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PubMed2002

Physical outcome measurements via the Internet: reliability at two Internet speeds.

We have developed a software application to enable interactive rehabilitation via the Internet. The reliability of the telemedicine application was examined by comparing it with face-to-face assessment. The physical outcome measures assessed were knee range of motion, quadriceps muscle strength, limb girth and an assessment of gait. One therapist performed both in-person and Intemet-based measurements of all outcome measures on 20 normal subjects. There was good agreement between the two techniques (the 95% limits of agreement included zero for all the variables studied). Internet assessments were conducted at two bandwidths: ISDN at 128 kbit/s and the telephone network at 17 kbit/s. Bandwidth had no significant influence on any of the measures. This study suggests that Internet-based physiotherapy interventions delivered to the home are suitable for further development.

Adult↗

PubMed1987

[Verbal interaction and heart rate in the course of the therapeutic process in a neurotic patient. A psychobiologic pilot project].

Whereas measurements of physiologic variables are widely used in investigations of psychosomatic illnesses, this proceeding is not an established strategy when dealing with the therapeutic process of neuroses which lack coarse bodily symptoms. Therefore, we investigate the heart rate response pattern and the verbal dialog during therapeutic sessions of a patient with an impulsive neurosis. Recordings are made before and after the obsessive symptoms improve. Changes are found in the heart rate response as well as in the verbal interaction between patient and therapist. While symptoms persist the patient's behavior alternates between patient and therapist. While symptoms persist the patient's behavior alternates between gross defense and a panic like disturbance. Concurrently the heart rate response shows an inconspicuous pattern interrupted by sudden heart rate increases. After the obsessive symptoms had ceased the patient has been better controlled in his behavior but is more tense. Compared to the previous state this is accompanied by more frequent and longer lasting periods of reduced heart rate variability and only moderate increases.

Adult↗

PubMedDate not supplied

Factors related to evidence-based practice among U.S. occupational therapy clinicians.

OBJECTIVE: The purpose of this study was to examine how U.S. occupational therapists access and use clinically relevant research results. METHOD: During the spring of 2000, 209 clinically practicing occupational therapists who were members of the American Occupational Therapy Association responded to a survey (58% response rate). The distribution of opinions and self-reported behavior was portrayed by descriptive statistics, and chi-square cross-tabulations and Pearson correlation coefficients were calculated between demographic and evidence-based practice variables. RESULTS: Respondents occasionally accessed research information through a variety of resource media. The majority (57%) implemented between one and five new, research-based treatment plans in the past year. Compared with respondents with less experience, a greater proportion of respondents with 15 or more years of clinical experience did not believe that research conclusions usually translated into treatment plans for individual clients (chi 2 = 20.620, p < .01). Almost three fifths (59%) of respondents reported that time was provided on the job to attend continuing education; however, 45% strongly disagreed that time was available at work to access research information. Other reported barriers to research utilization included lack of time on the job, high continuing education costs, weak research analysis skills, and placing higher value on clinical experience than on research. CONCLUSIONS: These findings suggest that therapists are currently engaging in a modest amount of evidence-based practice. Removing the barriers identified in this study may increase research utilization among clinicians.

Evidence-Based Medicine↗

PubMed2006

Incremental cost-effectiveness of a collaborative care intervention for panic disorder.

