PubMed Health⌕ Search

Biomedical subjects

R J Gatchel

Publications and source records attributed to R J Gatchel.

At least 19 recordsLinked to original sources
PubMed1992

Reliability problems associated with the modified Schöber technique for true lumbar flexion measurement.

The modified Schöber technique, a method for assessing lumbar spine flexion, was subjected to an analysis of reliability. Fifty normal subjects (21 men, 29 women) were evaluated for lumbar flexion mobility using a blind inter-rater "worst case" protocol. Simultaneously, other sources of error affecting test reliability, such as presence of dimples of Venus, relationship of skin distraction to movement of underlying structures, and upper level of Schöber skin landmarks were also considered. Analysis suggested that systematic error can be introduced that adversely affects inter-rater reliability (r = 0.71). Moreover, skin landmarks are inconsistently present, being completely absent in 26% of cases. Skin tends to distract even over completely immobile bony structures (eg, the sacrum), whereas, on average, only 3.5 of the 6 spinal segments (T12-S1) are included in the Schöber technique for purported measurement of "lumbar spine flexion." The utility of this method is questioned on both scientific and clinical grounds.

Adult↗
PubMed1992

Managing anxiety and pain during dental treatment.

Behavioral techniques can teach patients how to cope with anxiety and tension while undergoing dental procedures. Practitioners need to know which technique best fits each patient. This report reviews the repertoire of procedures.

Behavior Therapy↗
PubMed1991

Effectiveness of a videotaped behavioral intervention in reducing anxiety in emergency oral surgery patients.

This study evaluated the effectiveness of a videotaped behavioral treatment program in reducing dental anxiety in emergency oral surgery patients. It compared a videotaped placebo program and a no-treatment control condition. Anxiety, measured for two periods during the study (an anticipatory phase just before oral surgery and a post oral surgery phase), was evaluated by means of self-report, physiological, and behavioral observation measures. Results revealed significant treatment group as well as Group X Sex interaction effects for the heart rate index of physiological arousal. Results also revealed that the treatment program was reported by subjects to be significantly more helpful than the placebo program. Overall, these results suggest that a short, videotaped behavioral intervention can have a positive effect on the oral surgery patient, and that the sex of the subject may be an important variable to be incorporated in evaluating the effectiveness of this type of treatment program.

Analysis of Variance↗
PubMed1991

Differentiation between somatic and cognitive/affective components in commonly used measurements of depression in patients with chronic low-back pain. Let's not mix apples and oranges.

Patients with chronic low-back pain are frequently diagnosed as depressed. However, many of the neurovegetative signs of depression may also result from pain. The purpose of the present study was 1) to investigate the relationship between commonly used measurements of depression and pain perception; and 2) to examine the utility of differentiating between somatic signs and cognitive/affective symptoms of depression in patients with chronic low-back pain. The Beck Depression Inventory and the Hamilton Psychiatric Rating Scale for Depression were divided into cognitive/affective and somatic subscales. These measures, as well as the Minnesota Multiphasic Personality Inventory, were administered to 111 patients with chronic low-back pain. Analyses revealed significant correlations between depression scores and self-reported pain intensity. The cognitive/affective subscale of the Beck Depression Inventory resulted in the only nonsignificant correlation with pain intensity. These findings suggest that commonly used measurements of depression are confounded with pain symptomatology and that the cognitive/affective category of the Beck Depression Inventory may prove to be a more accurate measurement of depression in patients with chronic low-back pain.

Adult↗
PubMed1991

The SCL-90R evaluated as an alternative to the MMPI for psychological screening of chronic low-back pain patients.

The efficacy of using the SCL-90R as an alternative measure to the MMPI in the psychological screening of chronic low-back pain (CLBP) patients was investigated. The MMPI and the SCL-90R were administered to 99 CLBP patients (63 men and 36 women) at the time of admission to a functional restoration treatment program. The SCL-90R was readministered after successful completion of the treatment program. Analyses indicated that there were significant changes on almost all SCL-90R clinical scales from pretreatment to post-treatment (P less than 0.01). Moreover, there were adequate levels of correlation between corresponding MMPI and SCL-90R scales (r ranged from 0.35 to 0.51). However, analyses of the interscale correlations of the SCL-90R indicated that it may be a single-factor instrument that assesses general psychological distress. It was suggested that the SCL-90R may be used as a screening device for psychological distress in CLBP patients, but if more detailed information about the patients' psychological condition is needed, the MMPI will be a more useful instrument.

Adult↗
PubMed1990

Improved physical performance outcomes after functional restoration treatment in patients with chronic low-back pain. Early versus recent training results.

