SEARCH · PubMed Health

Results for “Therapist variable”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources

PubMed1996

Predicting the effect of cognitive therapy for depression: a study of unique and common factors.

The ability of several process variables to predict therapy outcome was tested with 30 depressed clients who received cognitive therapy with or without medication. Two types of process variables were studied: 1 variable that is unique to cognitive therapy and 2 variables that this approach is assumed to share with other forms of treatment. The client's improvement was found to be predicted by the 2 common factors measured: the therapeutic alliance and the client's emotional involvement (experiencing). The results also indicated, however, that a unique aspect of cognitive therapy (i.e., therapist's focus on the impact of distorted cognitions on depressive symptoms) correlated negatively with outcome at the end of treatment. Descriptive analyses that were conducted to understand this negative correlation suggest that therapists sometimes increased their adherence to cognitive rationales and techniques to correct problems in the therapeutic alliance. Such increased focus, however, seems to worsen alliance strains, thereby interfering with therapeutic change.

Adult↗

PubMed1992

Interobserver variability in assessing pediatric postextubation stridor.

The reliability of parameters used to assess pediatric postextubation upper respiratory distress is unknown. We prospectively studied the interobserver reliability of six parameters commonly used to assess respiratory distress in children. Eligible patients were less than 15 years old and hospitalized for traumatic injuries at Harborview Medical Center between March and September 1989. At extubation, patients were examined independently by a physician, a nurse, and a respiratory therapist, each of whom evaluated respiratory rate (RR), stridor, air movement, flaring/retractions (F/R), level of consciousness (LOC), and oxygen saturation (O2 sat). Reliability was measured by percentage agreement and weighted kappa (Kw). The 25 children (27 extubations) had a median age of 7 years, and eight of the 27 required treatment for upper airway obstruction. Percentage agreement ranged from 82% (for air movement) to 96% (for O2 sat). Weighted kappas were excellent for RR and F/R (Kw greater than .6); moderate for LOC, stridor, and O2 sat (0.4 less than Kw less than .06); and poor for air movement (Kw less than .4). Further improvements in interobserver agreement are required to provide more consistent upper airway management in critically ill children.

Academic Medical Centers↗

PubMed2006

Gender aspects in the planning of psychotherapy for borderline personality disorder.

OBJECTIVE: The aim of the study was to generate hypotheses for examining gender-specific variables with predictive value for the planning of successful psychotherapy in patients with borderline personality disorder. METHODS: Anxiety, aggression, interpersonal problems, locus of control and self-concept were investigated in twenty psychiatric inpatients before and after psychoanalytically oriented psychotherapy lasting for six weeks. RESULTS: Women in gender-matched patient-therapist dyads gained insight into relationships between anxiety, aggression and interpersonal problems to the extent that they experienced them as ego-syntonic problems and as a concern of their own self-concept, and were therefore able to engage in further outpatient psychotherapy. Men more often remained in regressive resistance and in narcissistically boosted conviction of self-efficacy, with simultaneous persistence of aggression and non-engagement in further psychotherapy. CONCLUSION: The results underline the importance of considering gender role stereotypes and suggest the significance of gender-sensitive attitudes in dealing with aggression and exploring attachment styles and reflective functioning.

Adult↗

PubMed2005

Subjective and objective descriptors of clinical lumbar spine instability: a Delphi study.

Accurate ability to diagnose lumbar spine clinical instability is controversial for numerous reasons, including inaccuracy and limitations in capabilities of radiographic findings, poor reliability and validity of clinical special tests, and poor correlation between spinal motion and severity of symptoms. It has been suggested that common subjective and objective identifiers are specific to lumbar spine clinical instability. The purpose of this study was to determine if consensual, specific identifiers for subjective and objective lumbar spine clinical instability exist as determined by a Delphi survey instrument. One hundred and sixty eight physical therapists identified as Orthopaedic Clinical Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists participated in three Delphi rounds designed to select specific identifiers for lumbar spine clinical instability. Round I consisted of open-ended questions designed to provide any relevant issues. Round II allowed the participants to rank the organized findings of Round I. Round III provided an opportunity to rescore the ranked variables after viewing other participant's results. The results suggest that those identifiers selected by the Delphi experts are synonymous with those represented in related spine instability literature and may be beneficial for use during clinical differential diagnosis.

