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Biomedical subjects

S M Skevington

Publications and source records attributed to S M Skevington.

At least 19 recordsLinked to original sources
PubMed2006

Relationships among adolescents' weight perceptions, exercise goals, exercise motivation, quality of life and leisure-time exercise behaviour: a self-determination theory approach.

Exercise has an important role to play in the prevention of child and adolescent obesity. Recent school-based interventions have struggled to achieve meaningful and lasting changes to exercise levels. Theorists have suggested that this may, in part, be due to the failure to incorporate psychosocial mediators as they relate to behaviour change. Using a sample of 580 British schoolchildren, a model grounded in self-determination theory was explored to examine the effects of exercise goals on exercise motivation, leisure-time exercise behaviour and quality of life (QoL). Results of structural equation modelling revealed that adolescents perceiving themselves to be overweight and pressurized to lose weight, endorsed extrinsic weight-related goals for exercise. Extrinsic goals negatively predicted, whereas intrinsic goals positively predicted, self-determined motivation, which in turn positively predicted QoL and exercise behaviour. Furthermore, self-determined motivation partially mediated the effects of exercise goals on reported exercise behaviour and QoL. Multi-sample invariance testing revealed the proposed model to be largely invariant across gender. Results suggest that holding extrinsic exercise goals could compromise exercise participation levels and QoL. A role for teachers and parents is proposed with the aim of orienting young people towards intrinsic goals in an attempt to enhance future exercise behaviour and QoL.

Adolescent↗
PubMed2006

How does psoriasis affect quality of life? Assessing an Ingram-regimen outpatient programme and validating the WHOQOL-100.

UNLABELLED: BACKGROUND, OBJECTIVES AND METHODS: This paper reports a longitudinal study of the quality of life (QOL) of outpatients receiving treatment for psoriasis in secondary care that was designed to validate a new QOL measure for use in psoriasis: the WHOQOL-100. Additional aims were to monitor the changes to the QOL of psoriasis patients (n = 83) following a course of topical treatment--a modified Ingram regimen--and to compare their QOL with healthy people (n = 105). RESULTS: General QOL was much improved following treatment; psychological facets of body image and appearance, self-esteem and negative feelings were particularly responsive to clinical change, in addition to positive feelings and cognitive capacity. Domains on spirituality, independence and physical health also improved. Compared with healthy controls, pretreatment psoriasis patients showed poorer physical, psychological, independence and spiritual QOL. Validity and reliability were investigated and found to be good to excellent. Internal consistency was very good in 23 facets out of 25. Domains and facets were strongly correlated (weaker for spirituality) largely reaffirming the WHOQOL concept. While physical, independence and psychological domains have some components similar to the Short Form-36, the social and environment domains represent novel conceptual areas for the WHOQOL. Facets about positive and negative feelings were validated by results from the Profile of Mood States. Psoriasis severity was associated with QOL in only six facets out of 25. CONCLUSIONS: The WHOQOL-100 is reliable and valid, and hence a new and important measure for assessing quality of life in psoriasis.

Adolescent↗
PubMed2004

The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group.

Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Adolescent↗
PubMed2001

Validation of the WHOQOL-100: pain management improves quality of life for chronic pain patients.

OBJECTIVE: The study aimed to validate a new, multidimensional, multilingual instrument (the WHOQOL-100) for assessing QOL in chronic pain patients. METHODS: Chronic pain patients (N = 106) who agreed to participate in an established pain management program (PMP) were assessed for quality of life (QOL) before and one month after the intervention. The WHOQOL-100 is a generic profile containing 25 facets of QOL organized in 6 domains. It was administered concurrently with the MOS Short Form-36, the Beck Depression Inventory, and measures of pain intensity, duration, disruption and distress. RESULTS: The patients were outpatients and inpatients with a mean age of 44 years and mean pain duration of 8 years. The sample included 70 (66%) women. After the PMP, QOL had significantly improved generally. and in the physical, psychological and independence domains, as well as in 10 facets of QOL including pain and discomfort. Good QOL is consistently associated with low levels of pain severity and pain distress and little pain disruption. Overall internal consistency reliability was good and for most facets and domains but marginal for the pain facet. When compared with the SF-36. the WHOQOL-100 shows good concurrent validity, greater comprehensiveness and very good responsiveness to clinical change. DISCUSSION: The WHOQOL-100 indicates significant improvements to QOL for those entering a PMP and is validated for the clinical assessment of chronic pain patients and for use in multi-national clinical trials, clinical governance and audit.

Adult↗
PubMed2001

Changes in the quality of life of patients receiving antidepressant medication in primary care: validation of the WHOQOL-100.

