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Results for “Therapist variable”

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PubMed2006

The development of the therapeutic working alliance, patients' awareness and their compliance during the process of brain injury rehabilitation.

PURPOSE: To examine the development and interaction of the therapeutic alliance, patients' compliance and awareness during the process of brain injury rehabilitation and the role of demographic and injury related variables in this process. Subjects were 86 patients who underwent a holistic neuropsychological outpatient rehabilitation programme. Patients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10). MEASURES: The therapeutic alliance between clients and their primary therapists, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists. RESULTS: The development of the process measures over time is described in the article. Clients' and therapists' perspectives on their alliance tended to converge over time. Clients' experience of their emotional bond with their therapist added as much to the prediction of clients' awareness as the localization of their brain injury. Clients' awareness was related to their compliance and mediated the impact of the therapeutic alliance on their compliance. DISCUSSION: A good working alliance is the basis of successful rehabilitative work. The article discusses therapeutic implications of the results.

Adult↗

PubMed1999

Parent bonding in clinically depressed deaf and hard-of-hearing adults.

This study assessed the relationships between parent communication variables and the parent bonding factors of care and overprotection using a sample of 38 deaf and hard-of-hearing individuals connected with mental health services who had DSM-III-R or DSM-IV diagnoses of depression-related disorders. The 22 therapists working with these individuals also contributed to data collection. Results based on revised depression (BDI-R) and parent bonding (PBI-R) questionnaires, together with background data from both clients and therapists, indicate that higher ratings of depression are associated with less perceived care by mother and greater perceived overprotection by both mother and father. Paternal care and overprotection were negatively correlated, as were maternal care and overprotection. In comparison to hard-of-hearing counterparts, deaf participants were less depressed and had more positive ratings of communication with their parents. The BDI-R scores positively and significantly correlated with coded severity of diagnosis. Due to the small sample size, findings are suggestive. Further study is warranted.

Journal Article↗

PubMed1980

The assessment of the ego states.

The hypothesis that ego states, as defined in Transactional Analysis, are distinct and identifiable phenomena was tested. Ten TA therapists were asked to assess which of the three ego states, Parent, Adult or Child, were present in forty statements extracted from the tape of a family therapy session. The level of agreement reached was statistically highly significant. There was a certain amount of interrater variability, and potential sources of disagreement are discussed.

Ego↗

PubMed2005

Identifying highly effective psychotherapists in a managed care environment.

OBJECTIVE: To investigate the variability and stability of psychotherapists' effectiveness and the implications of this differential effectiveness for quality improvement in a managed care environment. STUDY DESIGN: Subset archival outcome data for patients receiving behavioral health treatment were divided into 2 time periods to cross-validate the treating therapists' effectiveness. After categorizing the therapists as "highly effective" and "others" during the baseline period, the stability of their individual effectiveness was cross-validated in the remaining time period. METHODS: Outcomes for 10 812 patients (76.0% adults, 24.0% children and adolescents) treated by 281 therapists were included. Patients initiated treatment between January 1999 and June 2004. Mean residual change scores obtained by multiple regression were used to adjust for differences in case mix among therapists. Raw change scores as well as mean residualized change scores were compared between the 71 psychotherapists identified as highly effective (25%) and those identified as other (remaining 75%). RESULTS: During the cross-validation period, mean differences in residualized change score between highly effective therapists and others were statistically significant (difference = 2.8; P < .001), which corresponded to an average of 53.3% more change in raw change scores with the highly effective therapists. Results could not be explained by case mix differences in diagnosis, age, sex, intake scores, prior outpatient treatment history, length of treatment, or therapist training/experience. CONCLUSION: Behavioral health outcomes for a large system of care could be significantly improved by measuring clinical outcomes and referring patients to therapists with superior outcomes.

Adolescent↗

PubMed1981

Predicting client improvement from and satisfaction with community mental health center services.

The present study assesses client improvement from and satisfaction with CMHC services, and attempts to examine the presence of positive bias from responders. Results based on questionnaires mailed to 1,000 former clients indicated both high consumer satisfaction and reported improvement attributable to treatment. Responders and nonresponders did not differ on demographic or treatment variables related to post-treatment improvement. A multiple regression analysis was computed and yielded an estimated index of improvement for responders. No differences obtained on this measure between responders and nonresponders, thereby not supporting the presence of a positive bias in this sample. confidence in therapist, satisfaction with the therapeutic relationship, and number of individual sessions were the most positive improvement correlates, with lack of contact and increasing age most negatively related to improvement. Discussion focuses on the implications for generalization of results based on responders' data.

