Musculoskeletal pain in primary health care: subgroups based on pain intensity, disability, self-efficacy, and fear-avoidance variables.

The purpose of this study was to identify and describe subgroup profiles based on self-reported pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing in patients with musculoskeletal pain. Two primary health care samples (n = 215 and n = 161) were used. Self-report questionnaires were completed at the start of physical therapy treatment. Cluster analysis was used to generate subgroups. Three subgroups were identified in sample 1 and replicated in sample 2. These were labeled "High self-efficacy-Low fear-avoidance," "Low self-efficacy-Low fear-avoidance," and "Low self-efficacy-High fear-avoidance." The subgroups differed significantly in work-status in both samples (P < .001), but not in age, gender, or duration of pain. The results show the presence of subgroups based on pain intensity, disability, self-efficacy, fear of movement/(re)injury, and catastrophizing. The profile patterns suggest that different management strategies may be relevant in each subgroup. PERSPECTIVE: This article presents subgroups of patients with musculoskeletal pain with different profiles in pain intensity, disability, and psychosocial variables possible to modify by physical therapy management. The results could potentially aid clinicians in tailoring assessment and treatment approaches to each subgroup.     

Women's emotions and concerns during pregnancy following perinatal loss

PURPOSE: To determine the specific emotions and concerns of women who are pregnant following a perinatal loss. STUDY DESIGN AND METHODS: Data were collected through a mailed questionnaire using an open response format. The sample consisted of 73 women on the membership mailing lists from two pregnancy-after-loss support groups. A content analysis was conducted on women's self-reports; five primary emotions and five main concerns were expressed during their pregnancies. RESULTS: "Anxious," "nervous," and "scared" were the most frequent emotions reported by these women. However, most women also included a positive emotion in their list, indicating the mixed emotions of their pregnancy experience. Eight categories of profound concerns were identified: "losing another baby," "overall health of the baby," "emotional stability of self," "impact of another loss on my future," "lack of support from others," "fear of bad news," "own impact on the baby," and "worries never end." Responses of currently pregnant women as compared with women retrospectively reporting on their last pregnancy experiences were essentially similar. CLINICAL IMPLICATIONS: Women pregnant after a previous perinatal loss are skeptical about pregnancy. Clinicians should be cognizant of the constellation of concerns and the simultaneous contrasting emotions experienced by these women in order to provide supportive prenatal care. Because the women's concerns are ongoing, responsive care should include asking about specific concerns throughout the pregnancy.     

Parental preparation of children for routine physical examinations.

Preparation of the child and parents/caretakers for health care events is expected to decrease a child's anxiety and uncooperative behaviors. The purpose of this study was to ascertain the methods of preparation (discussion, reading, play, other) and levels of discussion used by parents in readying their preschool and school-age children for six selected events during routine physical examinations. A phone survey was conducted to all parents of children, ages 2 to 12 years, who visited an academic nursing center or public school for a routine physical examination (n = 132). The events are "listen to heart," "look in ears," "take temperature," "feel the stomach," "look at the throat," and "give a shot." The most common method of preparation parents used was discussion that consisted largely of procedural information rather than a reciprocal dialogue with the child. Preschool children were told what the health care provider would do and what they should do during the physical examination more often than school-age children.     

Dyspnea in the weaning patient: assessment and intervention

Dyspnea, the subjective sensation of uncomfortable breathing, is frequently experienced by patients during weaning from mechanical ventilation. As the clinical manifestation of increased work of breathing, dyspnea can be a valuable predictor and indicator of changes in patient respiratory status during the weaning process. The importance of measuring dyspnea is emphasized and the numerical rating and visual analog scales as direct measures of dyspnea are described. The most reliable physiologic variables that can be used to indirectly estimate dyspnea are discussed. Strategies such as positioning, coaching, "bagging," inspiratory muscle training, pressure support ventilation, oxygen, and relaxation/biofeedback techniques that can be used by the critical care nurse to decrease dyspnea are suggested.     