BACKGROUND: The study arises from the need for good quality of life (QOL) assessment and a new comprehensive generic QOL profile for cross-cultural use. AIMS: To examine changes in the QOL of patients receiving antidepressants from a general practitioner, and to assess the validity and sensitivity of a new QOL measure, the World Health Organization Quality of Life Assessment (100-item version) (WHOQOL-100). METHOD: Patients with moderate depression (n = 106) completed the WHOQOL-100 and Beck Depression Inventory at the start of treatment and again after 6 weeks. RESULTS: Depression decreased significantly over 2 months and 74% reported feeling better. WHOQOL-100 scores increased in 24 of the 25 facets, demonstrating that QOL improves significantly in the 8 weeks following the start of antidepressant treatment. It also shows the instrument's validity and sensitivity to changes in clinical condition. CONCLUSIONS: The UK WHOQOL-100 is confirmed as excellent to good. Antidepressants significantly and comprehensively improve QOL.

Adult↗
PubMed2000

Measuring the epidemiology of distress: the rheumatology distress index.

OBJECTIVES: (1) To examine clinical and psychological variables to determine which are associated with psychologic and psychosocial severity or "distress"; (2) to investigate whether patients with the 2 major rheumatic disorders, rheumatoid arthritis (RA) and osteoarthritis (OA), differ in distress variables and distress; and (3) to develop and validate a simple, clinically acceptable index of distress suitable for routine care and research purposes. METHODS: A total of 2,403 patients were evaluated in 2 data sets (N = 1,399 and N = 1,490). The first data set was evaluated in the clinic by a routine clinical examination and administration of the Clinical Health Assessment Questionnaire (CLINHAQ). This instrument includes measures of pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. The second data set was evaluated by a mailed questionnaire that included the CLINHAQ, but also coping scales, the Beliefs in Pain Control Questionnaire, the Self Performance Scale, and the Arthritis Helplessness Index. RESULTS: RA and OA groups had similar scores for the variables associated with distress: pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. Patients with fibromyalgia (FM) had more abnormal scores for every variable, reflecting overall distress. Using patients with FM as a "gold standard" of distress, we developed an index in data set 2. the Rheumatology Distress Index (RDI), made up of 5 variables, anxiety, depression, global severity, fatigue, and sleep disturbance, that best identified patients with FM compared to other patients. We then validated the instrument on the distress severity clusters formed in data set 1. The correlation between RDI and distress severity cluster was 0.874 with all patients considered and 0.867 with FM patients excluded. In addition, RDI predicted 1,174 of 1,399 (83.9%) cluster memberships correctly. Compared with a battery of psychological and clinical tests that classified 74% of FM and non-FM patients correctly, the RDI and is only slightly less effective, classifying 70.3% correctly. CONCLUSION: Distress is a patient rather than a disease phenomenon. A simple, easy to administer self-report questionnaire can be used to classify patients according to their level of distress. The resulting index, the RDI. accurately identifies distressed and non-distressed patients. Such an index should be useful for patient care and research.

Aged↗
PubMed1999

Measuring quality of life in Britain: introducing the WHOQOL-100.

Quality of life is an important outcome measure in the evaluation of treatments for a range of chronic physical and psychological disorders. The psychometric properties of a new British quality-of-life instrument-the WHOQOL-100--are presented, as part of an international project to create a multilingual, multidimensional profile for cross-cultural use. The WHOQOL was completed by an adult sample (N = 320) of well people and patients attending GP surgeries and out-patient clinics and from inpatient wards. The sick represented 16 disease categories and all were selected for age, gender, and disease severity. The levels of quality of life of different disease groups and sociodemographic categories are reported. The presence or absence of positive feelings provides the best single predictor of quality of life in Britain today, and this improves when supplemented by information about mobility and energy. The scores of the scale discriminate well between sick and well people and concur with reported health status. The concept of quality of life covering 25 facets (hierarchically organized within six domains) was largely confirmed by mapping intercorrelations. The WHOQOL-100 shows excellent overall internal consistency reliability and can be used with individuals. This level of reliability extends to all domains and patient subgroups. Seven UK national items were also assessed for inclusion. The results show that WHOQOL-100 promises to be a comprehensive profile for generic use in the evaluation of contemporary health care.

Activities of Daily Living↗
PubMed1999

Selecting national items for the WHOQOL: conceptual and psychometric considerations.

The WHOQOL is a new measure designed to assess quality of life cross-culturally in health and health care. An international core of 276 items covering 29 facets of quality of life organised into 6 domains has been established conceptually and then assessed in psychometric terms. The method also allowed for the inclusion of extra national items to enable the concept of quality of life to be complete for each language and culture and to achieve conceptual equivalence between different language versions in participating centres. The present study investigates the properties of these national items using data obtained from 3740 participants world-wide, who completed the instrument in 10 of 16 original WHOQOL centres. Five statistical criteria were applied to 144 national items to examine their performance in competition with internationally agreed core items from the same facet, using data obtained from within that centre. Multi-dimensional scaling and cluster analysis was used to examine the structural relationship of national items within their own facet and directed their inclusion. Forty (29%) national items were selected and detailed examples demonstrate the selection methods used. They show how entirely new facets as well as individual items can be assessed for appending to the core WHOQOL-100. They also enable ambiguity to be resolved where there may be doubt about whether proposed items constitute part of an existing facet or justify a new one. Where national items are similar in more than one centre, a mechanism is provided whereby these items can be re-evaluated as candidates for inclusion in any future revision of the international core. Lastly, a case is identified that may provide justification for the establishment of national facets.