BACKGROUND: Panic disorder is a prevalent, often disabling, disorder among primary-care patients, but there are large gaps in quality of treatment in primary care. This study describes the incremental cost-effectiveness of a combined cognitive behavioral therapy (CBT) and pharmacotherapy intervention for patients with panic disorder versus usual primary-care treatment. METHOD: This randomized control trial recruited 232 primary-care patients meeting DSM-IV criteria for panic disorder from March 2000 to March 2002 from six primary-care clinics from university-affiliated clinics at the University of Washington (Seattle) and University of California (Los Angeles and San Diego). Patients were randomly assigned to receive either treatment as usual or a combined CBT and pharmacotherapy intervention for panic disorder delivered in primary care by a mental health therapist. Intervention patients had up to six sessions of CBT modified for the primary-care setting in the first 12 weeks, and up to six telephone follow-ups over the next 9 months. The primary outcome variables were total out-patient costs, anxiety-free days (AFDs) and quality adjusted life-years (QALYs). RESULTS: Relative to usual care, intervention patients experienced 60.4 [95% confidence interval (CI) 42.9-77.9] more AFDs over a 12-month period. Total incremental out-patient costs were 492 US dollars higher (95% CI 236-747 US dollars ) in intervention versus usual care patients with a cost per additional AFD of 8.40 US dollars (95% CI 2.80-14.0 US dollars ) and a cost per QALY ranging from 14,158 US dollars (95% CI 6,791-21,496 US dollars ) to 24,776 US dollars (95% CI 11,885-37,618 US dollars ). The cost per QALY estimate is well within the range of other commonly accepted medical interventions such as statin use and treatment of hypertension. CONCLUSIONS: The combined CBT and pharmacotherapy intervention was associated with a robust clinical improvement compared to usual care with a moderate increase in ambulatory costs.

Adult↗

PubMed1993

Movement patterns of adolescents rising from a bed.

BACKGROUND AND PURPOSE: The purposes of this study were to describe the movement patterns (MPs) adolescents use when rising from a supine position on a bed to a standing position and to determine whether these MPs vary with age across adolescence. SUBJECTS: Sixty nondisabled adolescents participated in the study. METHODS: Twenty adolescents from each of three age groups (ie, 11, 14, and 17 years) were videotaped performing 10 trials of rising from a bed. The MPs of each of four body regions were described, and the most common forms of movement observed in each age group were determined. RESULTS: The observed incidence (frequency of occurrence) of MPs in each body region varied with age, and in two of the four regions, the predominant pattern varied across age groups. Eighty-nine different forms of rising were observed, with the greatest variability among 11-year-old subjects. The most frequent forms of rising were seen in only 5% to 15% of the trials for each age group; one of these was common across age groups. CONCLUSION AND DISCUSSION: Therapists should consider how MPs vary with age and avoid unnecessarily using a specific approach when teaching this activity.

Adolescent↗

PubMed1991

A model for database design.

Computerized databases can facilitate several types of occupational therapy research. The value and usefulness of any database, however, is dependent on how well it has been designed. In this paper, a systematic, sequential-process model for the development of a computerized database is introduced. Each component of the model is illustrated by examples of its application to the actual design of a database for a community agency that provides occupational therapy services. The model focuses on issues related to the development of the contents of a database rather than on computer hardware and software. The issues addressed by the model include decisions about the purpose of the database, selection of the variables, and identification of the most appropriate measures with which to operationalize these variables. Content-related development issues have been given little attention in the literature, yet their neglect typically results in important limitations on the usefulness of a database. Therefore, this paper provides a set of guidelines for occupational therapists planning to establish a database for facilitating research.

Databases, Factual↗

PubMed2000

[Patient evaluation of inpatient psychiatric occupational therapy. Determinants of reported patient satisfaction].

OBJECTIVE: The present study, which falls back on data collected within an extensive evaluation of indoor psychiatric ergotherapy, aims at the investigation of the interaction between patients' satisfaction and patients' characteristics, duration of treatment, and patients' assessments of specific single treatment aspects. METHODS: Fifty-eight inpatients assigned to three ergotherapeutic treatment programs were included into study. Assessments included--among others--a German version of the Client Satisfaction Questionnaire as well as a 74-items questionnaire on specific treatment aspects, such as perceived support, perceived practical orientation, and perceived personal problem orientation. RESULTS: As expected, a high level of satisfaction with treatment was reported. Patients' satisfaction is correlated with some variables under study, such as patients' subjective well-being and patients' assessments of psychosocial and professional treatment aspects. CONCLUSIONS: Findings indicate that--for the purpose of high patient satisfaction--ergotherapeutic treatment programs should distinguish themselves by supportive therapists, practical orientation, and personal problem orientation.

