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 685 records · Page 38Linked to original sources

PubMed2003

Pavlov and the foundation of behavior therapy.

The foundation, achievements, and proliferation of behavior therapy have largely been fueled by the movement's foundation in behavioral principles and theories. Although behavioral accounts of the genesis and treatment of psychopathology differ in the extent to which they emphasize classical or operant conditioning, the mediation of cognitive factors, and the role of biological variables, Pavlov's discovery of conditioning principles was essential to the founding of behavior therapy in the 1950s, and continues to be central to modern behavior therapy. Pavlov's reliance on a physiological model of the nervous system, sensible in the context of an early science of neurology, has had an implication for behavior therapists interested in the study of personality types. However, Pavlov's major legacy to behavior therapy was his discovery of "experimental neuroses," shown by his students Eroféeva and Shenger-Krestovnikova, to be produced and eliminated through the principles of conditioning and counter-conditioning. This discovery laid the foundation for the first empirically-validated behavior therapy procedure, systematic desensitization, pioneered by Wolpe. The Pavlovian origins of behavior therapy are analyzed in this paper, and the relevance of conditioning principles to modern behavior therapy is demonstrated. It is shown that Pavlovian conditioning represents far more than a systematic basic learning paradigm. It is also an essential theoretical foundation for the theory and practice of behavior therapy.

Animals↗

PubMed1985

High voltage stimulation. Effects of electrode size on basic excitatory responses.

The purpose of this study was to examine the effects of electrode size on thresholds of sensory and motor excitation, strongest motor excitation without pain perception, and strongest motor excitation coupled with maximally tolerated painful stimulation. A high voltage stimulator with monophasic pulsatile current was applied to the quadriceps femoris muscles of 14 healthy subjects. Voltage output, pulse-charge density, and isometric muscle torque were measured during random application of four electrode pairs measuring 3 X 3, 6 X 6, 9 X 9, and 5 X 16.2 cm. Results indicated a dependence of the measured variables on electrode size; the larger electrodes required greater voltage output but less pulse-charge density than the smaller electrodes. The two largest electrodes evoked significantly greater non-painful and maximally tolerated painful muscle torques. Maximal volitional contraction increased 13.3% after completion of all stimulations. Electrode size should be considered by physical therapists when administering transcutaneous electrical nerve stimulation.

Adult↗

PubMed2006

Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: study protocol of a randomized clinical trial [NCT00257998].

BACKGROUND: Recently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR. METHODS/DESIGN: Consecutive patients with LBP referred to physical therapy clinics in one of four geographical locations who satisfy the CPR will be invited to participate in this randomized clinical trial. Subjects who agree to participate will undergo a standard evaluation and complete a number of patient self-report questionnaires including the Oswestry Disability Index (OSW), which will serve as the primary outcome measure. Following the baseline examination patients will be randomly assigned to receive the lumbopelvic manipulation used in the development of the CPR, an alternative lumbar manipulation technique, or non-thrust lumbar mobilization technique for the first 2 visits. Beginning on visit 3, all 3 groups will receive an identical standard exercise program for 3 visits (visits 3,4,5). Outcomes of interest will be captured by a therapist blind to group assignment at 1 week (3rd visit), 4 weeks (6th visit) and at a 6-month follow-up. The primary aim of the study will be tested with analysis of variance (ANOVA) using the change in OSW score from baseline to 4-weeks (OSWBaseline - OSW4-weeks) as the dependent variable. The independent variable will be treatment with three levels (lumbo-pelvic manipulation, alternative lumbar manipulation, lumbar mobilization). DISCUSSION: This trial will be the first to investigate the effectiveness of various manual therapy techniques for patients with LBP who satisfy a CPR.

Adolescent↗

PubMed1980

The relationship between professional productivity and educational level, Part 1. Review of the literature and methodology.

The primary purpose of this study was to explore the relationship of the educational level of occupational therapists to their professional productivity in the areas of practice, education, research, publication, professional activities, and health care policy planning. These areas of professional productivity were also studied in relationship to selected educational curricula through their alumni. In this article, the first of two, the literature and methodology are reviewed, the independent and dependent variables are defined, and the hypotheses are presented. The results will be presented and discussed in Part 2.

Educational Status↗

PubMed2002

[Authenticity in psychology and psychotherapy].

Authenticity, in psychological sense of the word, is connected with human identity and it belongs among the effective factors of psychotherapy. We can define it as a complex psychological variable and relatively constant characterization of a personality. Authenticity expresses the degree of a person's self-identity and, at the same time, it shows how much is his behaviour towards his surrounding connected with his self-concept. In the researches, for authenticity we can use the term congruence. In the psychotherapy therapist's authentic behaviour leads to release of the patient's spontaneity and to the increase of his own authentic behaviour. Mentally healthy person is authentic and independent, he leads a meaningful life and his decisions mainly depends on his own experience. Authenticity we can detect directly with the help of the clinical methods [interview] and indirectly through the self-concept and incongruences. One of the main instruments used to measure authenticity are rating scales.

