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Biomedical subjects

Joan E Broderick

Publications and source records attributed to Joan E Broderick.

14 recordsLinked to original sources
PubMed2006

Recalled pain ratings: a complex and poorly defined task.

UNLABELLED: Self-report ratings of pain intensity are ubiquitous in research and clinical practice. In addition to rating their current pain, patients are often asked to provide ratings to represent pain intensity over several days or weeks. Few data are available that provide insight into how people understand and accomplish this recall task. This study describes the results of structured interviews with 106 rheumatology patients with chronic pain about how they arrived at their ratings of pain intensity on a visual analog scale referenced to the past week. Most patients were unable to coherently articulate how they derived their ratings. Moreover, there was no consistency across patients. A variety of different strategies were identified that guided their responses. These results support the concern about the meaning and validity of retrospective recall ratings. Recall of pain, a seemingly simple task, is a deceptively more complex phenomenon. Efforts to improve the measurement of recalled pain need to be explored. Improving instructional sets, clearer specification of the dimensions of pain being targeted, avoiding use of a single item to measure pain, improved description of intended reference groups, and determining the length of time that patients are able to remember pain and limiting recall periods are reasonable methods that need to be explored. PERSPECTIVE: These results emphasize our lack of a full understanding of the meaning of the information elicited by commonly used pain recall questions. They point to the potential importance of clearly specifying what qualities of pain are sought and how the patient should summarize them over the reporting period.

Adult↗
PubMed2006

Paper and electronic diaries: Too early for conclusions on compliance rates and their effects--Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006).

This commentary discusses 4 issues relevant to interpretation of A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) article: (a) Self-reported compliance in medical settings has generally been substantially higher than verified compliance, suggesting that this is not a rare phenomenon; (b) none of the studies reported in Green et al. explicitly verified paper diary compliance; (c) the impact of participant motivation on diary compliance is unknown, and it may be difficult for researchers to accurately assess it in their own studies; and (d) without objective verification of diary compliance, analysis of the effects of noncompliance on data quality is difficult to interpret. The authors conclude that compliance in paper diaries and the effects of noncompliance on data quality are still unsettled issues.

Adolescent↗
PubMed2005

Variability of momentary pain predicts recall of weekly pain: a consequence of the peak (or salience) memory heuristic.

Patients' recall of their recent pain is commonly assessed by both researchers and clinicians. However, concerns have been raised about differences between recalled pain and the average of real-time recordings of pain taken over the same period, in part because of the possibility that memory processes affect how retrospective pain is reported. It was hypothesized that memory processes affect the accuracy of recall, such that those with higher versus lower variability of real-time pain will recall pain at higher levels, relative to their average momentary pain. Sixty-eight chronic pain patients with rheumatologic conditions reported their pain several times a day for 2 weeks and also recalled their weekly pain at the end of each of those 2 weeks. The hypothesis was confirmed and it was concluded that variability of real-time pain affects the recall of pain.

Chronic Disease↗
PubMed2004

Associations among pain intensity, sensory characteristics, affective qualities, and activity limitations in patients with chronic pain: a momentary, within-person perspective.

UNLABELLED: The purpose of this article is to explore the multidimensionality of the pain experience for patients with chronic pain by using a within-person, longitudinal approach. An Ecological Momentary Assessment design with a patient electronic diary was used to collect random momentary pain assessments several times a day for 2 weeks. We examined the within-person relationships between pain intensity, sensory characteristics, affective qualities, and activities limited by pain. All 3 dimensions (sensory, affective, and activities) were significantly related to pain intensity in a monotonic, but nonlinear, manner. These results expand our understanding of the pain experience by showing that changes of pain over time are associated with changes in sensory symptoms, affective distress, and activity limitations. PERSPECTIVE: Although the relationships between pain dimensions have been examined between people, the results have been interpreted as within-persons. This article confirms that pain intensity is significantly related to sensory characteristics of pain, affective qualities of pain, and activity limitations due to pain within a person.

Activities of Daily Living↗
PubMed2004

Understanding recall of weekly pain from a momentary assessment perspective: absolute agreement, between- and within-person consistency, and judged change in weekly pain.

To better understand the association between pain recalled over a previous week and the average of multiple momentary reports of pain taken during the same period, 68 patients with chronic pain completed both weekly recall and momentary reports over a 2-week period and assessed their change in pain over the 2 weeks. Pearson correlations and intraclass correlation coefficients were computed to index three different ways of comparing the measures on both a between-person and within-person basis. Between-person correspondence between weekly and momentary reports was generally moderate to high, but within-person correspondence was low. Judged change was only weakly related to changes over a week computed from weekly recall or from average momentary reports. Given the importance of within-person change for treatment studies, these results indicate a serious nonequivalence in weekly recall and averaged momentary reports of pain.

Adolescent↗
PubMed2004

Stability of patient adaptation classifications on the multidimensional pain inventory.