Adult↗

PubMed1989

[The effect of the therapist's personality on the course of group psychotherapy].

The work is based on a one-year investigation in the course of which the therapists of the psychotherapeutic department for neuroses were divided into two teams of four which differed significantly in some personality characteristics, in particular dominance, extraversion, directiveness and warmth. The author investigated the influence of differences in these personality variables on the course of eight closed patient groups. Every team was in charge of four consecutive groups. The results of the work suggest that a more warm, more permisive and less directive behaviour of members of the therapeutic team leads during group therapy of neuroses to a significant increase of cohesion, activity in treatment and a feeling of satisfaction and usefulness of the group sessions.

Adult↗

PubMed1993

[Effect of therapy variables on suicide of released psychiatric clinic patients. Results of a controlled study].

We studied therapeutic factors influencing the risk of suicide during outpatient treatment. A total of 64 former psychiatric inpatients who had committed suicide within one year after their discharge were compared with the same number of control patients fulfilling the following matching criteria: sex, age, RDC diagnosis, year of discharge and length of observation period. There were no significant differences between the two groups in psycho-social or clinical pre-discharge variables including previous suicidal behavior, but the suicide subjects became more frequently suicidal during the post-discharge outpatient treatment. The formal conditions of the treatment were comparable in both groups. However, the control patients were treated by therapists with substantially longer professional experience and they also more frequently received psychopharmacological agents including lithium.

Adult↗

PubMed2005

Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time.

OBJECTIVE: The aim of this investigation was to compare the efficacy of computer-assisted cognitive therapy against standard cognitive therapy and a control group without treatment for outpatients with nonpsychotic major depressive disorder. METHOD: Medication-free participants (N=45) with major depressive disorder were randomly assigned to cognitive therapy (N=15), computer-assisted cognitive therapy (N=15), or a wait list (N=15). Both active treatments consisted of nine sessions over 8 weeks. Therapist time was reduced after the first visit for computer-assisted cognitive therapy, with 25-minute sessions rather than 50-minute sessions. Assessments were completed pretreatment, after 4 and 8 weeks of therapy, and 3 and 6 months posttreatment. RESULTS: Computer-assisted cognitive therapy and standard cognitive therapy were superior to the wait list control group for treatment of depression and did not differ from each other on the primary outcome variables. Very large between-group effect sizes were observed. Improvement in depression for both computer-assisted cognitive therapy and standard cognitive therapy was maintained at the 3- and 6-month follow-up evaluations. Computer-assisted cognitive therapy had more robust effects, relative to being wait-listed, than standard cognitive therapy in reducing measures of cognitive distortion and in improving knowledge about cognitive therapy. CONCLUSIONS: A multimedia, computer-assisted form of cognitive therapy with reduced therapist contact was as efficacious as standard cognitive therapy. Computer-assisted therapy could decrease costs and improve access to cognitive therapy for depression.

Adolescent↗

PubMed2006

Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder.