Functional restoration, a medically supervised team treatment approach that addresses deficits that accompany the deconditioning process in patients with chronic low-back pain, has emerged as a viable rehabilitation alternative. While the primary emphasis of this treatment approach has remained unchanged since its inception over 6 years ago, recent rapid advances in quantification technology and understanding of the complexity of the chronic low-back pain (CLBP) syndrome have led to more sophisticated and aggressive rehabilitation efforts. In the current study, the authors examined two groups of patients with CLBP, from the treatment program's initial (n = 45) and most recent years (n = 57) of operation, respectively, to determine if the evolution of the treatment program has resulted in increased gains in physical capacity between these groups of patients. Patients in each group were assessed on measures of isokinetic trunk strength and spinal range of motion at program admission and discharge. Both groups demonstrated improved physical capacity levels, but the recent group also demonstrated considerably higher physical capacity levels than the early group, at both program admission and discharge. It was concluded that functional restoration continues to be successful with CLBP patients, and that increased preprogram training and education may facilitate a more rapid elimination of inhibitory factors (ie, pain, fear of reinjury), which often impede and slow physical training.

Adult↗
PubMed1990

Changes in MMPI profile levels of chronic low back pain patients following successful treatment.

The present study evaluated changes in the Minnesota Multiphasic Personality Inventory (MMPI) profile levels of chronic low back pain (CLBP) patients following successful treatment for their disability. A total of 69 patients were evaluated at admission and 6 months after completing the treatment program. Results demonstrated significant decreases of the Hysteria, Depression, and Hypochondriasis scales toward normal ranges at the 6-month evaluation. These results indicate that MMPI profile levels of CLBP patients are significantly reduced to normal ranges following successful treatment.

Adult↗
PubMed1989

Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients.

The present study compared the computed tomography (CT) scan muscle area/muscle density and isokinetic trunk strength of a group of spinal surgery patients (35 males and 11 females) 3 months postoperatively. Analyses showed trunk strength means to be below 50% of gender-specific "normal" values obtained by evaluating a normative sample. Extensor strength was more significantly affected than flexors. Single-cut CT scans performed at the time of isokinetic trunk strength assessment demonstrated psoas and erector spinae atrophy through a significant decrease in muscle density, with only a trend towards decreased cross-sectional area. Findings also indicated that there was a significant correlation between increased mechanical trunk strength performance and greater muscle density on CT scan. Strength was significantly lower for the male patients undergoing spinal fusion compared with those undergoing disc excision. However, no significant difference was found in strength measures between: males with high versus low pain level and working versus nonworking males at the time of evaluation.

Adult↗
PubMed1989

Psychosocioeconomic predictors of treatment success/failure in chronic low-back pain patients.

The present study evaluated various psychosocioeconomic variables in chronic low-back pain (CLBP) patients being treated in a functional restoration rehabilitation program. The purpose of the study was to identify those factors that may have predictive value with respect to treatment outcome. Three groups of patients (Success, Failure, Dropout) were examined based on outcome and follow-up data 1 and 2 years after program completion. Once group assignment was made based on outcome, a variety of psychologic, socioeconomic, and demographic data obtained at the time of program admission was analyzed to determine if there were differences among the groups. Several factors were found to distinguish among the groups, including Minnesota Multiphasic Personality Inventory (MMPI) and Millon Behavioral Health Inventory (MBHI) scale scores, prior surgical history, level of worker compensation, and pain intensity ratings. These results confirm the presence of psychosocioeconomic differences among CLBP patients and suggest the need for continued research in this area to improve treatment efficacy in these patients.

Adult↗
PubMed1989

A psychosociomedical prediction model of response to treatment by chronically disabled workers with low-back pain.

There has been much interest in identifying variables that can predict which individuals are susceptible to developing chronic low-back pain. There currently are a number of studies that are evaluating primary predictors (which uninjured workers are likely to develop chronic low-back pain) and secondary predictors (which workers with acute episodes will develop chronic pain). The present study reports the first results from a large-scale investigation of tertiary predictors. Specifically, it addresses the issue of what psychosociomedical variables are predictive of success/failure in response to a comprehensive Functional Restoration treatment program by workers who are chronically disabled with low-back pain. Three stages were involved in the development of this prediction model. First, a group of treatment and research professionals who had extensive experience in the area of chronic low-back pain identified an array of 42 variables, from a larger pool of quantified physical, psychosocial, and medical parameters rated to be important with this patient population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The prevalence of dental fear and avoidance: expanded adult and recent adolescent surveys.

This study evaluates the current incidence of dental fear and avoidance in a general population of adults and adolescents. Two adult samples were collected. The consisted of 1,882 individuals who were contacted randomly by telephone; the second sample consisted of 357 junior high and secondary school teachers who received a questionnaire. The adolescent sample, also surveyed by questionnaire, consisted of 641 junior high school students and 801 secondary school students. Results indicate that 11.2% to 12.3% of the adults reported high dental fear; 17.5% to 18.2% reported moderate dental fear. Similar rates were found among the adolescents. A major new finding was that more adolescents than adults had not seen a dentist in a year or more.

Adolescent↗
PubMed1989

Quantifying postoperative deficits of physical function following spinal surgery.