This study examined the adaptational classification stability of the multidimensional pain inventory (MPI) in two samples of female fibromyalgia syndrome patients. Retest resulted in one-third of patients being assigned to a different classification. Twenty patients had four repeated MPI assessments over a 10-month period; 85% of them changed classification at least once. Prediction of classification stability using demographic variables and measures of pain, depression, anxiety, impression management, and self-deception was unsuccessful. Examination of the MPI Variable Response Scale and an index of the goodness of fit of the cluster for each patient did not yield sufficient predictive power. The implication of this study is that for a sizable number of chronic pain patients, MPI classifications may not be stable, trait-like characterizations. As such, caution must be applied when treatment is tailored to MPI clusters and when classification change is used as an outcome measure.

Adaptation, Psychological↗
PubMed2004

Salivary cortisol sampling compliance: comparison of patients and healthy volunteers.

OBJECTIVE: Problems of compliance with in vivo data collection and treatment protocols have been identified. This study investigated compliance with salivary cortisol sampling in a 7-day protocol. Impact of non-compliance on cortisol data was evaluated. METHODS: Female fibromyalgia patients were matched with healthy female volunteers and randomized to Aware or Unaware conditions regarding objective monitoring of their sampling compliance. The protocol entailed collecting five saliva samples at prescribed times on each of 7 consecutive days. Participants self-reported time of each sample, and electronic monitor caps provided an objective date and time stamp of each sample. RESULTS: Objective compliance among participants unaware of monitoring was 71%, though their self-reported compliance was 93%. Aware participants' objective compliance was 90% which was consistent with self-reported compliance of 93%. Within-subject comparison of early morning rise and day slope of cortisol for compliant and non-compliant samples found significant differences with non-compliant samples resulting in flatter slopes. Patients were somewhat more compliant than healthy volunteers. Slight decrements in compliance were found for the afternoon sample (1600 h) and for the last 3 days of sampling. Compliance did not differ on weekdays versus weekends. CONCLUSIONS: Self-report of compliance in a salivary cortisol sampling protocol substantially overestimates actual compliance in the absence of objective monitoring. Non-compliance with the sampling protocol results in cortisol data that significantly differs from compliant data. Awareness of electronic monitoring of sampling results in satisfactory compliance.

Adult↗
PubMed2004

The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions.

BACKGROUND: Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease. PURPOSE: This study was a randomized, controlled effectiveness trial with 4 arms: 2 active treatment writing groups, 1 inactive writing group, and 1 attention control group. It represents the first attempt to translate the expressive writing intervention into a low-cost, community-based intervention in the form of a videotaped program. METHODS: Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients (N = 373). RESULTS: The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs. Seventy-nine percent of eligible patients agreed to take the program home; 49% of these patients reported that they followed the protocol. Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program. CONCLUSIONS: Intent-to-treat analyses found no effect of the treatment. Pretreatment differences among the protocol-adherent patients complicated treatment outcome interpretation. The standard writing instructions did not yield an effect; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results. Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed.

Adaptation, Psychological↗
PubMed2003

Patient compliance with paper and electronic diaries.

Paper diaries are commonly used in health care and clinical research to assess patient experiences. There is concern that patients do not comply with diary protocols, possibly invalidating the benefit of diary data. Compliance with paper diaries was examined with a paper diary and with an electronic diary that incorporated compliance-enhancing features. Participants were chronic pain patients and they were assigned to use either a paper diary instrumented to track diary use or an electronic diary that time-stamped entries. Participants were instructed to make three pain entries per day at predetermined times for 21 consecutive days. Primary outcome measures were reported vs actual compliance with paper diaries and actual compliance with paper diaries (defined by comparing the written times and the electronically-recorded times of diary use). Actual compliance was recorded by the electronic diary. Participants submitted diary cards corresponding to 90% of assigned times (+/-15 min). However, electronic records indicated that actual compliance was only 11%, indicating a high level of faked compliance. On 32% of all study days the paper diary binder was not opened, yet reported compliance for these days exceeded 90%. For the electronic diary, the actual compliance rate was 94%. In summary, participants with chronic pain enrolled in a study for research were not compliant with paper diaries but were compliant with an electronic diary with enhanced compliance features. The findings call into question the use of paper diaries and suggest that electronic diaries with compliance-enhancing features are a more effective way of collecting diary information.

Adolescent↗
PubMed2003

Intensive momentary reporting of pain with an electronic diary: reactivity, compliance, and patient satisfaction.

Patient self-reports are the primary method for capturing the experience of pain, and diaries are often used to collect patient self-reports. This study was designed to determine if momentary monitoring of pain with an electronic diary affected pain levels over time, if it affected weekly recall of pain, and if daily sampling density affected compliance rates and patients' reactions to the study. Ninety-one patients with chronic pain were randomized into four groups with differing levels of momentary monitoring over 2 weeks. Little support was found for reactivity defined as temporal shifts in pain over the study or as changes in recalled weekly pain due to momentary monitoring. Compliance with the electronic diary protocol was 94% or better, and was not related to sampling density. Patients reported little difficulty with the diary procedures and were not unduly burdened by the protocol.

