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Thomas Hadjistavropoulos

Publications and source records attributed to Thomas Hadjistavropoulos.

15 recordsLinked to original sources
PubMed2007

An interdisciplinary expert consensus statement on assessment of pain in older persons.

This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.

Age Factors↗
PubMed2006

A meta-analysis of psychological and pharmacological treatments for Body Dysmorphic Disorder.

Although psychological and pharmacological treatment approaches for Body Dysmorphic Disorder have been evaluated, the relative effectiveness of these two types of interventions has not been examined. We conducted a meta-analysis of randomized clinical trials and case series studies involving psychological (i.e., behavioural, cognitive-behavioural, cognitive) or medication therapies. Our findings support the effectiveness of both types of therapy, but suggest that cognitive-behavioural treatment may be the most useful. These findings require cross-validation through large-scale clinical trials.

Cognitive Behavioral Therapy↗
PubMed2005

Fear of pain and fear of falling among younger and older adults with musculoskeletal pain conditions.

BACKGROUND: The fear-avoidance model of pain accounts for the debilitating consequences of strong fear as a component of reactions to painful conditions (eg, movements become anxiety-provoking because they cause pain). The model, which is supported in the literature, posits that fear of pain interferes with recovery because it leads to avoidance of beneficial activity. Despite the high prevalence of pain among the elderly, investigations of fear of pain in this population are scarce. A related construct, fear of falling, has been studied among elderly (but not younger) adults as an age-specific concern. OBJECTIVES: To examine the relationship between fear of pain and fear of falling. Specifically, it is hypothesized that fear of pain and fear of falling are distinct constructs. Moreover, the authors investigated whether fear of falling becomes more relevant with increasing age in a sample of seniors and younger adults with musculoskeletal conditions. METHODS: A convenience sample of younger and older adult physiotherapy outpatients (n=226) receiving treatment for musculoskeletal conditions were recruited for the study. Fear of pain and fear of falling were assessed using self-report measures. RESULTS: There were no age differences with respect to fear of pain and fear of falling. Regression analyses showed that fear of pain measures contribute substantial unique variance to the prediction of each other; however, they only make minor unique contributions to the prediction of fear of falling. Similar results were obtained through confirmatory analyses using structural modelling techniques. CONCLUSIONS: The analyses supported the distinctiveness of fear of pain and fear of falling. Moreover, among physiotherapy outpatients with musculoskeletal pain conditions, fear of falling and fear of pain are distinct constructs that appear to represent the concerns of both seniors and younger pain patients.

Accidental Falls↗
PubMed2005

A qualitative investigation of seniors' and caregivers' views on pain assessment and management.

The literature suggests that pain in the elderly, especially among seniors with dementia, is under-assessed and under-treated. This qualitative study solicited the perspectives of seniors, front-line nursing staff, nursing-home administrators, and informal caregivers of seniors with dementia on the current status of pain assessment and management. The views of these participants complement the research findings reported in the literature. While some of their explanations and potential solutions concerning under-treatment of pain in seniors echo views that have been presented in the literature, the participants also pointed to factors and avenues that have been given less formal consideration (e.g., systemic barriers to effective assessment and treatment of pain). They also highlighted the need for pain-control strategies beyond medication. The implications of these findings are discussed.

Aged↗
PubMed2004

Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC).

The purpose of this study, conducted in three phases, was to develop a clinically useful observational tool (i.e., the Pain Assessment Checklist for Seniors With Limited Ability to Communicate [PACSLAC]) to assess pain in seniors with severe dementia. In Phase 1, professional caregivers of seniors with severe dementia were interviewed in order to generate a list of pain-related behaviors that are characteristic of care recipients living in long-term-care facilities. Based on a systematic examination of interview transcripts by experienced researchers and an independent coder, a behavioral checklist (i.e., the initial version of the PACSLAC) was developed. The checklist items were organized into conceptually based subscales (e.g., facial expressions, activity/body movement). Phase 2 focused on an assessment of the internal consistency of the checklist (alpha =.92). Following an item analysis, the subscales of the PACSLAC (Social/Personality/Mood Indicators, Facial Expressions, Activity/Body Movement, and Physiological Indicators/Eating/Sleeping Changes/Vocal Behaviors) were found to be internally consistent. Phase 3 focused on a preliminary validation of the PACSLAC. Analyses suggest that the PACSLAC discriminated among pain events (during which there was a clear and recognizable cause for the patients' pain), events during which patients were experiencing nonpainful distress, and situations during which patients were calm.

Adult↗
PubMed2004

The problem of pain management among persons with dementia, personhood, and the ontology of relationships.

While pain is common among seniors, it is not adequately treated or managed. In particular, pain in seniors with dementia is often undertreated and undermanaged. Although the undertreatment of pain among persons with cognitive impairments represents a serious ethical concern for pain clinicians, most writers in the area explain the undertreatment of pain by focusing on issues related to liability, fears of addiction to opioids, and erroneous beliefs that pain is a normal part of the ageing process. We argue that the philosophical notion of personhood must also be given careful attention when considering the problem of pain undermanagement. In this paper, we consider the undertreatment of pain among seniors with dementia, while focusing on the ontology of relationships and on existential philosophy. Moreover, we outline a series of recommendations to help minimize the probability of pain undertreatment in this population and to encourage considerations relating to personhood when treating people with dementia.

Aged↗
PubMed2003

The relevance of health anxiety to chronic pain: research findings and recommendations for assessment and treatment.

Health anxiety is a dimensional construct that is characterized by extreme concern about one's health at one end of the continuum and lack of concern about health on the other. Research evidence is consistent with the notion that high levels of health anxiety among patients with pain represent a poor prognostic indicator. Moreover, the experience of chronic pain can serve to increase health anxiety levels. This article concludes with a series of practical recommendations to assist practitioners in the assessment and management of patients with health anxiety.