Adult↗

PubMed2005

Intersession coping skill practice mediates the relationship between readiness for self-management treatment and goal accomplishment.

Underlying pain self-management treatments is the expectation that patients must adhere to coping skill practice recommendations to obtain treatment benefits. Recently, a model of motivation for pain treatment has proposed that patients' readiness to adopt a self-management approach serves as a predictor of active participation in treatment, and ultimately, of improved outcomes. This study compared the ability of pain readiness to change, as measured by the Pain Stages of Change Questionnaire (PSOCQ), and self-efficacy (SE) ratings, to predict adherence and goal accomplishment in cognitive-behavioral therapy (CBT) for chronic pain. Further analyses tested the hypothesis that adherence mediated the relationship between readiness to change and goal accomplishment. Data were collected as part of a larger randomized controlled trial of primary care based CBT. Participants were 78 patients recruited from a VA primary care clinic. At pre-treatment Ss completed the PSOCQ to assess readiness to adopt a self-management approach to chronic pain and an SE measure to quantify certainty of achieving up to five behavioral treatment goals. Criteria were means of aggregated intersession adherence ratings and mean post-treatment goal accomplishment ratings. Pre-treatment PSOCQ variables significantly predicted intersession adherence and goal accomplishment. SE did not significantly predict either criterion. The statistical relationship between pre-treatment PSOCQ and behavioral goal accomplishment was significantly attenuated when intersession adherence was taken into account. These data provide support for a motivational model of pain treatment that asserts adherence to therapist recommendations for coping skill practice mediates readiness to change and self-reported goal attainments.

Adaptation, Psychological↗

PubMed1996

Motor fitness in children and adolescents with traumatic brain injury.

OBJECTIVE: This study examined the test-retest reliability of selected motor fitness test items among children with severe traumatic brain injury. DESIGN: A cohort study consisting of two testing session, one week apart. SETTING: All subjects were recruited from among the former clients of a pediatric rehabilitation center. SUBJECTS: A convenience sample of 19 subjects, 13 boys and 6 girls aged 8 to 17 years, volunteered to participate. All participants had a diagnosis of a severe traumatic brain injury (X +/- SD = 5.88 +/- 1.71 on the Glascow Coma Scale), had completed a program of physical rehabilitation, and were evaluated at 4.16 +/- 2.61 years after their injury. MAIN OUTCOME MEASURES: Performance on twelve motor fitness test items (including flexibility, agility, muscular strength, cardiorespiratory endurance, power, muscular endurance, and coordination) was measured at each of two structured evaluation sessions. RESULTS: No differences (t tests, p < or = .05) were found between the performances on the two testing sessions for any of the variables. The test-retest reliability was established via the intraclass correlation (ICC) and ranged from .84 to .98, indicating "almost perfect" agreement. CONCLUSION: The data indicate that these motor fitness testing protocols are reliable and applicable to traumatic brain injured children in a clinical setting and can thus be used by therapists to plan future interventions to improve the fitness of this clientele.

Adolescent↗

PubMed2001

Shamanism as a healing paradigm for complementary therapy.

