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Biomedical subjects

W R Nielson

Publications and source records attributed to W R Nielson.

14 recordsLinked to original sources
PubMed2001

Psychosocial aspects of fibromyalgia.

The view that fibromyalgia syndrome (FMS) is a psychiatric disorder or can be caused by stress or abuse is unproven. The construct of posttraumatic FMS has not been adequately validated. Similarly, there is no evidence that communicating the diagnosis to patients causes iatrogenic consequences. Research suggesting a higher rate of posttraumatic stress disorder among those with FMS is weak. More research examining specific psychological processes in FMS is desirable. Because of the potential for harm to patients, clinicians should be cognizant of possible undue influences on medical opinion by agencies providing health care and research funding.

Fibromyalgia↗
PubMed2001

An activity pacing scale for the chronic pain coping inventory: development in a sample of patients with fibromyalgia syndrome.

Patients with fibromyalgia syndrome (FS) experience a decreased ability to participate in both vocational and avocational activities. Although many treatment programs advocate activity pacing techniques, 'pacing' is a poorly understood concept for which there are no available measures. The present study describes a brief six-item pacing scale that can be administered as part of the Chronic Pain Coping Inventory (CPCI). Preliminary data indicate that this scale is a valid, reliable index of the pacing construct that is associated with physical impairment in patients with FS and is unrelated to simple task persistence.

Adaptation, Psychological↗
PubMed2001

Biopsychosocial approaches to the treatment of chronic pain.

BACKGROUND: Biopsychosocial treatments address the range of physical, psychological, and social components of chronic pain. OBJECTIVE: This review sought to determine how effective unimodal and multimodal biopsychosocial approaches are in the treatment of chronic pain. METHODOLOGY: The literature search identified three systematic reviews of the literature and 21 randomized controlled trials to provide the evidence for this review. RESULTS: The systematic reviews and 12 randomized controlled trials reported on chronic low back pain. Other randomized controlled trials studied fibromyalgia (three trials) and back or other musculoskeletal disorders (five trials). Biopsychosocial components reviewed were electromyogram feedback and hypnosis as unimodal approaches, and behavioral and cognitive-behavioral treatments and back school, or group education, as multimodal approaches for chronic low back pain. For other chronic pain disorders, cognitive-behavioral treatments were reviewed. Comparisons were hindered by studies with heterogeneous subjects, varied comparison groups, different cointerventions and follow-up times, variable outcomes, and a range of analytic methods. CONCLUSIONS: Multimodal biopsychosocial treatments that include cognitive-behavioral and/or behavioral components are effective for chronic low back pain and other musculoskeletal pain for up to 12 months (level 2). There is limited evidence (level 3) that electromyogram feedback is effective for chronic low back pain for up to 3 months. The remaining evidence of longer-term effectiveness and of effectiveness of other interventions was inadequate (level 4a) or contradictory (level 4b). Future studies of cognitive-behavioral treatments should be condition specific, rather than include patients with different pain conditions.

Behavior Therapy↗
PubMed2001

Interventions for disability management.

BACKGROUND: With an increasing prevalence of low back pain, management can include modified work, work-conditioning, or work-hardening programs. Modified work programs, or employer's worksite interventions or clinic-based programs under medical supervision, provide a gradual increase of workload. Work-conditioning programs, or unimodal physical conditioning and function activities, promote return to work. Work-hardening programs, or graded work simulations and psychological interventions, are used as part of an interdisciplinary program addressing physical and functional needs. OBJECTIVE: The objective of the review was to determine how effective modified work programs, work hardening, and work conditioning are in the management of chronic pain disability. METHODOLOGY: The literature search identified two systematic literature reviews to provide the evidence about these interventions for disability management. RESULTS: Studies of work conditioning showed methodological variability, heterogeneous subjects, variable definitions of modified work, and limited outcome measures. Using return-to-work outcomes, 8 of the 11 studies of adequate methodological quality reported positive effects of modified work programs, mostly light duty. For work conditioning and work hardening, studies showed methodological variability combined with heterogeneous subjects, including varying times out of work and varying work ethics from different countries. Most study results were uncertain, though results of three of the four medium-quality studies were positive. CONCLUSIONS: Modified work programs may improve return-to-work rates of workers with work-related injuries for 6 months or longer (level 2). There is inadequate evidence (level 4a) to determine what particular aspects of modified work programs are helpful. Work conditioning and work hardening may or may not improve the return to work of more chronically disabled workers (level 4b).

Chronic Disease↗
PubMed1999

Concentration and memory deficits in patients with fibromyalgia syndrome.

The present study compared 30 patients with Fibromyalgia Syndrome (FS) to 30 healthy control subjects matched for age, sex, and estimated intellectual level on standardized measures of attention, concentration, and memory as well as subjective ratings of memory abilities and sleep quality. In addition, in order to investigate the relationship between cognitive functioning and other physical and psychological symptoms, subjects with FS completed psychological measures of pain severity, trait anxiety, and depression. Results indicated that patients with FS performed more poorly on tests of immediate and delayed recall, and sustained auditory concentration, and their ratings of both their memory abilities and sleep quality were lower than those of controls. Furthermore, perceived memory deficits of the FS subjects were disproportionately greater than their objective deficits. Results indicated significant correlations between performance on memory and concentration measures and scores on questionnaires of pain severity and trait anxiety. Implications of these results for multidisciplinary treatment programs are discussed.

Adult↗
PubMed1995

Occupational and longitudinal differences in health-care and non-health-care worker attitudes concerning AIDS exposure and work: evidence of professional dedication.

