, high initial neck pain, more severe disability, higher levels of somatisation and sleep difficulties. Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery. The accuracy of the predictions of the prognostic models was high, meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered. These findings add to the growing body of evidence, indicating that socio-demographic, physical and psychological factors affect short- and long-term outcome after whiplash injury. Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work-related activities.     

Acute and critically ill peripartum cardiomyopathy and 'bridge to' therapeutic options: a single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices

Introduction  

Peripartum cardiomyopathy (PPCM) patients refractory to medical therapy and intra-aortic balloon pump (IABP) counterpulsation or in whom weaning from these therapies is impossible, are candidates for a left ventricular assist device (LVAD) as a bridge to recovery or transplant. Continuous-flow LVADs are smaller, have a better long-term durability and are associated with better outcomes. Extra corporeal membrane oxygenation (ECMO) can be used as a temporary support in patients with refractory cardiogenic shock. The aim of this study was to evaluate the efficacy and safety of mechanical support in acute and critically ill PPCM patients.     

The relationship of perceived control to outcomes in older women undergoing surgery for fractured neck of femur

This paper examines the relationship between internal locus of control and recovery from surgery for fractured neck of femur in women over the age of 65 years, in order to inform strategies for nursing care. Structured interviews were carried out at 5 and 30 days postsurgery with 112 women (mean age 78.6 years) in five general hospitals in the North of England. Locus of control was assessed as a factor associated with the outcomes of physical disability (measured as dependence in activities of daily living) and psychological distress (measured using the Hospital Anxiety and Depression Scale). Internal locus of control was significantly related to less physical disability, but no association was found between locus of control and depression and anxiety at 30 days postsurgery when age, 5-day measures and other 30-day outcome measures were controlled. The findings suggest that nursing interventions that enhance perceived internal control by patients during rehabilitation may result in better physical outcomes. Further work is required to explore the relationship of control to psychological outcomes.     

Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest

AIM: The aim of this study was to describe the relationship between prehospital clinical variables, interventions and survival time after cardiac arrest and to determine whether various factors affect the risk of death differently at early and late time periods. METHODS: Time-to-death (days) after collapse was identified using the paramedic record, the social security death index or obituaries for adult (> or =18 years) out-of-hospital cardiac arrest (OOHCA) cases from Pittsburgh, Pennsylvania between 1998 and 2002. Clinical prehospital variables included age of patient, sex, witnessed collapse, bystander CPR, use of an automated external defibrillator (AED), initial ECG rhythm, medications and response time intervals. We used Cox regression with time varying coefficients to describe the effects of each covariate separately upon short-term (on day 1) and long-term (after day 1) survival. RESULTS: Of 1496 adult patients, overall mortality was 89.5%. The majority (75%) of deaths occurred on day 1. Of the 1339 deaths, 1213 (90.6%) occurred by day 3, 1272 (95.0%) occurred by day 7 and 1299 (97.0%) occurred by day 14. Witnessed collapse (hazard ratio 0.85; 95% CI: 0.75-0.97) or the use of epinephrine (adrenaline) (1.57; 1.20-2.07), lidocaine (0.78; 0.66-0.91) or dopamine (0.75; 0.56-1.00) were independently associated with risk of death on day 1 (day of collapse). Epinephrine use (1.84; 1.23-2.78) and age (1.02; 1.01-1.03) were independently associated with risk of death after day 1. The proportional hazards assumption was satisfied. CONCLUSIONS: Survival after out-of-hospital cardiac was characterized by a large number of deaths on day 1. Most subsequent deaths were identified within 14 days after collapse. Prehospital factors have markedly different relationships with short- and long-term survival. Linkage between prehospital intervention and short- and long-term outcomes must consider the survival time characteristics of this population.     

Development of and recovery from short- and long-term low back pain in occupational settings: A prospective cohort study

Using the data of the EuroBack Unit prospective cohort study, this paper investigated the role of work-related physical factors and psychological variables in predicting the development of and recovery from short-term and long-term LBP. At baseline, 1294 predominantly male industrial workers from 10 companies in Belgium and the Netherlands filled in questionnaires. At follow-up, data from 812 employees were available. Odds ratios (ORs) were calculated using simple and multiple logistic regression analyses. For those workers reporting 0 days LBP in the year prior to baseline, negative affectivity (OR 1.06, 95% CI 1.01-1.11) was a risk factor for the development of short-term LBP (=1-30 days total of LBP in the year prior to follow-up). For those who reported 1-30 days total of LBP in the year prior to baseline, only high fear of (re)injury due to movement (OR 1.07, 95% CI 1.02-1.12) increased the risk for failure to recovery from short-term LBP. For the development of long-term LBP (=more than 30 days total of LBP in the year prior to follow-up), a significant increased risk was observed among workers with high pain severity (OR 1.19, 95% CI 1.01-1.40) and with pain referred to the ankles or feet (OR 2.92, 95% CI 1.09-7.83). The risk was reduced by social support of co-workers (OR 0.73, 95% CI 0.59-0.92) and by manual handling of materials (OR 0.63, 95% CI 0.46-0.85). For those who reported more than 30 days total of LBP in the year prior to baseline, high pain severity (OR 1.18, 95% CI 1.04-1.34) increased the risk for failure to recovery from long-term LBP. Results are compared to the baseline study (Gheldof et al., 2005) and discussed in relation with prospective studies.     

Social role quality,physical health,and psychological well-being in women after heart surgery

Women's social role quality may be an important factor in their adaptation after heart surgery. Relationships among different dimensions of role quality, physical health, and psychological well-being were examined in 157 midlife and older women who had undergone heart surgery. Overall, older women (n = 89) were similar to younger women (n=68) in physical recovery from heart surgery. Poorer health outcomes were associated with number of health problems, not age. Women with more health problems and lower subjective health perceptions had lower role quality. Multiple regression analyses indicated that, in general, role quality mediated the effects of physical health on psychological well-being. Regardless of the extent of physical health problems, women with higher role quality had higher levels of psychological well-being.