Review: Can we identify how programmes aimed at promoting self‐management in musculoskeletal pain work and who benefits? A systematic review of sub‐group analysis within RCTs

Background: There are now several systematic reviews of RCTs testing self‐management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self‐management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub‐groups of patients SM is optimally effective. Aims: To systematically review randomized controlled trials of self‐management for chronic musculoskeletal pain that reported predictors, i.e., ‘baseline factors that predict outcome independent of any treatment effect’; moderators, i.e., ‘baseline factors which predict benefit from a particular treatment’; or mediators i.e., ‘factors measured during treatment that impact on outcome’ of outcome. Method: We searched relevant electronic databases. We assessed the evidence according to the methodological strengths of the studies. We did meta‐regression analyses for age and gender, as potential moderators. Results: Although the methodological quality of primary trials was good, there were few relevant studies; most were compromised by lack of power for moderator and mediator analyses. We found strong evidence that self‐efficacy and depression at baseline predict outcome and strong evidence that pain catastrophizing and physical activity can mediate outcome from self‐management. There was insufficient data on moderators of treatment. Conclusions: The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with ‘a priori’ hypotheses and adequate statistical power.     

Poststroke Shoulder Pain: Inevitable or Preventable?

Cerebral vascular accident or stroke is recognized as the leading cause of disability in the United States; consequently, it is important that all healthcare professionals working with this population develop competency of care to promote functional recovery. One of the most profound effects of stroke is upper‐extremity dysfunction. With correct handling, proper positioning, and ongoing patient‐caregiver education, healthcare professionals can positively influence upper‐extremity recovery and prevention of poststroke shoulder pain. In doing so, they will help patients avoid the mass effect that pain can impart on daily routines. The purposes of this article are to describe poststroke shoulder pain, discuss possible causes of shoulder pain, and detail best practices nurses can use to prevent or minimize poststroke shoulder pain.     

Parkinson’s disease and the Stroop color word test: processing speed and interference algorithms

Objective: Processing speed alters the traditional Stroop calculations of interference. Consequently, alternative algorithms for calculating Stroop interference have been introduced to control for processing speed, and have done so in a multiple sclerosis sample. This study examined how these processing speed correction algorithms change interference scores for individuals with idiopathic Parkinson’s disease (PD, n = 58) and non-PD peers (n = 68). Method: Linear regressions controlling for demographics predicted group (PD vs. non-PD) differences for Jensen’s, Golden’s, relative, ratio, and residualized interference scores. To examine convergent and divergent validity, interference scores were correlated with standardized measures of processing speed and executive function. Results: PD–non-PD differences were found for Jensen’s interference score, but not Golden’s score, or the relative, ratio, and residualized interference scores. Jensen’s score correlated significantly with standardized processing speed but not executive function measures. Relative, ratio, and residualized scores correlated with executive function but not processing speed measures. Golden’s score did not correlate with any other standardized measures. Conclusions: The relative, ratio, and residualized scores were comparable for measuring Stroop interference in processing speed-impaired populations. Overall, the ratio interference score may be the most useful calculation method to control for processing speed in this population.     

Problem alcohol use in veterans with mild traumatic brain injury: Associations with cognitive performance and psychiatric symptoms

Introduction: Given that little is known about the associations between alcohol use, cognition, and psychiatric symptoms among veterans with a history of mild traumatic brain injury (mTBI), we aimed to (a) characterize how they differ from veteran controls on a measure of problem drinking; (b) investigate whether problem drinking is associated with demographic or mTBI characteristics; and (c) examine the associations between alcohol use, mTBI history, psychiatric functioning, and cognition. Method: We assessed 59 veterans (n = 32 with mTBI history; n = 27 military controls) for problem alcohol use (Alcohol Use Disorders Identification Test: AUDIT), psychiatric symptoms, and neuropsychological functioning. Results: Compared to controls, veterans with mTBI history were more likely to score above the AUDIT cutoff score of 8 (p = .016), suggesting a higher rate of problem drinking. Participants with mTBI history also showed elevated psychiatric symptoms (ps < .001) and lower cognitive scores (ps < .05 to < .001). Veterans with higher AUDIT scores were younger (p = .05) and had less education (p < .01) and more psychiatric symptoms (ps < .01), but mTBI characteristics did not differ. After controlling for combat and mTBI history (R² = .04, ns) and posttraumatic stress disorder (PTSD) symptoms (ΔR² = .08, p = .05), we found that higher AUDIT scores were associated with poorer attention/processing speed, F(9, 37) = 2.55, p = .022; ΔR² = .26, p = .03. Conclusions: This preliminary study suggested that veterans with mTBI history may be at increased risk for problem drinking. Problem alcohol use was primarily associated with more severe PTSD symptoms and poorer attention/processing speed, though not with combat or mTBI characteristics per se. Importantly, findings emphasize the importance of assessing for and treating problematic alcohol use and comorbid psychiatric symptoms among veterans, including those with a history of neurotrauma.     

A Cross-Walk of Professional Competencies Involved in Expanded School Mental Health: An Exploratory Study

Expanded school mental health (ESMH) programs often involve individuals from a variety of professions working together to address student needs evident across school, family, and community systems. Profession-driven differences in philosophies, expectations regarding confidentiality, and graduate training that reinforces isolated rather than interprofessional approaches to working with students, however, represent real challenges to maximizing the potential of ESMH. To address these issues, this exploratory study identified a common set of competencies to support interprofessional practice in ESMH. A total of 51 competencies were identified across seven theme areas, including: (1) Key Policies and Laws; (2) Interprofessional Collaboration; (3) Cross-Systems Collaboration; (4) Provision of Academic, Social-Emotional, and Behavioral Learning Supports; (5) Data-Driven Decision-Making; (6) Personal and Professional Growth and Well-Being; and, (7) Cultural Competence. Mapping of the competencies to existing accreditation and practice standards for selected professions revealed shared and unique competencies. Implications for workforce development and future research are offered.