Adolescent↗
PubMed1999

Designing response scales for cross-cultural use in health care: data from the development of the UK WHOQOL.

Designing response scales for use in cross-cultural situations presents several semantic and conceptual challenges. Here we report response scales designed in the UK, using a method developed collaboratively by the WHOQOL Group to tackle some of these issues. The response scales were generated for use with items established for a British version of a new cross-cultural quality of life measure for health and health care--the UK WHOQOL. A quota sample of 20 sick and well people assigned 60 descriptions to separate 100 mm lines (15 for each of 4 types of response scale) where the polar anchor points had been internationally agreed as meaningful in 10 countries. Means and standard deviations (SD) were calculated for each label appropriate to that response scale. The closest mean and smallest SD earmarked labels for each type of scale at the 25%, 50% and 75% interval. This research provides a set of contemporary, 5-point interval response scales that have the potential to be used in any number of British health and health-care questionnaires where subjective measures are needed.

Adult↗
PubMed1996

A randomized and controlled trial of hydrotherapy in rheumatoid arthritis.

OBJECTIVE: The aim of this study was to evaluate the therapeutic effects of hydrotherapy which combines elements of warm water immersion and exercise. It was predicted that hydrotherapy would result in a greater therapeutic benefit than either of these components separately. METHODS: One hundred thirty-nine patients with chronic rheumatoid arthritis were randomly assigned to hydrotherapy, seated immersion, land exercise, or progressive relaxation. Patients attended 30-minute sessions twice weekly for 4 weeks. Physical and psychological measures were completed before and after intervention, and at a 3-month followup. RESULTS: All patients improved physically and emotionally, as assessed by the Arthritis Impact Measurement Scales 2 questionnaire. Belief that pain was controlled by chance happenings decreased, signifying improvement. In addition, hydrotherapy patients showed significantly greater improvement in joint tenderness and in knee range of movement (women only). At followup, hydrotherapy patients maintained the improvement in emotional and psychological state. CONCLUSIONS: Although all patients experienced some benefit, hydrotherapy produced the greatest improvements. This study, therefore, provides some justification for the continued use of hydrotherapy.

Arthritis, Rheumatoid↗
PubMed1996

On the mathematical modelling of pain.

In this review a case is presented for the use of mathematical modelling in the study of pain. The philosophy of mathematical modelling is outlined and a recommendation is made for the use of modern nonlinear techniques and computational neuroscience in the modelling of pain. Classic and more recent examples of modelling in neurobiology in general and pain in particular, at three different levels-molecular, cellular and neural networks-are described and evaluated. Directions for further progress are indicated, particularly in plasticity and in modelling brain mechanisms. Major advantages of mathematical modelling are that it can handle extremely complex theories and it is non-invasive, and so is particularly valuable in the investigation of chronic pain.

Analgesia↗
PubMed1996

The role of N-methyl-D-aspartate (NMDA) receptors in wind-up: a mathematical model.

We present a mathematical model for the phenomenon of wind-up (Mendell, 1966, Exper. Neur. 16,316-22) which occurs in many neurons. We concentrate on its occurrence in the substantia gelatinosa of the dorsal horns of the spinal cord, where it is connected with certain pathological and nonpathological pain states. The model is a development of the model by Britton & Skevington (1989, J. Theor. Biol. 137, 91-105) for Melzack & Wall's gate control theory of pain (1965, Science, New York, 150, 971-9; 1982, The Challenge of Pain, Penguin: Harmondsworth), modified to take account of more recent information. Its variables are the electric potentials of various cells in the midbrain and the spinal cord. Britton & Skevington's original model simulated many of the phenomena observed in acute pain in humans, but not the wind-up mechanism. This is not surprising, since this model did not include the N-methyl-D-aspartate (NMDA) receptors that are now recognized as being crucial to the phenomenon. Here we rectify this omission, and obtain good agreement between the model and experimental data on wind-up. The positive feedback that NMDA receptors exhibit is shown to be the essential feature in producing wind-up. As an independent test of the model we simulate a completely different experimental set-up, and obtain good qualitative agreement with data there. Finally, we present a prediction of the model that has yet to be tested experimentally.

Animals↗
PubMed1993

The experience and management of pain in rheumatological disorders.