Age Factors↗

PubMed1989

Reflections on the philosophy of caring in mental health.

The trend towards definition of the role of the nurse as 'therapist' in mental health has resulted in clarification of what some nurses might do, with some patients, to resolve fairly specific problems of living. Not all psychiatric nurses are, however, satisfied that the developments which arise from this role definition will necessarily benefit the service overall. Indeed, the concept of the nurse-as-therapist has led, indirectly, to an expression of anxiety over the balance of 'care' versus 'therapy'. This is manifested at a time when nurses outwith the mental health setting are describing the need for a stronger emphasis upon therapeutic factors in nursing care, especially involving psychosocial variables.

Health Promotion↗

PubMed2005

Monitoring respiration during sleep.

Monitoring of respiration during sleep allows the assessment of physiologic variables that are required to characterize SRBD events. The patency of the upper airway, the pattern of breathing, oxygenation, and ventilation usually can be inferred from simultaneous measurements of airflow, respiratory effort, thoracic volume, and blood gases. As new techniques of respiratory monitoring emerge, the respiratory therapist and sleep technologist must be familiar with the advantages and shortcomings of each modality.

Humans↗

PubMed1997

Guilt about first intercourse: an antecedent of sexual dissatisfaction among college women.

First sexual intercourse is often viewed as a rite of passage to adulthood. While one's initial coital experience may lead to affirmation of self-identity, it is disappointing for many, resulting in feelings of guilt and shame. If guilt feelings do emerge, the likelihood of future sexual dissatisfaction is greatly increased. In particular, women with high levels of sexual guilt tend to perceive less sexual arousal, resulting in less enjoyment from their sexual encounters. The purposes of this investigation were to identify those factors correlated with feeling guilty about first sexual intercourse and to examine the influence of guilt about first intercourse on current sexual satisfaction. An anonymous questionnaire was administered to never-married college women, with the subsample for this investigation consisting of 570 women. Significant variables correlated with guilt at first sexual intercourse include uncommunicative mother and father figures, overstrict father figure, uncomfortableness with sexuality, physiological and psychological sexual dissatisfaction with first intercourse, guilt feelings about current intercourse, and psychological sexual dissatisfaction. These findings have substantial implications for sex researchers, sex therapists, family therapists, and sexuality educators who wish to promote healthy sexuality, through both attitudes and behavior.

Adolescent↗

PubMed1996

Physical therapy and health outcomes in patients with knee impairments.

BACKGROUND AND PURPOSE: Physical therapy is usually initiated with the belief that treatment will improve patients health, particularly the ability to perform daily activities and function in expected roles. The purpose of this report to describe health outcomes and related factors in patients with knee impairments receiving physical therapy. SUBJECTS: Data were obtained from a sample of 426 patients with knee impairments treated in 63 physical therapy practices across the United States. METHODS: Data were obtained during 1993 and 1994 from the Focus on Therapeutic Outcomes database. Health outcomes over an episode of physical therapy care were described using the SF-36 and the Lysholm Knee Rating Scale. Multivariate analyses were used to determine which patient and treatment characteristics were associated with these outcomes. RESULTS: The patients health improved, as measured by all but one of the SF-36 outcomes scales, with effect sizes ranging from 0.18 to 0.93 in scales in which change occurred. The patient and treatment characteristics that were studied accounted for 23% to 37% of the variability in health outcomes. CONCLUSION AND DISCUSSION: Patients who were older, had no surgery, were out of work because of their health, or were depressed were more at risk for poor health outcomes than were patients without these characteristics. These findings suggest a need for physical therapists to look for new approaches to identifying and treating patients with these characteristics.

Adult↗

PubMed2000

Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study.

OBJECTIVE: The pain experienced by burn patients during physical therapy range of motion exercises can be extreme and can discourage patients from complying with their physical therapy. We explored the novel use of immersive virtual reality (VR) to distract patients from pain during physical therapy. SETTING: This study was conducted at the burn care unit of a regional trauma center. PATIENTS: Twelve patients aged 19 to 47 years (average of 21% total body surface area burned) performed range of motion exercises of their injured extremity under an occupational therapist's direction. INTERVENTION: Each patient spent 3 minutes of physical therapy with no distraction and 3 minutes of physical therapy in VR (condition order randomized and counter-balanced). OUTCOME MEASURES: Five visual analogue scale pain scores for each treatment condition served as the dependent variables. RESULTS: All patients reported less pain when distracted with VR, and the magnitude of pain reduction by VR was statistically significant (e.g., time spent thinking about pain during physical therapy dropped from 60 to 14 mm on a 100-mm scale). The results of this study may be examined in more detail at www.hitL.washington.edu/projects/burn/. CONCLUSIONS: Results provided preliminary evidence that VR can function as a strong nonpharmacologic pain reduction technique for adult burn patients during physical therapy and potentially for other painful procedures or pain populations.