CONTEXT: Dialectical behavior therapy (DBT) is a treatment for suicidal behavior and borderline personality disorder with well-documented efficacy. OBJECTIVE: To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non-behavioral psychotherapy experts. DESIGN: One-year randomized controlled trial, plus 1 year of posttreatment follow-up. SETTING: University outpatient clinic and community practice. PARTICIPANTS: One hundred one clinically referred women with recent suicidal and self-injurious behaviors meeting DSM-IV criteria, matched to condition on age, suicide attempt history, negative prognostic indication, and number of lifetime intentional self-injuries and psychiatric hospitalizations. INTERVENTION: One year of DBT or 1 year of community treatment by experts (developed to maximize internal validity by controlling for therapist sex, availability, expertise, allegiance, training and experience, consultation availability, and institutional prestige). MAIN OUTCOME MEASURES: Trimester assessments of suicidal behaviors, emergency services use, and general psychological functioning. Measures were selected based on previous outcome studies of DBT. Outcome variables were evaluated by blinded assessors. RESULTS: Dialectical behavior therapy was associated with better outcomes in the intent-to-treat analysis than community treatment by experts in most target areas during the 2-year treatment and follow-up period. Subjects receiving DBT were half as likely to make a suicide attempt (hazard ratio, 2.66; P = .005), required less hospitalization for suicide ideation (F(1,92) = 7.3; P = .004), and had lower medical risk (F(1,50) = 3.2; P = .04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; P < .001) and had fewer psychiatric hospitalizations (F(1,92) = 6.0; P = .007) and psychiatric emergency department visits (F(1,92) = 2.9; P = .04). CONCLUSIONS: Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychotherapy. Dialectical behavior therapy appears to be uniquely effective in reducing suicide attempts.

Adaptation, Psychological↗

PubMed1983

Bibliotherapy within a correctional setting.

Evaluated the psychotherapeutic adjunct of bibliotherapy in a maximum security correctional setting with 54 volunteers from a general and segregation population. Results indicated no differences between the treatment methods, but significant increases in self-concept and internal locus of control with an interaction on the dependent measure of Chance locus of control. There were no significant effects on the dependent variables as a result of the level of participation of the volunteers. It was concluded that bibliotherapy may have a facilitative effect on self-concept and internal locus of control, but cannot be differentiated from the effects of therapist intervention.

Adult↗

PubMed1992

Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial.

Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post-chemotherapy nausea and emesis. In this study, 67 bone marrow transplant patients with hematological malignancies were randomly assigned to one of four groups prior to beginning transplantation conditioning: (1) hypnosis training (HYP); (2) cognitive behavioral coping skills training (CB); (3) therapist contact control (TC); or (4) treatment as usual (TAU; no treatment control). Patients completed measures of physical functioning (Sickness Impact Profile; SIP) and psychological functioning (Brief Symptom Inventory; BSI), which were used as covariates in the analyses. Biodemographic variables included gender, age and a risk variable based on diagnosis and number of remissions or relapses. Patients in the HYP, CB and TC groups met with a clinical psychologist for two pre-transplant training sessions and ten in-hospital "booster" sessions during the course of transplantation. Forty-five patients completed the study and provided all covariate data, and 80% of the time series outcome data. Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation. Risk, SIP, and BSI pre-transplant were found to be effective predictors of inpatient physical symptoms. Nausea, emesis and opioid use did not differ significantly between the treatment groups. The cognitive behavioral intervention, as applied in this study, was not effective in reducing the symptoms measured.

Adult↗

PubMed2003

Are all cognitive therapies alike? A comparison of cognitive and noncognitive therapy process and implications for the application of empirically supported treatments.

The definition of an empirically supported treatment (EST) arguably embodies 2 untested assumptions: (a) that different manualized renditions of the same therapy are functionally equivalent and (b) that therapies can be reliably applied independently of therapist, setting, and format. These assumptions were tested as applied to cognitive therapy (CT), using process data from a large multisite study (N = 235) that included 3 cognitive and 6 alternative therapies. Although the non-CTs were more variable than the CTs on 2 of 4 dimensions studied (directiveness and emotional arousal), there was considerable variation among the 3 CTs, even when implemented in the current context of rigorous training, manualization, and adherence checks. Results are discussed as related to the assumptions underlying EST criteria.

Adult↗

PubMed2004

Spiritual transcendence as a predictor of psychosocial outcome from an outpatient substance abuse program.