A case for studying the psychological aspects of pain is made through a discussion of the problems resulting from investigations of the so-called rheumatoid personality. Following a review of the current theory about pain mechanisms, proposals are made about the best ways of measuring pain in the rheumatological disorders. Later sections tackle issues about the many meanings of pain. Discussion particularly focuses on expectations about pain, on lay beliefs about the rheumatic diseases and on beliefs about pain control. Recommendations are made about the ways in which some of these psychological features might profitably be incorporated into the management of clinical pain.

Arthritis, Rheumatoid↗
PubMed1989

A mathematical model of the gate control theory of pain.

The first test which any theory of pain must pass is that it must be able to explain the phenomena observed in acute pain in humans. This criterion is used to test the major theory of pain at present, the gate control theory of Melzack & Wall (1965, 1982). The theory is explicit enough to be cast in mathematical terms, and the mathematical model is shown to explain the observations considered. It also points up a common misconception on the consequences of the theory, and thus demolishes an argument which has been used against it. A hypothesis of the origin of rhythmic pain is then made, and consequent testable predictions given. This is the first time that the gate control theory has been used to explain any quality of pain. It has important consequences for the treatment of such pain. Finally, the applicability of the gate control theory as an explanation for chronic pain is discussed.

Humans↗
PubMed1988

Ankylosing spondylitis--an analytical review of 1500 patients: the changing pattern of disease.

To avoid biases inherent in the study of referral patients seen at a single unit, we investigated a group of 1500 patients (males 71%), members of the UK National Ankylosing Spondylitis Society (NASS). Patients were divided into 15 cohorts by year of onset (mean size 91). The median delay in diagnosis for these cohorts was greater than 6 years until 1974. Thereafter, there was a marked improvement with the most recent cohort waiting a median of 2 years for diagnosis (e.g., 1969/72 cohorts vs 1979/82 cohorts; mean delay 7.4 years vs 2.3 years, p less than 0.0001). Until 1974 the median delay for women was 9 years compared to 6 years for men (e.g., 1956/62 cohorts 11 and 7 years, p less than 0.0015, falling to 3 and 2.5 years, respectively by 1979/82, p = NS). Major differences were seen when the 14 health regions were taken separately; the median delay ranged from 9 years for the 3 "worst" regions to 4 years for the 3 "best" (p = 0.022). This was reflected in the percentage with delay in diagnosis longer than 2 years (80 and 58%, respectively; chi 2 = 11.31, p less than 0.01). Strikingly, the median age of onset of symptoms steadily increased from 18 years in 1930/40 to 28 years in 1981/82 (e.g., 1956/62 vs 1969/72; mean ages 21.4 vs 23.5 years, p less than 0.004 and 1969/72 vs 1979/82; 23.5 years vs 28.7 years p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Self-esteem and perception of attractiveness: an investigation of early rheumatoid arthritis.

During an investigation into the self-esteem of early rheumatoid patients and controls matched individually by age and sex, it was found that at their first visit to out-patients, patients had lower self-esteem. The items of low self-esteem showed a similarity with features of the rheumatoid personality. An observation that the word attractive in the Carlson Adjective Checklist was rarely used by both groups, and that items at the beginning and end of the checklist were less often ticked, led to a second study of 67 undergraduates where the position of the word attractive was experimentally varied in three forms of the scale. The results show that position only marginally affects response to this item. Probability analyses confirm that the word attractive is used very rarely by patients, rarely by healthy adults and less often than expected by healthy students, possibly demonstrating the respective effects of pain and illness, and age. Attractive tends to be included in the self-concept only after self-esteem reaches a relatively high level.

Adolescent↗
PubMed1986

Psychological aspects of pain in rheumatoid arthritis: a review.

Pain in rheumatoid arthritis (RA) is reviewed from a socio-cognitive perspective. Questions are raised about the usefulness of the distinction between organic vs non-organic pain patients, and alternative explanations for the behaviour of seronegatives is presented. A case based on physiology and behaviour is made for more studies of the acute and prechronic stages of RA. Four major areas of methodology are considered: studies of lay explanations about RA show that people hold relatively accurate views about the nature of pain in RA, and where causal explanations are given for pain and illness, this is conducive to good mental health. A section on the measurement of pain addresses issues about the applicability and standardisation of scales, and welcomes the move from the exclusive use of quantitative to qualitative multidimensional measures. The pain language of RA is described. Experimental studies of pain in RA appear to be of limited use. A review of activities and functional disability indicates that cognitive and behaviour modification techniques appear to have most promise in motivating chronic patients to be more active, and to comply with medication, as well as improving mental health. In a discussion of successful therapies, the principles of reducing uncertainty and increasing perceptions of control are the underlying features. However the reliability of cognitive therapies in the treatment of RA so far remains unproven.

Activities of Daily Living↗