Early access to physical therapy treatment for subacute low back pain in primary health care: a prospective randomized clinical trial

OBJECTIVES: To evaluate the effects of early access (EA) to physical therapy treatment for patients with subacute low back pain compared to access with a 4-week waiting list. DESIGN: A prospective, randomized clinical trial. SETTING: Primary health care. PATIENTS: Sixty consecutive patients with subacute low back pain. INTERVENTIONS: Patients were randomized either to EA within 2 days for physical examination and individualized physical therapy treatment (n=32) or a control group with a 4-week waiting list (n=28). OUTCOME MEASURES: Self-administrated questionnaires were used for assessment at inclusion, at discharge, and at 6 months. Primary outcome measure was pain intensity assessed by Borg category scale for ratings of perceived pain. Secondary outcomes included the Orebro musculoskeletal pain screening questionnaire, the Roland and Morris disability questionnaire, sick-leave, visits to health care, and physical therapy. RESULTS: The results showed no significant differences in pain between the groups at discharge. At 6 months, the reduction of pain was significantly greater in the EA group compared to the control group (P=0.025). Changes in secondary outcome measures were not significantly different between groups. CONCLUSIONS: This study indicated that EA to physical therapy resulted in greater improvement in perceived pain at 6 months compared to later access. In this study, EA to physical therapy could be introduced by reorganization without additional resources.     

Parents Plus Programme 1: Evaluation of Its Effectiveness for Pre‐School Children with Developmental Disabilities and Behavioural Problems

Background This study aimed to evaluate the effectiveness of the Parents Plus programme with families of pre‐school children with developmental disabilities and significant behavioural problems in the Irish health service. The Parents Plus programme is a group‐based parent training package involving video modelling, which was designed to be effective for children with conduct problems, but without developmental disabilities. Materials and methods Pre‐ and post‐treatment assessments were conducted with 22 treated cases and 19 waiting‐list controls with a protocol that included the Strengths and Difficulties Questionnaire, the Child Behaviour Checklist, the General Health Questionnaire‐12, the Kansas Parental Satisfaction Scale, the Family Assessment Device, the Perceived Social Support Scale, the Family Inventory of Life Events and Changes, the Parenting Stress Index and the Questionnaire on Resources and Stress. Results Following the treatment, a comparison of treatment and control group means showed that the treated group showed better adjustment on the total difficulties scale of the Strengths and Difficulties Questionnaire. These gains were maintained at 10‐month follow‐up. Fifty per cent of treated cases showed clinically significant improvement and 14% showed reliable change on the Strengths and Difficulties Questionnaire. The treatment group reported a high level of satisfaction with the Parents Plus programme and showed significant goal attainment after treatment and at follow‐up. Conclusions For some families of pre‐school children with developmental disabilities and significant behavioural problems, the Parents Plus programme is an effective intervention and may be incorporated into routine early intervention clinics in the Irish health service.     

Patients waiting for a hip or knee joint replacement: is there any prioritization for surgery?

Objective To investigate whether patients are prioritized for joint replacement surgery on the basis of severity of osteoarthritis, pain and physical functioning. Method A total of 105 patients on the waiting list for primary total knee or hip replacement from a UK regional orthopaedic centre were interviewed at baseline and followed up at 3, 6 and 9 months or until joint replacement. Measurement tools were the visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Oxford hip or knee score. Results Most participants (81, 77%) were categorized on the waiting list as ‘routine’, despite having high levels of pain according to the measurement scales. There was no significant correlation between the waiting list categorization and the actual waiting time for a hip or knee joint replacement operation (Kendall’s tau = 0.17; P = 0.062) and the waiting list categorization did not appear to ensure that patients were operated upon earlier. There were also no significant differences in measures (VAS pain, WOMAC and Oxford hip or knee scores) between those individuals who had their operations earlier (before 6 months) compared with those participants who had their operations later (6 months or greater) or even not at all. Of the 105 patients who were listed for joint replacement, 24 (25%) patients did not have their operation due to: a medical delay (14); self‐delay/cancellation (7); arthroscopy instead (2); and death (1). Conclusion With the expected increase in demand for joint replacement, there needs to be a re‐examination of assessment procedures of patients listed for joint replacement. The use of measurement tools to assess symptoms such as pain and physical function would be one way forward.     

Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial.

OBJECTIVE: To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women. METHODS: Thirty women with fibromyalgia were randomly assigned to an exercise therapy group (n = 15) or a control group (inactive) (n = 15). The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Questionnaire and the anxiety state with State-Trait Anxiety Inventory. Physical fitness was measured using the following tests: Canadian Aerobic Fitness; hand-grip dynamometry; 10-metre walking; 10-step stair-climbing and blind 1-leg stance. RESULTS: After 8 months of training, the exercise therapy group improved compared with the control group in terms of physical function (20%), pain (8%), stiffness (53%), anxiety (41%), depression (27%), Fibromyalgia Impact Questionnaire total scores (18%), State-Trait Anxiety Inventory score (22%), aerobic capacity (22%), balance (30%), functional capacity for walking (6%), stair-climbing with no extra weight (14%) and stair-climbing 10 kg-weighted (25%). CONCLUSION: Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes.     

The role of physical activity and physical fitness in postcancer fatigue: a randomized controlled trial

Purpose

Patients suffering from postcancer fatigue have both an inferior physical activity and physical fitness compared to non-fatigued cancer survivors. The aims of this study were (1) to examine the effect of cognitive behavior therapy, an effective treatment for postcancer fatigue, on physical activity and physical fitness and (2) to examine whether the effect of cognitive behavior therapy on postcancer fatigue is mediated by physical activity and/or physical fitness.

Methods

Severely fatigued cancer survivors were randomly assigned to either the intervention (cognitive behavior therapy) or the waiting list condition. After assigning 23 patients in the intervention condition and 14 patients in the waiting list condition, they were assessed both at baseline and 6 months later. Physical activity was assessed via actigraphy and physical fitness was assessed by a maximal exercise test. A nonparametric bootstrap approach was used to test the statistical significance of the mediation effects.

Results

A significant increase in physical activity was observed in the intervention group from baseline to follow-up, whereas physical activity did not change from baseline to follow-up in the waiting list group. Physical fitness did not significantly change after cognitive behavior therapy or after 6 months of waiting for therapy. Fatigue decreased more significantly in the intervention group than in the waiting list group. The mediation hypotheses were rejected.

Conclusions

Cognitive behavior therapy effectively reduced postcancer fatigue and increased physical activity but did not change physical fitness. The effect of cognitive behavior therapy on postcancer fatigue is not mediated by a change in physical activity or physical fitness.     

Qigong and Exercise Therapy for Elderly Patients With Chronic Neck Pain (QIBANE): A Randomized Controlled Study

The aim of this study was to evaluate the effectiveness of qigong compared with exercise therapy and no treatment. Elderly patients with chronic neck pain (>6 months) were randomly assigned to qigong or exercise therapy (each 24 sessions over a period of 3 months) or to a waiting list control. Patients completed standardized questionnaires at baseline and after 3 and 6 months. The main outcome measure was average neck pain on the visual analogue scale after 3 months. Secondary outcomes were neck pain and disability (NPAD) and quality of life (SF-36). One hundred seventeen patients (age, 76 ± 8 years, 95% women) were included in the intention-to-treat analysis. The average duration of neck pain was 19.0 ± 14.9 years. After 3 months, no significant differences were observed between the qigong group and the waiting list control group (visual analogue scale mean difference, ?11 mm [CI, ?24.0; 2.1], P = .099) or between the qigong group and the exercise therapy group (?2.5 mm [ ? 15.4; 10.3], P = .699). Results for the NPAD were similar (qigong vs waiting list ?6.7 (?15.4; 2.1), P = .135; qigong vs exercise therapy 2.3 (?6.2; 10.8); P = .600). We found no significant effect after 3 months of qigong or exercise therapy compared with no treatment. Further studies should include outcomes more suitable to elderly patients, longer treatment, and patients with less chronic pain.PerspectiveIn a randomized controlled study, we evaluated whether a treatment of 24 qigong sessions over a period of 3 months is (1) superior to no treatment and (2) superior to the same amount of exercise therapy in elderly patients (age, 76 ± 8 years, 95% women) with long-term chronic neck pain (19.0 ± 14.9 years). After 3 and 6 months, we found no significant differences for pain, neck pain, disability, and quality of life among the 3 groups.     