Pain and neuromuscular disease: the results of a survey

OBJECTIVE: The objective of this study was to evaluate pain frequency, severity, location, treatment, and relief in a population of adult patients with neuromuscular disorders (NMD). DESIGN: The authors used a self-completion mail questionnaire from the Physical Medicine Clinic at the Lille University Medical Center (northern France). Two hundred eighty-one adults with a confirmed diagnosis of hereditary neuromuscular disease were mailed a questionnaire, which was returned by 125 subjects (response rate = 45%). The main outcome measures were mean motor deficiency scores (on the Brooke and Vignos scales), anxiety and depression scores, pain intensity (on a 0-10 numeric scale) and location, frequency of pain-aggravating situations, and pain treatment and relief. RESULTS: Seventy-three percent of respondents reported pain and 62% reported chronic pain (defined as pain for at least 3 mos). The mean pain intensity was 6.1/10 with 40% reporting severe pain (a score of > or = 7). Forty-six percent and 16% of subjects had a high risk for anxiety and depression, respectively. The most common pain-aggravating situations were "walking," "standing," and "muscle stretching." Walking was more frequently cited as a pain-aggravating situation by the chronic pain population than by the acute pain population. Seventy percent of patients with pain had received at least one analgesic drug. Massage was the most frequently prescribed physical treatment. CONCLUSIONS: Pain is a frequent symptom in adult patients with NMD and needs to be better characterized in this population. The use of painkillers and physical pain treatments did not seem to provide adequate relief for the patients studied here.     

The Tradition of Toughness: A Study of Nonprofessional Nursing Care in Psychiatric Settings

Violence is a significant problem in psychiatric settings; however, nursing research that identifies organizational influences related to violent patient behavior is rare. This paper reports on an exploratory study conducted on the psychiatric units of a metropolitan public hospital. The key concept generated by the data was the "tradition of toughness." Within this psychiatric setting, "control" of patient behavior was emphasized resulting in norms and roles that operationalized the theory. The norms were (a) "The need for physical restraint" and (b) "It's not you we don't trust." The nursing role was labelled "enforcing" and included the strategies of (a) "Policing," (b) "Supermanning," and (c) "Putting on a show."     

Identifiers suggestive of clinical cervical spine instability: a Delphi study of physical therapists

BACKGROUND AND PURPOSE: Clinical cervical spine instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI. SUBJECTS: One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey. METHODS: This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI. RESULTS: The symptoms that reached the highest consensus among respondents were "intolerance to prolonged static postures," "fatigue and inability to hold head up," "better with external support, including hands or collar," "frequent need for self-manipulation," "feeling of instability, shaking, or lack of control," "frequent episodes of acute attacks," and "sharp pain, possibly with sudden movements." The physical examination findings related to cervical instability that reached the highest consensus among respondents included "poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement," "abnormal joint play," "motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming," and "aberrant movement." DISCUSSION AND CONCLUSION: The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings.     

The relationship among medical diagnosis, nursing diagnosis, and nursing intervention and the implications for home health care.

The purpose of this study was to identify the most commonly used medical diagnoses, nursing diagnoses, and nursing interventions for home health care based on 244 patient records. Nursing interventions were categorized into three groups: assessment, instruction, and other. The results showed that for the three most commonly used medical diagnosis groups--"infectious and parasitic disease," "disease of the circulatory system," and "neoplasms"--the most related nursing diagnoses were "alteration in mobility," "alteration in cardiac status," and "alteration in comfort: pain." The most used nursing interventions were "instructions." The results indicated that nurses identified patients' physiological problems mostly in relation to medical diagnoses, and teaching was the most frequently used nursing intervention in home health care.     

A comparison of the stress and coping strategies between the parents of children with Duchenne muscular dystrophy and children with a fever

This university hospital-based case control study included 31 parents with a Duchenne muscular dystrophy (DMD) child and 30 parents (control group) of a child with a fever. The study was conducted in southern Taiwan. The study compared the differences of stress and coping strategies between the two groups using closed-ended questionnaires. The control group (fever group) showed higher "stress," "conflict," and "help needs." The DMD subjects had a tendency to use wish-fulfilling fantasy to cope. "Impact" was influenced by income and religion, and income and mother's age influenced coping strategies. Professionals need to manage the parent's conflict, to provide information and resources, and to support the parent's emotional reactions to caring for a child with acute and chronic illness.     

Needs of young children with cancer during their initial hospitalization: an observational study.

The aim of this study was to describe young (under the age of 7) children's needs as expressed by their behavior, body language and verbal expression through observations during their initial hospitalization after being diagnosed with cancer. Twelve children under the age of seven were followed during 26 hours with non-participant unstructured observations. Field notes were written after each observation and transcribed into a narrative text, which was analyzed by content analysis at both manifest and latent level. Five themes were identified, of which "need to have the parent close by" was the most prominent. The other themes were "need to play and feel joy," "need for participation in care and treatment," "need for a good relationship with the staff," and "need for physical and emotional satisfaction." The results indicate that the children needed their parents and the parents' presence helped the children to express other needs. Professionals need to support the child and his or her parents so that the parents in their turn can support and alleviate their child's hospitalization and cancer treatment.     