Anxiety Disorders↗
PubMed2003

Comparing two observational systems in the assessment of knee pain.

OBJECTIVE: Research has demonstrated the utility of the Pain Behavior Measurement (PBM) system as a pain index. PBM involves the recording of sighing, rubbing, grimacing, guarding and bracing. A modification of this system has been proposed, focusing on the occurrence of joint flexing, rubbing, unloading the joint, guarding and rigidity, specifically for patients with knee pain. The aim of the present study was to compare the original PBM to the modified version in a sample of knee replacement patients to assess the utility of the more specialized approach. It was expected that the more discomforting physiotherapy activities (knee bending and quadriceps exercises) would result in more pain behaviours than intermediate activities (walking and standing), which, in turn, would result in more pain behaviours than reclining. The extent to which each system reflected this expected pattern was examined. METHODS: Ninety-three seniors were observed while completing a series of structured post-knee surgery physiotherapy activities (knee bending, standing, walking, reclining and a quadriceps exercise). RESULTS: Analyses of self-reported levels of pain were consistent with the expected pattern of pain levels in relation to the physiotherapy activities. Specific pain behaviours within each system (eg, grimacing, rigidity) occurred in a manner consistent with the expected pattern, while other behaviours (e.g., rubbing the affected area) did not. CONCLUSIONS: Although there was no clear advantage for the modified system over the PBM, an optimal approach may involve combining specific behaviours from each system.

Aged↗
PubMed2003

The ethical ideologies of psychologists and physicians: a preliminary comparison.

The ethical ideologies of psychologists (who provide health services) and physicians were compared using the Ethics Position Questionnaire. The findings reveal that psychologists tend to be less relativistic than physicians. Further, we explored the degree to which physicians and psychologists report being influenced by a variety of factors (e.g., family views) in their ethical decision making. Psychologists were more influenced by their code of ethics and less influenced by family views, religious background, and peer attitudes than were physicians. We argue that these differences reflect the varied professional cultures in which practitioners are trained and socialized.

Codes of Ethics↗
PubMed2002

Using facial expressions to assess musculoskeletal pain in older persons.

Past research examined measures of pain among seniors who were experiencing movement-related exacerbations of musculoskeletal pain and obtained clear support for the utility of the behavioural coding of pain-related body movements (e.g., bracing, guarding). Support for the utility of the Facial Action Coding System (FACS), which involves the objective coding of facial reactions, was not as strong. The findings concerning FACS could have been an artifact of the methodology that was used. Specifically, the duration of the facial reactions was not taken into account and the patients suffered from a variety of painful conditions. Thus, the physical activities involved in the study could have been painful for some patients but not for others. The present study corrected these methodological concerns by accounting for the duration of facial reactions and ensuring that all patients suffered from the same painful condition. Participants were 82 post-surgical (knee replacement) inpatients. Cognitive status was assessed using the Modified Mini Mental Status Examination. Under physiotherapist's supervision, the patients performed structured activities (i.e., reclining, standing, knee bends). Facial reactions were coded using FACS. Facial reactions varied as a function of the degree to which the various activities were strenuous. The results support the utility of FACS in the assessment of musculoskeletal pain among seniors undergoing rehabilitation following knee surgery.

Aged↗
PubMed2002

Ethical orientation, functional linguistics, and the codes of ethics of the Canadian Nurses Association and the Canadian Medical Association.

The literature on codes of ethics suggests that grammatical and linguistic structures as well as the theoretical ethical orientation conveyed in codes of ethics have implications for the manner in which such codes are received by those bound by them. Certain grammatical and linguistic structures, for example, tend to have an authoritarian and disempowering impact while others can be empowering. The authors analyze and compare the codes of ethics of the Canadian Nurses Association (CNA) and the Canadian Medical Association (CMA) in terms of their ethical orientation and grammatical/linguistic structures. The results suggest that the two codes differ substantially along these two dimensions. The CNA code contains proportionally more statements that provide a rationale for ethical behaviour; the statements of the CMA code tend to be more dogmatic. Functional grammar analysis suggests that both codes convey a strong deontological tone that does not enhance the addressee's ability to engage in discretionary decision-making. The nurses' code nonetheless implies a collaborative relationship with the client, whereas the medical code implies that the patient is the recipient of medical wisdom. The implications of these findings are discussed.

Canada↗
PubMed1999

Ethical principles of the American Psychological Association: an argument for philosophical and practical ranking.

Unlike the American Psychological Association (APA), the Canadian Psychological Association has adopted a code of ethics in which principles are organized in order of importance. The validity of this hierarchical organization has received some empirical and theoretical support. We conducted a theoretical analysis that revealed conceptual justification for a ranking of the 6 principles in the APA code. Such a ranking could assist psychologists in making more informed and consistent moral choices when confronted with ethical dilemmas that involve conflicts among principles.

Codes of Ethics↗
PubMedDate not supplied

A study of thematic content in hospital mission statements: a question of values.

We examined the content of Canadian hospital mission statements using thematic content analysis. The mission statements that we studied varied in terms of both content and length. Although there was some content related to goals designed to ensure organizational visibility, survival, and competitiveness, the domain of values predominated over our entire coding structure. The primary value-related theme that emerged concerned the importance of patient care.

Canada↗
PubMedDate not supplied

An analysis of the ethical and linguistic content of hospital mission statements.

An analysis of the ethical and functional linguistic content of Canadian hospital mission statements was conducted. The ethical content analysis identified deontology as the dominant ethical orientation. The functional linguistic analysis revealed a trend toward the depersonalization and objectification of action. Implications for formulating effective mission statements were discussed.

Canada↗