Any healing process--whether recovery from infection, physical trauma, or psychological distress--must entail the stimulation and direction of the body's own restorative functions. In former times these functions were called the vis mediatrix naturae. Arguably best articulated within traditional Chinese medicine (e.g. Reid 1993), many complementary therapies have identified this principle. The immune system is implicated in the operation of these healing processes, and immune system functions are modulated by both internal and external variables. External variables include the nature of the infection or trauma. Internal variables include the meaning of the illness to the patient or the patient's imagery surrounding the illness. It follows that any modulation of internal variables that increases immune function will therefore be highly beneficial in the healing process. Sometimes such modulation happens spontaneously, when it may be referred to as the placebo effect, or a good bedside manner, or spontaneous remission. Sometimes such modulation may be brought about intentionally either by the patient or by a therapist or healer. One body of technique for such modulation is shamanism, which pays particular attention to bridging the internal world of the patient to the external world where the problem originates. Shamanic practice is specifically focused on this healing task, and has its own toolkit of techniques for the modification of consciousness, the manipulation of imagery and meaning, and the generation of a healing milieu and therapeutic images from its mythic content. Early concerns about the mental health of shamanic practitioners are now thoroughly resolved (e.g. Stephen & Suryani 2000). Indeed, the relevance of shamanism to positive mental health is currently being explored (e.g. Money 1994, Singh 1999). Its relevance to social work (Voss et al. 1999) and to the near death experience (Green 1998) are also subjects of academic inquiry. The shamanic corpus exemplifies a healing paradigm that may also be used to understand the essential elements of healing, which underpin some established complementary therapies and some other healing modalities such as spiritual healing,'psychic' healing, spontaneous remission, and the placebo effect. The comparatively recent psychoneuroimmunological perspective appears to be congruent with and also to validate ancient shamanic healing technique. Both may share essential principles with complementary therapies and illuminate their essential healing processes.

Female↗

PubMed1996

Physical therapy and health outcomes in patients with spinal impairments.

BACKGROUND AND PURPOSE: Little is known concerning the effects of physical therapy on health outcomes in patients with spinal impairments. This research examined the pattern of health outcomes in patients with spinal impairments and the relationship of outcomes to the physical therapy provided. SUBJECTS: Data were obtained from 1,097 patients with spinal impairments who completed an episode of care in any of 68 physical therapy practices across the United States. METHODS: Data were derived from the Focus on Therapeutic Outcomes database during 1993 and 1994. Multivariate analyses were used to determine which of the treatment variables, controlled for baseline health status and relevant patient characteristics, were related to outcomes. RESULTS: Improvement occurred in nearly all health scales. Inclusion of endurance exercise was most consistently associated with better outcomes. Inclusion of heat or cold modalities was associated with poorer outcomes. CONCLUSION AND DISCUSSION: This study suggests that physical therapists take a broader view of patient-related goals and documentation of outcomes. It also provides evidence that the type of intervention is related to outcomes.

Activities of Daily Living↗

PubMed1986

Relation of family factor to treatment outcome for bulimic patients.

The psychotherapy of 25 normal weight bulimic adolescent and late adolescent women (age 15-32 years, mean = 21 years), was reviewed to evaluate developmental and diagnostic precursors and the outcome of psychoanalytically oriented long-term therapy (mean = 33 sessions). Psychotherapy outcome was scored in these categories: bingeing and purging; food obsession; school/work satisfaction; equilibration with family of origin, and achievement of heterosexual closeness. On factor analysis, all factors loaded highly and a global outcome score was derived which was used as the dependent variable in a step-wise regression analysis with 18 family factors as independent variables. To identify family patterns that predicted degree of improvement, a multiple regression analysis was performed. Results indicated that family variables associated with maternal warmth explained an appreciable proportion of the variance in outcome. Such a finding is consistent with the formulation that patients with benign archaic maternal representations were better able than their counterparts with less benign maternal images to form a positive transference and better working alliance with the (female) therapist.

Adolescent↗

PubMed1996

Mental health clinicians' attitudes about reporting threats against the president.