Effects on the Human Body of a Dietary Supplement Containing L-Carnitine and Garcinia cambogia Extract: A Study using Double-blind Tests

The effect of a dietary supplement with L-carnitine (600 mg/day) and Garcinia cambogia extract (500 mg/day as hydroxycitric acid) as main ingredients was studied in 35 healthy volunteers {48.3 +/- 6.9 years, body mass index (BMI): 26.3 +/- 1.7} in a double-blind test (18 subjects in the Test Group and 17 in the Control Group). The yearly examination includes the standard yearly medical tests done in Japan, tests for assessing hormonal age, and a survey for assessing physical and mental fitness of the subjects, called the Anti-Aging QOL Common Questionnaire (AAQol). Use of this supplement significantly improved the level of lipid peroxides (-12.8%) in the blood as well as physical symptoms such as "tired eyes," "blurry eyes," "muscle pain/stiffness," "early satiety," "epigastralgia," "dizziness," "arthralgia" and "easily breaking into a sweat." The Control Group showed a significantly favorable improvement rate, especially for "dizziness." On the other hand, groups of subjects using the test compounds saw a significant rise in total cholesterol (4.5%), fasting blood sugar (4.1%) and HbA1c (3.4%). Our findings suggest that the consumption of the supplement can reduce the oxidative damage; however, the effect on QOL was equivocal. Garcinia cambogia extract did not show dietary efficacy.     

Changes in body image experienced by adolescents with cancer.

Cancer and its treatments affect adolescents' body image. However, it is not known what factors impinge on adolescents' perception of their body image. This multiple case study explored how 5 adolescents with cancer perceived their body image and the impact of this perception on their daily life. Adolescents described their body image as "I don't look normal," a theme that comprised 2 dimensions: "I look ugly" and "I look sick." For the adolescent with cancer, these 2 dimensions evoked feelings of being vulnerably exposed: "People look at me." Consequently, adolescents adopted a new set of coping strategies to help them manage their physical appearance and social interactions: "avoiding," "maintaining normality," "testing the waters," and "peer-shield" themes. Although the adolescents perceived their body image as altered, coping mechanisms enabled adolescents to think of themselves as normal and re-establish their social lives. The results of this small study suggest 2 potential nursing approaches to facilitate adolescents' adaptation to their new body image.     

Health support program for family members with hospitalized child

In 2001, we began conducting Health Support Programs on the pediatric ward of Miyazaki Medical College Hospital. The program is designed to help family members who accompany and care for their children who are ill and hospitalized to practice some physical movements for their own benefit. An interview survey was undertaken to clarify the effects and the purpose of the program by evaluating subjective data from program participants, as well as by evaluating changes in participants' blood pressure rates. Findings indicate that the program's effects include "reduction of stress and/or lack of exercise," "refreshing effect," "comfort and/or exhilaration," "relaxation," and "alleviation of physical symptoms." We also have noted that mothers become more aware of their own health issues and that the program offers an opportunity to reexamine their health conditions. Furtherrnore, we have learned that for parents and children who participate together, the program offers a fun environment, and that, on occasion, mothers are the ones who are cared for in the program.     

An act of courage: women's decision-making processes regarding outpatient cardiac rehabilitation attendance.

The purpose of this qualitative study was to describe the factors that affect women's attendance and adherence to a cardiac rehabilitation (CR) program after a myocardial infarction (MI). We used in-depth interviews and a health survey form to collect data. The purposive sample consisted of 40 women who had experienced a first MI within the previous 6 weeks to 12 months. Of those 40, 18 women were not offered the program, 8 declined it, and 14 attended. Using content analysis and constant comparison, we identified three distinct phases: "initial decision," "CR attendance," and "reevaluation." Four data clusters positively influenced the continuation of CR attendance: "Psychological Appraisal," "Program Components," "Staff Behaviors," and "Outcomes." When women encountered a fifth cluster--"Barriers"--they entered the reevaluation phase. Results of this study support specific interventions for each phase.     

Accepting pain management or seeking pain cure: an exploration of patients' attitudes to chronic pain.

This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible.     

Protective resources and perceptions of stress in a multi-ethnic sample of school-age children

PURPOSE: To investigate the relationship among protective resources of social connectedness, coping skills, and the perception of stress in 613 Hispanic and White school-aged children. METHODS: A secondary analysis of data, part of a longitudinal cohort-sequential study designed to investigate health-risk behaviors in school-age children. Data were collected by computer-assisted self-interviewing from a non-probability sample of 8-12-year-olds in three independent school districts. FINDINGS: Hierarchical multiple regression analysis indicated that social connectedness and the frequency of coping strategies used accounted for 18.8% of the variation in stress. "Feeling sick" was the primary stressor of the participants, while the two most frequently endorsed coping strategies were "watch TV or listen to music" and "draw, write, or read something." CONCLUSION: The findings are significant because nurses working with children are in a strategic position to assess risk factors and protective resources related to stress and intervene in a timely manner to assist children and families develop resiliency.