Adult↗
PubMed2003

Signaling does not adequately improve diary compliance.

HYPOTHESIS: Compliance with a paper diary protocol would be improved by using auditory signaling. BACKGROUND: Prior research has demonstrated that compliance with the reporting schedule in paper diary protocols is poor. METHODS: Adults with chronic pain (N = 27) were recruited from the community to participate in a 24-day experience sampling protocol of 3 pain assessments per day (10:00 a.m., 4:00 p.m., 8:00 p.m.). Diaries were instrumented to record openings and closings, thereby permitting determination of date and time when the participant could have made diary entries. Participants were signaled with a programmed wristwatch at the onset of each 30-min assessment window. Two compliance windows were defined: -/+ 15 min and -/+ 45 min of the targeted assessment time. RESULTS: Self-reported compliance based on participants' paper diaries was 85% and 91% for the 30- and 90-min windows. Verified compliance was 29% and 39% for the two windows. Signaling produced a significant increment in verified compliance when compared with an identical trial without signaling. A significant eroding of verified compliance was observed across the 3 weeks of the study. CONCLUSIONS: Self-report dating of diary entries may be misleading investigators about compliance with diary protocols. Although auditory signaling enhances compliance, the result is still unsatisfactory.

Adolescent↗
PubMedDate not supplied

Compliance with saliva sampling protocols: electronic monitoring reveals invalid cortisol daytime profiles in noncompliant subjects.

OBJECTIVE: Ambulatory saliva collections for subsequent analysis of free cortisol levels are now frequently applied to measure adrenocortical activity in healthy subjects and patient populations. Despite the prime importance of accurate timing of saliva collection outside the laboratory, no data are available on the compliance of study participants following a given sampling protocol. This study investigated how accurately subjects adhered to the instructions to collect six saliva samples throughout 1 day. METHODS: Subjects were instructed to collect six saliva samples throughout 1 day (directly after awakening, 30 minutes after awakening, 11 AM, 3 PM, 8 PM, 10 PM). Objective compliance was measured using an electronic monitoring device given to the subjects either with ("informed" N = 23) or without ("noninformed" N = 24) their knowledge of the nature of the device. Data on subjective compliance were obtained by self-report. RESULTS: Thirty-one subjects (74%) were found to comply with the sampling instructions, and 11 (26%) failed at least once to obtain the saliva sample at the correct time of day. Nine of the 11 noncompliant subjects (82%) had two or more noncompliant samples. Fifty-five percent (6 of 11) of the noncompliant subjects took sample 2 outside the sampling window. The circadian cortisol profile differed significantly between compliant and noncompliant subjects (F = 7.98, p =.007). The most important effect of compliance was seen in the rise of cortisol at awakening. Compliant subjects showed a robust increase, whereas noncompliant individuals had only minimal changes from baseline at 30 minutes after awakening (t = 2.89, p =.007). Thus the steepness of the circadian cortisol decline was greater for compliant subjects (t = 2.10, p =.043). Furthermore, the informed group adhered more closely to the sampling protocol than the noninformed subjects (p =.001). Self-reported compliance also differed significantly between study groups (p =.03). In the noninformed group, self-reported sampling accuracy was significantly higher than objectively measured compliance (p =.03); the two measures were similar in the informed group (p = NS). CONCLUSIONS: A significant number of subjects did not obtain saliva samples reliably in an ambulatory setting. This can partially invalidate the cortisol results and mask potential differences between subject groups of interest. We therefore recommend the use of electronic monitoring devices or other suitable methods and that study participants be informed about the device when ambulatory saliva collection is performed.

Adolescent↗
PubMedDate not supplied

Written emotional expression produces health benefits in fibromyalgia patients.

OBJECTIVE: Written expression of traumatic experiences, an intervention found to have health benefits in rheumatoid arthritis, asthma, and breast cancer, was tested in a randomized, controlled trial with female fibromyalgia patients. It was hypothesized that relative to controls, patients engaging in the writing intervention would experience improved status on psychological well-being and physical health variables. METHODS: Patients (N = 92) were randomized into a trauma writing group, a control writing group, or usual care control group. The two writing groups wrote in the laboratory for 20 minutes on 3 days at 1-week intervals. Psychological well-being, pain, and fatigue were the primary outcome variables. Assessments were made at pretreatment, posttreatment, 4-month follow-up, and 10-month follow-up. RESULTS: The trauma writing group experienced significant reductions in pain (effect size [ES] = 0.49) and fatigue (ES = 0.62) and better psychological well-being (ES = 0.47) at the 4-month follow-up relative to the control groups. Benefits were not maintained at the 10-month follow-up. CONCLUSION: Fibromyalgia patients experienced short-term benefits in psychological and health variables through emotional expression of personal traumatic experiences.

Adaptation, Psychological↗