OBJECTIVE: A recent review by the United States Secret Service of cases involving threats against the President indicated that about 50 percent of subjects had received mental health care. However, only 12 percent of referrals for investigation came from mental health professionals. This study explored reasons for this discrepancy by examining mental health clinicians' attitudes about reporting threats against the President to the Secret Service. METHODS: A questionnaire developed using findings from a series of focus groups was mailed to a stratified sample of 1,200 psychiatrists, psychologists, and social workers in four states. The instrument included questions about their experience with threats against the President, factors that influence reporting of threats, and knowledge about the Secret Service and its functions. RESULTS: A total of 592 questionnaires were returned, for a response rate of 49.3 percent. Therapists know very little about the Secret Service and are unclear about how to appropriately respond to threats against the President by their clients. The majority of respondents (89.9 percent) indicated they would report a threat against the President only if they thought the threat was "real," contingent on situational and patient variables and elements of the threat itself. Most of the respondents (62.4 percent) indicated that regardless of what information they considered clinically relevant to the investigation. CONCLUSIONS: Given the importance of clinical information for assessing risk to the President, the Secret Service should consider increased educational efforts to inform the mental health community about the functions and mission of the Secret Service and to clarify professional obligations to report threats against the President.

Adult↗

PubMedDate not supplied

Post-breast cancer lymphedema: understanding women's knowledge of their condition.

PURPOSE/OBJECTIVES: To investigate chronic condition representations and treatment choices among women with post-breast cancer lymphedema (LE) to understand their receipt and use of accurate medical information. DESIGN: Qualitative, template analysis. SETTING: Midsized midwestern city and surrounding rural areas. SAMPLE: 18 Caucasian women aged 37-87 years (mean = 58.8 years) with LE. METHODS: Telephone and face-to-face interviews, lasting 45-60 minutes, were conducted by research students and graduate nursing students. Interviews were audiotaped, professionally transcribed, and verified for transcription accuracy. Self-regulation theory as a template was applied to (a) understand participants' use of health information to cope with LE and (b) evaluate the accuracy of participants' health information that may have influenced participants' abilities to make appropriate prevention or treatment choices. MAIN RESEARCH VARIABLES: Participants' illness representations and coping strategies. FINDINGS: Participants were aware of the fundamental cause of their LE--breast cancer treatment. They also were conscious of other causes of symptom onset. These causes are supported by existing empirical evidence. Participants' treatment choices were consistent (e.g., use of compression treatment, massage, elevation, pumps, therapists and therapy centers, and positive attitude and faith) and inconsistent (e.g., effectiveness of exercise and medication in management of LE) with empirical evidence. CONCLUSIONS: Future research and practice should target the role of exercise as a cause of LE and as a treatment option, investigate allergic reactions as a possible catalyst of LE symptoms, work to improve diagnosis of LE and patient education, and examine the effectiveness of medications as a treatment method. IMPLICATIONS FOR NURSING: Review of LE risk factors in the postoperative period and continued assessment and education are vital to a comprehensive approach to post-breast cancer LE care.

Adaptation, Psychological↗

PubMed1995

A study of pinch strength in normal Taiwanese adults.

The purpose of this study was to describe norms of pinch strength for normal Taiwanese adults and to investigate the effects of age, gender, height, weight, and digit length on pinch strength. Three types of pinch (i.e. tip, key, and palmar pinch) were measured for a sample of 356 adults aged 20 to 88 years from a major metropolitan city located in southern Taiwan. A newly calibrated B&L pinch gauge was used for strength measurements with a standardized position during testing. The dominant hand was tested first, followed by the nondominant hand. The average of two trials for each pinch strength test was used as the subject's test scores. The results indicated that in the male group, pinch strength remained relatively stable up to 50 to 59 years old before a decline began, whereas pinch strength peaked with the 40- to 59-year-old group for female subjects. Males were stronger than females on all prehension patterns. Pinch strength of the right hand was significantly affected by such variables as the lengths of thumb and index finger and height, along with weight. With regard to the left hand, only height and weight had significant impact on pinch strength. Finally, there was an overall 13% pinch strength difference between the dominant and nondominant hands for the total sample. These findings provide therapists with objective data concerning the pinch strength of the Taiwanese adult's hand for clinical use.