This study evaluates the degree of objectively quantified physical deconditioning of spinal surgery patients. The object is to evaluate the data in terms of the pain and disability claimed by 35 male and 11 female patients three months after spinal surgery. Among the males, two subgroups (i.e., disc excision or spinal fusion) were evaluated. All patients reported subjective indices of pain/disability and completed quantified tests of lumbar motion, sagittal trunk strength, lifting capacity, and bicycle ergometry. In general, true lumbar motion was markedly restricted to 50%-60% and trunk strength means were below 50% of gender-specific normative values. There were similar deficits for lifting capacity. Those who had spinal fusions tended to perform poorly, with a relatively high incidence of pain/disability. There were no differences found between the male group and subgroups who were gainfully employed or had a brief period of disability prior to surgery or had low subjective pain/disability. These results indicate that a patient's subjective pain/disability were not a reliable measure of functional capacity by three months postoperatively. Regardless of working status, pain level, or brevity of disability, there was a significant loss of performance ability and risk of persistent dysfunction after surgical treatment.

Adult↗
PubMed1988

Progressive isoinertial lifting evaluation. I. A standardized protocol and normative database.

Dynamic tests of trunk strength and lifting capacity have become more popular in recent years, offering certain advantages over static isometric tests in measuring patient progress in functional restoration programs for spinal disorders. However, equipment for performing such tests is expensive to buy, complex to run, and requires technical expertise and clinical volume unavailable in most physician offices. In this study, a new dynamic test known as Progressive Isoinertial Lifting Evaluation (PILE) is described, which draws upon prior psychophysical and isoinertial methods. An industrial sample of 61 male and 31 female incumbent workers were tested using the PILE, and a variety of anthropometric normalizing factors were evaluated. The isolation of an "Adjusted Weight" (AW) normalizing factor is documented, after which normative data are presented for male and female workers utilizing lumbar (0-30 inches) and cervical (30-54 inches) dynamic protocols.

Adult↗
PubMed1988

Progressive isoinertial lifting evaluation. II. A comparison with isokinetic lifting in a disabled chronic low-back pain industrial population.

The Progressive Isoinertial Lifting Evaluation (PILE), as described in Part I of this series of articles, is a simplified test combining psychophysical and isoinertial protocols to provide an unconstrained lifting assessment. In the second part of this study, 100 chronically disabled low-back pain patients (57 men and 43 women) were studied at two points: 1) at initial evaluation, when referred for possible entry into a comprehensive Functional Restoration treatment program; and 2) at the conclusion of the treatment (an average 7 weeks later). Results of simultaneous lumbar PILE and Cybex Liftask (Lumex, Ronkonkoma, NY) tests are presented, showing that patients may frequently double or triple initial lifting capacity after undergoing the functional restoration training program, achieving lifting levels at or above normal for incumbent industrial workers. Overall, results demonstrate that the PILE test can be an effective baseline screening test for lifting capacity under certain circumstances. Although several drawbacks affecting the PILE as an isolated test are discussed, its usefulness as part of a battery of physical capacity tests making up a quantitative functional evaluation is clearly demonstrated. Finally, the potential use of PILE as a safe, inexpensive, simple, and relevant screening test for frequent lifting capacity in worker selection is discussed.

Back Pain↗
PubMed1987

A prospective two-year study of functional restoration in industrial low back injury. An objective assessment procedure.

One hundred sixteen consecutive patients entered a functional restoration treatment program for chronic low back pain and were compared with 72 patients not treated. A two-year follow-up survey reached more than 85% of both groups; its findings were compared with earlier results of a five-month and one-year follow-up. Analysis demonstrated that 87% of the treatment group was actively working after two years, as compared with only 41% of the nontreatment comparison group. Moreover, about twice as many of the comparison group patients had additional spine surgery relative to the treatment group. The comparison group continued with an approximately five times higher rate of patient visits to health professionals in the second year as the treatment group. Also, treatment group reinjury rates were no higher than those expected in the general population, while nontreatment subjects had a higher incidence of reinjury. Finally, a small treatment "dropout" group did poorest of all, with results in almost all areas even worse than those of the comparison group patients.

Adult↗
PubMed1986

Comparative efficacy of behavioral stress management versus propranolol in reducing psychophysiological reactivity in post-myocardial infarction patients.

The present study compared the relative efficacy of a behavioral stress-management procedure versus a pharmacologic method (the beta-blocker propranolol) in reducing psychophysiological reactivity in post-myocardial infarction (MI) patients. A pretreatment-posttreatment assessment design was used, with 10 patients participating in six separate sessions. The first session involved evaluating psychophysiological reactivity to an emotional stressor (a public-speaking task). The subsequent five sessions involved the administration of the respective treatments, either stress management or drug. The patients were randomly assigned to each treatment group. The public-speaking stressor was readministered after the last treatment session. Results demonstrated that behavioral stress management reduced psychophysiological reactivity to public speaking to the same level seen with propranolol. The findings suggest that this nonpharmacological approach could be of use when beta-blocker therapy is not desired, not practical, or medically contraindicated.

Adult↗