Internet-Based Cognitive-Behavioral Therapy for Complicated Grief: A Randomized Controlled Trial

The present study investigates the efficacy of an Internet-based cognitive-behavioral therapy program for bereaved people suffering complicated grief. The program combines established methods of psychotherapy with new technology– therapists and patients communicated exclusively by e-mail. Bereaved individuals diagnosed with complicated grief (n = 55) were randomly assigned to either the treatment group or a waiting list control condition. The 5-week intervention consisted of three modules: (1) exposure to bereavement cues; (2) cognitive reappraisal; and (3) integration and restoration. The Impact of Event Scale (IES), a failure to adapt scale, and the depression and anxiety subscales of the Brief Symptom Inventory (BSI) were used to assess treatment outcomes. Participants in the treatment group (n = 26) improved significantly relative to participants in the waiting condition on symptoms of intrusion, avoidance, maladaptive behavior, and general psychopathology, and showed a large treatment effect. Follow-up results show that this improvement was maintained after 3 months.     

Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial

The present study investigates the efficacy of an Internet-based cognitive-behavioral therapy program for bereaved people suffering complicated grief. The program combines established methods of psychotherapy with new technology- therapists and patients communicated exclusively by e-mail. Bereaved individuals diagnosed with complicated grief (n = 55) were randomly assigned to either the treatment group or a waiting list control condition. The 5-week intervention consisted of three modules: (1) exposure to bereavement cues; (2) cognitive reappraisal; and (3) integration and restoration. The Impact of Event Scale (IES), a failure to adapt scale, and the depression and anxiety subscales of the Brief Symptom Inventory (BSI) were used to assess treatment outcomes. Participants in the treatment group (n = 26) improved significantly relative to participants in the waiting condition on symptoms of intrusion, avoidance, maladaptive behavior, and general psychopathology, and showed a large treatment effect. Follow-up results show that this improvement was maintained after 3 months.     

Comparison of the effectiveness of a 12 step substance use recovery program on quality of life

Substance‐related disorders can adversely impact quality of life. This study assessed a 12 step program on health‐related quality of life for Iranian individuals seeking to recover from substance use. The study used a quasi‐experimental, two group, three stage, pre‐ and post‐test design and collected data at baseline, and at 1 and 3 months’ post‐intervention. The treatment group comprised 35 participants in a 12 step program with a non‐equivalent comparison group of individuals admitted to addiction treatment centers. Physical and mental health quality‐of‐life domains were assessed using the Short Form 36 Health Survey Questionnaire. The treatment group improved in all aspects of health‐related quality of life. The treatment group improved compared to the comparison group for two of eight quality of life dimensions – physical functioning and role limitations due to emotional problems – at 1 month post‐intervention. There were additional improvements at 3 months’ follow up in six of eight quality‐of‐life subscales compared to the comparison group. The benefits to quality of life related to mental health recovery extended beyond the treatment program, indicating that the program principles were effectively implemented in daily life.     