Adult↗

PubMed2006

Media-based behavioural treatments for behavioural problems in children.

BACKGROUND: Many approaches are used to address behavioural problems in childhood including medication or, more usually, psychological treatments either directly with the child and/or his/her family. Behavioural and cognitive-behavioural interventions have been shown to be highly effective but access to these treatments is limited due to factors such as time and expense. Presenting the information parents need in order to manage these behaviour problems in booklet or other media-based format would most likely reduce the cost and increase access to these interventions. OBJECTIVES: To review the effects of media-based cognitive-behavioural therapies for any young person with a behavioural disorder (diagnosed using a recognised instrument) compared to standard care and no-treatment controls. SEARCH STRATEGY: The following electronic databases were systematically searched: CENTRAL (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to August 2005), EMBASE (1980 to August 2005), PsycINFO (1887 to August 2005), CINAHL (1982 to August 2005), Biosis (1985 to August 2005) and Sociofile (1974 to August 2005). References in all selected trials were checked for other trials and experts in the field were contacted for additional information. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials (e.g. trials which used sequential randomisation) of media-based behavioural treatments for behaviour problems in children. DATA COLLECTION AND ANALYSIS: Abstracts and titles of studies identified from searches of electronic databases were read to determine whether they met the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by the reviewers and queries were resolved by discussion. Data were analysed using RevMan 4.2. MAIN RESULTS: Eleven studies including 943 participants were included within this review. In general, media-based therapies for behavioural disorders in children had a moderate, if variable, effect when compared with both no-treatment controls with effects sizes ranging from -0.12 (-1.65, 1.41) to -32.60 (-49.93, -15.27) and as and adjunct to medication with effect sizes ranging from -2.71 (-5.86, -0.44) to -39.55 (-75.01, -4.09). Significant improvements were made with the addition of up to two hours of therapist time. AUTHORS' CONCLUSIONS: These formats of delivering behavioural interventions for carers of children are worth considering in clinical practice. Media-based interventions may, in some cases, be enough to make clinically significant changes in a child's behaviour, and may reduce the amount of time primary care workers have to devote to each case. They can also be used as the first stage of a stepped care approach. Consequently this would increase the number of families who could possibly benefit from these types of intervention, releasing clinician time that can be reallocated to more complex cases. Media-based therapies would therefore appear to have both clinical and economic implications as regards the treatment of children with behavioural problems.

Adolescent↗

PubMed1976

Stimulus control of self-destructive behavior in a psychotic child.

This study attemped to isolate some of the stimulus variables that controlled the self-destructive behavior of a psychotic child. In Experiment 1, the child was exposed to several demand and nondemand situations. In Experiment 2, the situation containing demands was modified so that demands now occurred in the context of a positive, ongoing interaction between the child and the adult therapist. The rates of self-destructive behavior underwent several orderly changes: (1) Rates were high in demand situations and low in nondemand and modifieddemand situations; (2) rates decreased sharply when a stimulus correlated with the termination of demands was introduced; and (3) rates of self-destruction typically showed gradual increases within each of those sessions which contained only demands. These results were interpreted as suggesting that (1) self-destruction, under certain circumstances, may be conceptualized as an escape response which is negatively reinforced by the termination of a demand situation and (2) certain modifications of the social environment may provide discriminative stimuli for behaviors other than self-destruction, thereby decreasing this behavior.

Animals↗

PubMed1997

Predicting the probability for falls in community-dwelling older adults.