Adolescent↗

PubMed2005

Contribution of psychosocial and mechanical variables to physical performance measures in knee osteoarthritis.

BACKGROUND AND PURPOSE: This cross-sectional study evaluated the relative contributions of psychosocial and mechanical variables to physical performance measures in people with knee osteoarthritis (OA). SUBJECTS: Fifty-four subjects (age, in years: mean=68.3, SD=8.7, range=50-87) with radiographically confirmed knee OA were included in this study. METHODS: Physical performance measures included the Six-Minute Walk Test (SMW), the Timed "Up & Go" Test (TUG), and a stair-climbing task (STR). Responses to psychosocial questionnaires that reflect depression, anxiety, and self-efficacy (a person's confidence in his or her ability to complete a task) were collected. Mechanical variables measured included body mass index and knee strength (force-generating capacity of muscle). Stepwise linear regressions were performed with the SMW, TUG, and STR as separate dependent variables. RESULTS: Functional self-efficacy explained the greatest amount of variance in all performance measures, contributing 45% or more. Knee strength and body weight also explained some variance in performance measures. Anxiety and depression did not explain any variance in performance. DISCUSSION AND CONCLUSION: Physical therapists evaluating the significance of the SMW, TUG, and STR scores in subjects with knee OA should note that a large part of each score reflects self-efficacy, or confidence, for physical tasks, with some contributions from knee strength and body weight.

Aged↗

PubMed1995

Development of a customizable universal digital hearing aid.

This paper presents the development of a digital binaural hearing aid using Texas Instruments' floating point TMS320C3X digital signal-processing chip. The device is referred to as the Customized Universal Digital Listening System (CUDLS). CUDLS uses a wide bandwidth (up to 16 kHz) and incorporates speech enhancement (noise reduction) as an integral part of the device. It is capable of sampling up to two input speech channels at a variable sampling rate. We are currently using a sampling rate of 20 kHz for each channel. We have developed our own customized hardware and software to implement CUDLS in real time with zero processing delay. The system has been designed to make it easy for the therapist to modify its features.

Correction of Hearing Impairment↗

PubMedDate not supplied

The basis for clinicians' caries risk grouping in children.

Despite the growing emphasis on targeting care to high-risk groups, little is known about the factors used by clinicians to designate risk. This study investigates the degree to which factors measured in a typical dental health survey are used by clinicians in assigning children to dental disease risk groups. A random sample of 9690 children aged 5-15 years was selected from the South Australian School Dental Service. Dentists or dental therapists judged each child as low-, medium-, or high-risk for dental disease. Clinicians recorded caries experience (DMFS/dmfs), and children's parents completed a questionnaire on dental behaviors and socioeconomic status (SES). Two binary logistic models were fitted using the risk grouping as the outcome variable, one comparing low- with moderate-risk and the other comparing moderate- with high-risk. Sixty percent of children were judged as moderate-risk, 27% as low-risk, and only 13% as high-risk. In the logistic models, proximal DMFS/dmfs were stronger predictors of assignment to the higher-risk groups than were factors indicating past occlusal caries, while factors describing caries on buccal or lingual surfaces appeared unimportant. Untreated lesions on permanent and primary teeth were among the strongest predictors of assignment to the higher-risk groups. Other significant factors (P < 0.05) were: exposure to professionally applied fluoride and sealants, country of birth, frequency of toothbrushing, and exposure to fluoridated water. No SES factors reached significance. The models explained nearly one-half the variation in the risk predictions. Clinical markers of past caries experience explained the greatest variation in the judgments, showing that clinicians base their risk predictions largely on children's past disease. The three types of surfaces contribute unevenly to the judgments and unrestored caries was the largest contributor to the decision.

Adolescent↗

PubMed1997

Computerized ventilator data selection: artifact rejection and data reduction.