Impact of urinary incontinence on sexual quality of life in Portuguese adults

Urinary incontinence (UI) is a symptom of an underlying disorder with a high prevalence, constituting an important public health problem due to its physical, psychological and social consequences. The impact it has on the individuals' quality of life is revealed in their daily activities, self‐perception, socialization, emotional health and in their sexual life. The objective of this study is to analyse the impact of incontinence on the sexual quality of life, identifying the role of the variables: gender, duration and severity of incontinence, impact of incontinence on the quality of life and type of incontinence. The sample was composed by 55 patients (54·05% male and 45·5% female) from health facilities, in Lisbon, with a mean age of 55 years, who answered a set of questionnaires, which included: the Incontinence Impact Questionnaire (IIQ‐7); the Urogenital Distress Inventory (UDI‐6); the Questionnaire on Sexual Quality of Life, male and female versions (SQoL‐F/SQoL‐M) and a sociodemographic questionnaire. The results indicate that UI has a negative impact on the sexual quality of life in general, especially if the incontinence symptoms endure for a long period of time; also the impact of UI on social relationships, and the stress UI has a significant and negative impact on the sexual quality of life. In this study, UI has a negative impact on sexual life compounded by restrictions and other negative consequences of living with urinary leakage. The authors conclude that further research is required to ascertain the full impact of UI on sexual quality of life. Finally, implications for nurses are also discussed: in addressing the sexual health of their patients, nurses have an important contribution in assuring that experiencing UI should not necessarily translate into negative sexual quality of life.     

Parental Substance Misuse and Child WelfareBrynna Kroll and Andy TaylorJessica Kingsley Publishers. ISBN: 1‐853‐02791‐X, 2003, 344 pp. with index, $26.95

Aims: To describe the development and preliminary evaluation of an intervention for partners of problem drinkers in their own right.

Design: A series of case studies (n = 15 partners, all women) leading to the development of guidelines for an intervention. A before‐and‐after study of the intervention offered to partners (n = 50, all but three women) by the first author and volunteer counsellors, with follow‐up to six months plus comparison with a small waiting list group and partial follow‐up to 12 months.

Measures: Main outcome measure: Symptom Rating Test (SRT). Additional measures: Short Coping Questionnaire (SCQ: sacrificing and engaged coping); Self‐esteem (SE); Independence (IND); Drinking Related Behaviour (DRB); and Outcome for the Problem Drinker (OPD).

Results: There were significant changes from initial assessment to three month follow‐up, and between three and six month follow‐up, in the case of SRT and SCQ sacrificing coping. In addition there were initial to three months changes on SE and IND, and three to six months changes for SCQ engaged coping. The small waiting list comparison suggested that changes in SRT and sacrificing coping occurred after the start of the intervention, and the partial 12 month follow‐up suggested that changes could be maintained. Most partners had sought help in order to try to change their relatives' drinking. Those who had sought help principally for themselves were more likely to have experienced violence, were more likely to have partners whose drinking was episodic and were more likely to drop out of treatment.

Conclusion: The present study demonstrates the possibility of delivering an effective intervention for partners of problem drinkers in their own right.     

Pain, physical functioning and quality of life of individuals awaiting total joint replacement: a longitudinal study

Objectives To investigate if pain, physical function and the quality of life changed among adults with osteoarthritis while on the waiting list for hip or knee joint replacement. Methods A longitudinal study of patients listed for primary hip or knee joint replacement. Participants were interviewed at baseline (n = 105) and followed up at 3 (n = 84), 6 (n = 47) and 9 months (n = 24), or until their joint replacement. Measurement tools used were a visual analogue scale (VAS), Western Ontario and McMaster’s Universities (WOMAC) Osteoarthritis Index and the Medical Outcomes Study Short Form Health Survey (SF‐36). Results Baseline data indicated high levels of pain as measured by VAS [mean 7.0 (SD 2.2)] and WOMAC pain [mean 11.2 (SD 3.5)]. At baseline, the mean physical function measured by WOMAC was 40.3 (SD 12.1). At the 3‐month follow‐up, there was significant deterioration in VAS pain scores (0.6; 95% CI mean difference 0.3, 1.0); WOMAC pain scores (1.2; 95% CI mean difference 0.7, 1.8) and WOMAC physical function scores (4.8; 95% CI mean difference 2.8, 6.7) compared with baseline. Conclusion The often long wait for joint replacement surgery and deterioration in pain and physical function has highlighted the need for active management by health professionals while patients are on the waiting list.     