Does the Spiritual Transcendence Scale (STS; R. L. Piedmont, 1999) predict psychosocial outcomes from an outpatient substance abuse program? Self-report data on symptoms, personality, and coping resources were obtained for 73 consecutive admissions (57 men and 16 women; ages 19-66 years) at intake and again from the 56 (47 men and 9 women) who completed treatment. Controlling for relevant demographic variables, pretreatment STS scores were significantly related to self-ratings at posttreatment. The STS predicted treatment outcomes over and above the contribution of the five-factor model of personality. Significant partial correlations between pretreatment STS scores and therapist ratings of treatment outcome were also obtained. Spiritual Transcendence, especially the facets of Universality and Connectedness, appears to play a significant role in substance abuse recovery.

Adaptation, Psychological↗

PubMed1999

Evaluation of antecedent stimulus parameters for the treatment of escape-maintained aberrant behavior.

We evaluated a methodology for identifying the range of stimulus features of antecedent stimuli associated with aberrant behavior in demand contexts in natural settings. For each participant, an experimental analysis of antecedents (Phase 1) was conducted to confirm the hypothesis that task instructions occasioned increases in aberrant behavior. During Phase 2, specific stimulus features associated with the presentation of task instructions were assessed by evaluating the child's behavior across two distinct settings, therapists, and types of tasks in a sequential fashion. Aberrant behavior occurred immediately across settings and therapists, presumably because the presence of a discriminative stimulus for escape-maintained behavior (the delivery of a task instruction) occasioned aberrant behavior. However, aberrant behavior decreased initially across tasks, suggesting that familiarity with the task might be a variable. During Phase 3, an experimental (functional) analysis of consequences was conducted with 2 participants to verify that aberrant behavior was maintained by negative reinforcement. During Phase 4, a treatment package that interspersed play with task instructions was conducted to disrupt the ongoing occurrence of aberrant behavior. Immediate and durable treatment effects occurred for 2 of the 3 participants.

Aggression↗

PubMedDate not supplied

[Collection of relevant data in psychoanalytically oriented inpatient psychotherapy--The Tiefenbrunn Documentation System].

We inform about development of the Tiefenbrunn documentation system for inpatient psychotherapy. Aims and scaffolding of the system and some difficulties to make the system run are outlined. The newly developed instruments are sketched. Patients received a questionnaire concerning their social situation and their family of origin. At the same time therapists indicate symptoms, diagnosis, work ability, prognosis, pretreatments and chronification (diagnosis sheet I) and results of treatment (diagnosis sheet II) when patients leave. During treatment complementary therapy (as e.g. massage etc.) is documented. From 1988 on we have 230 variables on every patient in our computers. Actual and further use of the system is described.

Data Collection↗

PubMedDate not supplied

Perceived risk as a constraint on occupational performance during hot and cold water pouring.

OBJECTIVE: Occupational therapists are interested in quality of movement under different environmental conditions. It has been shown that during reaching tasks, the physical aspects of the objects to be grasped can influence the quality of movement. This study investigated whether perceived risk (water temperature) affected the quality of movement during a pouring task. METHOD: In a counterbalanced, repeated measures design, 56 participants (M = 27.1 years, SD = 7.4 years) poured hot, then cold water to prepare hot and cold beverages. Dependent variables included movement time, displacement, peak velocity, percentage of movement time to peak velocity, and movement units. Data were analyzed with paired t tests. RESULTS: Participant performance in displacement and movement time was significantly different when considering the entire pouring task for both the hot and the cold conditions (ps < .05). In addition, significant differences were found in the discrete movement "sub-portions" of the pouring task (ps < .05). CONCLUSION: Perceived risk is an element of meaning that the occupational therapist can consider in providing the person with just enough challenge to facilitate successful performance. By varying the amount of perceived risk in the occupational form, the therapist can help the person experience and develop the range of movement strategies required by everyday occupations. Future research is needed to corroborate these findings in simple and more complex occupations as well as to examine perceived risk in special populations.

Activities of Daily Living↗