To assess changes in occupational preferences of health-care workers in response to the AIDS epidemic, attitudes for nine issues concerning AIDS in the workplace were gathered in 1990 and 1992. AIDS-aversive patterns strengthened for both health-care and non-health-care workers over time as AIDS incidence rose. Compared to non-health-care workers, significantly more health-care workers showed greater concern over job related AIDS exposure, and over time they also reported more approval of testing and status disclosure for AIDS. Despite these concerns, significantly more health-care workers than non-health-care workers were willing to work with an AIDS-infected coworker or boss, and significantly fewer health-care workers than non-health-care workers believed they had a right to refuse work with an AIDS-infected coworker. Training had little effect on AIDS-aversive preferences among health-care workers. But significantly more non-health-care workers with AIDS-related "protective" training reported a self-protective rejection of AIDS-infected coworkers. Implications for health-care management are explored.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Cognitive behavioral treatment of fibromyalgia syndrome: a followup assessment.

OBJECTIVE: In a previous study, we showed that cognitive behavioral therapy (CBT) was effective in the short term treatment of fibromyalgia (FMS). We tested the hypothesis that a pooled index of 10 target psychometric outcomes would show overall improved outcome at longterm followup versus pretreatment. METHODS: Using a quasiexperimental design and validated psychometric instruments, we compared pretreatment psychometric variables with longterm outcomes in the 25 subjects who had completed the earlier study. A distinction was made between target variables the program had specifically addressed and nontarget variables not specifically addressed. RESULTS: Twenty-two subjects participated at a mean of 30 months after discharge from the program. As at short term followup, no nontarget variable changed from pretreatment to longterm assessment. The short term improvement that had been observed in all 10 target variables was maintained in 3 variables at a Bonferroni corrected alpha level of 0.005: worry, p < 0.001; observed pain behavior, p < 0.001; and control over pain, p < 0.002. All 10 target variables changed in the direction of improvement. A pooled index of these 10 variables showed statistically significant improvement from baseline (p < 0.002). CONCLUSION: Our results suggest that CBT may have a role in the longterm treatment of FMS.

Adult↗
PubMed1992

Cognitive behavioral treatment of fibromyalgia syndrome: preliminary findings.

We used a simple quasiexperimental design to assess the efficacy of an inpatient cognitive-behavioral treatment program for persons with fibromyalgia syndrome (FS). Twenty-five participants were assessed on 3 occasions: (1) about 5 months before admission to the program, (2) on admission and (3) at discharge. In addition, the dependent variables (pain response measures) were divided into "target" (expected to change with treatment) and "nontarget" (not expected to change) to assess potential demand characteristics. Our results showed that, whereas no changes occurred in either target or nontarget variables between the initial assessment and admission, consistent changes were observed only in target variables between admission and discharge. Our data provide preliminary support for cognitive-behavioral treatment for FS.

Adolescent↗
PubMed1990

Preoperative anxiety: detection and contributing factors.

The purpose of this study was to determine whether there is a correlation between anxiety the night before surgery and that existing immediately preoperatively, whether anaesthetists can detect preoperative anxiety and to establish the presence of any factors that might assist in the determination of preoperative anxiety. Anxiety was measured objectively using the Spielberger State-Trait Anxiety Inventory (STAI), and the Multiple Affect Adjective Check List (MAACL). Anxiety was found to be higher in females and those not having had a previous anaesthetic, and to remain constant from the afternoon before surgery to the immediate preoperative period. Anaesthetists were found to be poor assessors of anxiety unless they specifically questioned their patients about this.

Adolescent↗
PubMed1990

Long-term cognitive and social sequelae of general versus regional anesthesia during arthroplasty in the elderly.

This study compared the effects of general and regional anesthesia on cognitive and psychosocial functioning in elderly persons. Sixty-four patients between 60 and 86 yr of age undergoing knee arthroplasty were randomly assigned to receive either general or regional anesthesia. A battery of psychometric tests, including the Satz-Mogel form of the Wechsler Adult Intelligence Scale-Revised, the Wechsler Memory Scale-Revised and the Sickness Impact Profile, and various neuropsychological measures were administered by a blinded observer just before surgery and again 3 months later. Analyses of covariance revealed improvements in most measures that were equivalent between groups. The results indicated that there were no cognitive or psychosocial effects of general or regional anesthesia after 3 months in elderly persons undergoing knee arthroplasty. In this patient population, general anesthesia poses no more risk to long-term mental function than regional anesthesia.

Aged↗
PubMed1987

Depression and activity patterns of spinal cord injured persons living in the community.

The present study examined the effects of depression and injury level (paraplegics/quadriplegics) on respondents' daily activity (ADL) patterns for 53 spinal cord injured (SCI) persons living in the community. This investigation involved the administration of the Beck Depression Inventory, the Clinical Depression Measure, the Multiple Affect Adjective Check List, and the Activity Pattern Indicators. The first issue of interest was the incidence of clinical depression in this community-based sample. Evidence of clinical depression was found in only 15% of the sample, with 45% of respondents showing evidence of mild depression. A second issue concerned the independent and/or interactive effects of depression and injury levels across several different types of ADL. Independent depression effects were found for personal activities, such that mildly depressed respondents reported fewer personal activities than nondepressed individuals. Independent injury level effects were found for overall frequency of activities, with quadriplegics achieving lower scores than paraplegics. Interactive effects were obtained between depression and injury level for work and travel. For each of these activities, similar levels were found for nondepressed quadriplegic, mildly depressed quadriplegic, and mildly depressed paraplegic respondents, all of whom were less active than nondepressed paraplegics. These results suggest that for some activities depression may play as important a role in long-term rehabilitation as degree of disability.

Activities of Daily Living↗