综合医院门诊多躯体症状患者的躯体疾病和精神心理特点

  目的  了解综合医院门诊多躯体症状患者的躯体疾病和精神心理特点, 并探讨其相关因素。  方法  2012年3月至10月采用方便取样的方法, 对北京协和医院消化内科、中医科和心理医学科门诊候诊患者通过躯体症状严重程度量表(somatic symptom scale of the Patient Health Questionnaire, PHQ-15)进行连续筛查。依据PHQ-15分数≥ 10或 < 10, 将患者分为多躯体症状组(SOM+组)和对照组(SOM-组)。每科各组均纳入25例患者, 共纳入150例患者。所纳入患者均完成7份自评问卷及结构化半定式访谈, 包括过去12个月所患躯体疾病和简明国际神经精神访谈。  结果  SOM+组患者女性(69.3%比53.3%)和低于大学文化程度者(54.8%比43.2%)所占比例较SOM-组更高(P < 0.05)。SOM+组患者并未发现患有更多的可明确诊断的躯体疾病; 而其抑郁发作、广泛性焦虑障碍和疑病症的患病率以及抑郁症状严重程度量表(depression scale of the Patient Health Questionnaire, PHQ-9)、广泛性焦虑量表(Generalized Anxiety Disorder 7-item scale, GAD-7)、健康焦虑量表(Whiteley-7 scale, WI-7)得分均显著高于SOM-组(P均 < 0.05), 其日常生活和就医行为受症状影响更显著(P均 < 0.01)。对多躯体症状预测因素进行Logistic回归分析(P < 0.01, 调整R²=0.53), 发现PHQ-9和WI-7总分高以及没有职业为影响因素。  结论  多躯体症状患者并未发现伴有更多可明确诊断的躯体疾病; 此类患者的焦虑及抑郁程度更高, 生活质量更低, 且其症状对日常生活和就医影响更大; 抑郁和健康焦虑水平高及没有职业是多躯体症状的预测因素。     

Long-term effects of heart transplantation: the gap between physical performance and emotional well-being

The purpose of our study was to assess physical and emotional factors in heart transplant patients. A prospective design was used to compare patients' physical symptoms, emotional complaints, and restrictions at admission to the waiting list, immediately after, and 1 and 5 years after heart transplantation. Thirty-three patients were included (30 male, 3 female) in the study. Their mean age at admission was 48 +/- 10.2 years. Of these, 23 suffered from cardiomyopathy, 8 from coronary heart disease, and 2 from valvular insufficiency. At admission, the patients suffered from symptoms of cardiac insufficiency, and were restricted in sports, gardening, hobbies, sexual life, job, food-intake, and mobility. More than three-fourths rated their physical and emotional status as moderate to poor. Emotionally, they suffered from irritability, restlessness, depression, psychic lability, lowered drive, lack of social contact, low self-esteem, and anxiety. At the end of rehabilitation (4-8 weeks after the operation), all physical and emotional complaints, as well as restrictions had significantly decreased (p < 0.0001 to p < 0.001), except for trembling, numbness of hands/feet, and food-intake. One year postoperatively, patients reported even fewer physical complaints (p < 0.01). Three-fourths rated their physical and emotional status good or excellent. Five years postoperatively--in contrast to physical status, restrictions, and physical complaints--the emotional complaints had increased significantly (p < 0.0001). Patients reported excellent physical performance up to 5 years postoperatively. On the other hand, the study revealed that their emotional well-being had significantly deteriorated from 1 to 5 years postoperatively. Attention should, therefore, not only be paid to the good physical health of the survivors, but also to the worsening of their emotional status.     