BACKGROUND AND PURPOSE: The objective of this retrospective case-control study was to develop a model for predicting the likelihood of falls among community-dwelling older adults. SUBJECTS: Forty-four community-dwelling adults (> or = 65 years of age) with and without a history of falls participated. METHODS: Subjects completed a health status questionnaire and underwent a clinical evaluation of balance and mobility function. Variables that differed between fallers and nonfallers were identified, using t tests and cross tabulation with chi-square tests. A forward stepwise regression analysis was carried out to identify a combination of variables that effectively predicted fall status. RESULTS: Five variables were found to be associated with fall history. These variables were analyzed using logistic regression. The final model combined the score on the Berg Balance Scale with a self-reported history of imbalance to predict fall risk. Sensitivity was 91%, and specificity was 82%. CONCLUSION AND DISCUSSION: A simple predictive model based on two risk factors can be used by physical therapists to quantify fall risk in community-dwelling older adults. Identification of patients with a high fall risk can lead to an appropriate referral into a fall prevention program. In addition, fall risk can be used to calculate change resulting from intervention.

Accidental Falls↗

PubMed1999

Staffing intensity, skill mix and mortality outcomes: the case of chronic obstructive lung disease.

The hospital re-engineering movement has resulted in major changes in hospital staffing. These staffing changes have the potential to reduce staffing intensity and skill mix, both generally and within specific caregiver groups. Prior research has shown that both skill mix and staffing intensity are positively associated with outcomes indicative of the quality of hospital care. This study extends beyond prior research by expanding the scope of staffing intensity and skill mix measures beyond that of physicians and nursing personnel and by focusing on a specific diagnostic group, patients with chronic obstructive pulmonary disease (COPD). Multiple regression analysis was performed using the 30-day post-admission observed mortality rate for Medicare patients being treated for COPD relative to the predicted rate as the dependent variable. Analyses were repeated for 1989, 1990 and 1991. Among the explanatory variables were staffing intensity measures for health care workers that were thought to contribute significantly to the care needed by patients with COPD. The results indicate that the only group of health care workers which showed staffing intensities positively associated with better outcomes in this group of patients was respiratory care practitioners, respiratory therapists and respiratory therapy technicians. The results relative to skill mix were inconclusive. It was concluded that during the 1989-1991 period, hospitals with higher staffing intensities for both respiratory therapists and respiratory therapy technicians had better outcomes for their Medicare inpatients being treated for COPD.

American Hospital Association↗

PubMed1995

A study of different postures on isometric lifting strength in normal college students.

The purpose of this study was to describe norms of isometric lifting strength for normal college students and to investigate the effects of gender, body weight, height, and upper and lower limb length on lifting strength. Three types of lifting (i.e., arm, back, and leg lifting) were measured in a sample of 104 college students aged between 18 and 26 years. A Force Evaluation and Testing System (FET 5000) was used for strength measurements with three standard lifting positions. The average of three trials for each lifting strength test was used as the subject's test score. The results showed that the highest mean lifting strength was recorded for leg lifting in both males and females. Both groups also had the lowest score in arm lifting. Of the total sample, there was a difference of strength of nearly three- times between leg and arm lifting. Males were stronger than females in all lifting patterns. In addition, lifting strengths were significantly affected by such variables as sex, weight and height. Body weight was an effective predictor of arm lifting strength, and height an effective predictor of leg lifting strength. Finally, we found that strength in one position had positive relations with strength in other positions. These findings and the establishment of data base can in future provide therapists with an objective evaluation regarding lifting strength of individuals for clinical use.

Adolescent↗

PubMed1978

Alcoholics in interactional group therapy: an outcome study.

Three interactional therapy groups of alcoholic patients (N = 20) were formed, and treatment outcome after eight months and again after 12 months of therapy was compared with the outcome of 17 neurotic patients in comparable therapy. Outcome assessment was obtained from three sources: patient, therapist, and independent judge, using both nomothetic and ideographic measures. The results indicated that although more alcoholic than neurotic patients terminated therapy within the first six sessions, a higher percentage of alcoholic patients remained in therapy for 12 months. At the end of 12 months, both samples had improved along a wide variety of variables, and there were no significant differences between the alcoholic and neurotic population in degree of improvement.

Adult↗