OBJECTIVE: To determine acceptable strategies for automated data acquisition and artifact rejection from computerized ventilators using the Medical Information Bus. DESIGN: Medical practitioners were surveyed to establish 'clinically important' ventilator events. A prospective study involving frequent data collection from ventilators was also conducted. SUBJECTS: Data from 10 adult patients were collected every 10 seconds from a Puritan Bennett 7200A ventilator for a total of 617.1 hours. INTERVENTIONS: Twelve different computerized data selection and artifact algorithms were tested and evaluated. MEASUREMENTS AND MAIN RESULTS: Data derived from 12 data selection algorithms were compared with each other and with data manually charted by respiratory therapists into a computerized charting system. Ventilator setting data collected by the algorithms, such as FIO2, reduced the amount of data collected to about 25% compared to manually charted data. The amount of data collected for measured parameters, such as tidal volume, from the ventilator had large variability and many artifacts. Automated data capture and selection generally increased the amount of data collected compared to manual charting, for example for the 3 minute median the increase was a modest 1.2 times. CONCLUSION: Computerized methods for collecting ventilator setting data were relatively straightforward and more-efficient than manual methods. However, the method for automated selection and presentation of observed measured parameters is much more difficult. Based on the findings and analysis presented here, the authors recommend recording ventilator setting data after they have existed for three minutes and measured parameters using a three minute median data selection strategy. Such an algorithm rejected most artifacts, required minimal computational time, had minimal time-delay, and provided clinically acceptable data acquisition. The results presented here are but a starting point in developing automated ventilator data selection strategies.

Adult↗

PubMed2002

Identification of environmental determinants of behavior disorders through functional analysis of precursor behaviors.

Experimental analysis procedures have been shown to be effective means for identifying the environmental determinants of problem behaviors. A potential limitation of these procedures is that it is necessary to produce and document patterns in the occurrence of the problem behavior during the assessment. In the case of severe behavior disorders, this may place the participant or therapist at such risk as to preclude the analysis. The current study arranged experimental analysis contingencies for precursor behaviors that had been observed to reliably precede the occurrence of problem behaviors targeted for reduction. For each of the 4 participants, it was possible to infer the maintaining variables for problem behaviors based on the outcomes of precursor analysis. These results suggest that the current procedures represent a promising alternative method for reducing risk during functional analysis of problem behaviors.

Adult↗

PubMed1992

Locus of control in nondisabled versus congenitally physically disabled adolescents.

Locus of control in 13 nondisabled and 8 congenitally physically disabled adolescents was examined with the use of the Nowicki-Strickland Locus of Control Scale for Children (Nowicki & Strickland, 1973a). All subjects with disabilities had IQs within normal limits, used wheelchairs, and could communicate verbally. The two groups were matched in IQ, age, sex, race, and socioeconomic status. It was hypothesized that the locus of control scores for the disabled group would evidence significantly more externality than the scores for the nondisabled group. A Mann Whitney U test was done to analyze the data gathered, and the results were found to be statistically nonsignificant (U = 58.50, p = .635). Adjunct analyses were conducted to explore the percentage of internal and external answers between the two groups. Race was the only variable correlating significantly with locus of control scores (r = .54, p = .05). The study's results suggest that disability is not a significant predictor of externality in adolescents. Persons with an internal locus of control are more assertive and better able to cope with their environment; occupational therapists can offer many therapeutic strategies to persons with an external locus of control for improved function and quality of life.

Adolescent↗

PubMed1988

A retrospective study of dropout rates from a community mental health centre and associated factors.

To ascertain if decentralization of mental health services, making them more accessible to the public, would be reflected in a decrease in the dropout rate, a comparison was made between dropout rates just prior to and immediately following decentralization. This involved examining 1350 closed files representing cases seen during a three-year period after decentralization and comparing the findings with those of a previous study of files of 588 cases seen during a year before decentralization. The dropout rate decreased from 46% to 43%; while statistically significant, this change was too small to be of any practical importance. However, analysis of demographic and clinical variables in the post-decentralization sample proved most interesting. On the whole, it confirmed the findings from previous investigations, i.e. dropouts tended to be younger, less well-educated, of low socioeconomic status (SES), and were most commonly diagnosed as having a personality disorder. Although some therapists had a comparatively large proportion of dropouts, this discrepancy may reflect the distribution of difficult cases rather than the effectiveness of the therapists.

Alberta↗

PubMed1998

Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy.

Patient and therapist expectancies regarding the "typical session" were measured during a controlled trial of short-term, time-limited individual psychotherapy. Relationships between expectancy ratings and measures of the therapeutic alliance and treatment outcome were examined. Significant relationships were tested in the presence of a competing predictor variable, either pre-therapy disturbance (depression) or the patient's quality of object relations (QOR). Expectancies were associated strongly with the alliance but only moderately with treatment outcome. In most instances, expectancy and QOR combined in an additive fashion to account for variation in alliance or outcome. The patient's capacity for mature relationships and expectancies for therapy appear to be important determinants of treatment process and outcome. The clinical value of establishing accurate, moderate expectancies prior to therapy is considered.

Adult↗