State and trait anxiety levels before coronary angiography

Aim. To investigate the factors that are related to increased anxiety before elective coronary angiography. Background. Anxiety before coronary angiography is an important factor for complications. To know the factors for increased anxiety, it is important for nurse to prevent complications. Design. A cross‐sectional study design was used. The study included 88 consecutive patients waiting for coronary angiography. Methods. A data‐collecting form, which included questions about demographic features, health history and angiography, was completed by the participants on the day of coronary angiography. The level of state and trait anxiety was measured by Spielberger's State‐Trait Anxiety Inventory. Multivariate Analysis was performed to disclose the independency of the relation between state anxiety and factors. Results. Both trait and state anxiety levels were found to be moderate (age = 46, SD = 9, 24–67 years and age = 40, SD = 10, 21–65 years, respectively). There was a significant relation between state and trait anxiety levels (r = 0·56, p < 0·001). Among the investigated factors, only the trait anxiety (p < 0·001) and time on waiting list (p = 0·020) were found to be independent. For predicting high level of state anxiety, the cut‐off value of trait anxiety was found to be 48 with a sensitivity of 67% and specificity of 67% and cut‐off value of time on waiting list was found to be seven days with a sensitivity of 83% and specificity of 52%. Conclusions. The time on waiting list and trait anxiety levels are the most important factors for state anxiety level. To prevent high level of coronary angiography‐related anxiety, those patients with trait anxiety level >48 and time on waiting list >7 days should be managed specifically. The preventive measures should be specifically focused on the connection between state and trait anxiety. Relevance to clinical practice. Nursing planning should be focused on patients especially those on a long‐time waiting list and on patients with high trait anxiety level prior to coronary intervention.     

Patients’ experiences of waiting for a liver transplantation

Organ transplantation has increased worldwide while the number of organ donors have not increased similarly. Consequently, the waiting period for transplant candidates is prolonged. Patient narratives have uncovered physical and psychosocial suffering in the transplantation process. However, relatively few studies have explored patients’ experiences in the actual waiting period. This qualitative study was conducted in Norway and aimed to describe patients’ experiences of being accepted as recipients of a new liver and their waiting following this decision. A sample of 21 patients with end‐stage liver disease, placed on the ordinary waiting list for a liver transplant, were interviewed in the hospital before they went home to wait for a compatible liver. Uncertainty related to life and death was a major issue, both in the waiting period and as a response to being put on the waiting list. Another central issue was their overwhelming lack of energy. Patients inferred a linear relationship between lack of energy, physical limitations and mental distress. Despite major advances in medical treatment, little follow‐up was given during the waiting period and most of the patients seemed resigned to the inevitability of their suffering. This raises issues of health personnel responsibility and a need to heighten awareness about patient suffering during the waiting period.     

The efficacy of group and individual cognitive therapy for mild depression

Eighteen mildly depressed subjects were randomly assigned to group or individual cognitive therapy. Twenty mildly depressed subjects were later recruited to serve as delayed treatment controls. Beck's cognitive therapy of depression was provided in a 6-week format by five graduate student therapists. Subjects were assessed before and after the 6-week treatment or waiting period using the Beck Depression Inventory, the D30 Depression Scale, the Brief Symptom Inventory, the State-Trait Anxiety Inventory, and the Tennessee Self Concept Scale. A repeated-measures multivariate analysis of variance determined that there was a significant treatment by time interaction. Subjects who received individual therapy improved more than subjects in the group and delayed treatment conditions. There were no statistically significant differences between subjects in the group and delayed treatment conditions, though subjects who received group therapy tended to show greater improvement than the controls..     

Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial

This study investigates utilization of the Internet in the rehabilitation of people on long-term sick leave with chronic pain and/or burnout. Fifty-five people were randomly assigned to two groups: a treatment group (n = 27) that participated in a rehabilitation course over the Internet and a waiting list group (n = 28). The goals were to improve participants' health and increase quality of life, and, for those who were not on permanent disability pensions, to increase work capacity, if possible. A 20-week program, based on 19 films on different themes, was supplemented with written material and a Socratic dialogue over the Internet. Upon completion of the rehabilitation course, statistically significant improvements were observed in the treatment group in comparison to the waiting list group, for variables such as depression, pain, vitality, social function, performance problems involving work or other activities due to physical illness and the presence of stress symptoms. Thirteen of 23 individuals (57%) also increased their work capacity. The number needed to treat regarding recovering from anxiety and depression was 2. For increased work capacity, the number needed to treat was 3. Rehabilitation of people on long-term sick leave carried out over the Internet is a good complement to other rehabilitation programs.