Behavior↗

PubMed2003

How mental health providers spend their time: a survey of 10 Veterans Health Administration mental health services.

BACKGROUND: Allocation of provider time across clinical, administrative, educational, and research activities may influence job satisfaction, productivity, and quality of care, yet we know little about what determines time allocation. AIMS: To investigate factors associated with time allocation, we surveyed all mental health providers in one Veterans Health Administration (VHA) network. We hypothesized that both facility characteristics (academic affiliation, type of organization of services, serving as a hub for treatment of severely mentally ill, facility size) and individual provider characteristics (discipline, length of time in job, having an academic appointment) would influence time allocation. METHODS: Eligible providers were psychiatrists, psychologists, social workers, physician assistants, registered or licensed practical nurses or other providers (psychology technicians, addiction therapists, nursing assistants, rehabilitation, recreational, occupational therapists) who were providing care in mental health services. A brief self-report survey was collected from all eligible providers at ten VHA facilities in late 1998 (N = 997). Data regarding facility characteristics were obtained by site visits and interviews with managers. Multilevel modeling was used to examine factors associated with three dependent variables: (i) total time allocation by activity (clinical, administrative, educational, research); (ii) clinical time allocation by treatment setting (inpatient vs. outpatient); and (iii) clinical time allocation by type of care (mental vs. physical). Licensed Practical Nurses (LPNs) were used as the reference group for all analyses because LPNs were expected to spend the majority of their time on clinical activities. RESULTS: Overall, providers spent most of their time on clinical activities (77%), followed by administrative (11%), and educational (10%). Surprisingly, research activities accounted for only 2% of their time. Multilevel analysis indicated none of the facility-level variables were significant in explaining facility variance in time allocation, but individual characteristics were associated with time allocation. The model for predicting time allocation by inpatient or outpatient settings explained 16-18% of the variance in the dependent variable. In all models, provider discipline and length of time in job played an important role. Having an academic appointment was important only in the model examining total time allocation by activity type. DISCUSSION: These simple models explained only a small amount of variance in the three dependent variables which were intended to capture issues related to time allocation; and the low number of facilities limited our power to examine effects of facility-level factors. Our models performed better in predicting allocation of clinical time to treatment setting and type of treatment than in predicting overall time allocation. Discipline and length of time in job were significant across all models. In contrast, having an academic appointment was associated with allocating significantly less time to clinical activities and more time to administrative activities but not to any significant difference in time spent in either research or education. IMPLICATIONS: While a gold standard of optimal time allocation does not exist, it is striking that research, a stated mission of the VHA, accounted for so little of providers' time. The lack of involvement of clinicians in research has implications for recruitment and retention of high-quality mental health providers in this network and for the education of future providers. Without involvement of clinicians, research conducted in the network by nonclinicians may be less relevant to "real-world" clinical issues. Reductions of funds available to mental health, coupled with increased clinical demands, may have prompted this pattern of time allocation, and these findings attest to the challenges faced by large institutions that are charged with balancing many often seemingly competing missions.

Health Services Research↗

PubMed1989

[Stuttering in children as a problem of phoniatric outpatient clinics].

Stuttering in young children is an extremely complex phenomenon. On all levels of intervention such as evaluation, differential diagnosis between stuttering and normal disfluency, diagnostic guidance of therapy process or direct and indirect treatment a number of questions arise for which answers have not been yet found. But realizing that the disorder is most difficulty to cure in adults and adolescents prevention or early treatment is essential. So diagnosticians and therapists need a high level of knowledge about the onset, the maintenance and the development of the disorder in every individual case of stuttering in young children. Decisions concerning the indications for diagnostic and therapeutic interventions must not be made by intuition but by professionally balancing the influencing factors such as psycho-social variables or marked deficits in mental, motor or sensory areas of the child's development. We want to demonstrate the different dimensions of the diagnostic and therapeutic process and the amount of professional time and effort which is necessary for the handling the stuttering child and his family.

Diagnosis, Differential↗

PubMed2005

A prototype rehabilitation device with variable resistance and joint motion control.

Resistance exercise has been widely reported to have positive rehabilitation effects for patients with neuromuscular and orthopaedic conditions. This paper presents the design of a versatile rehabilitation device in the form of a rotating joint arm mounted on the adjustable seat that provides passive resistance during strength training for muscles. The resistance is supplied by a magnetorheological damper. Intelligent controls are developed to produce resistance force based on the prescription of the therapist. The device provides both isometric and isokinetic strength training and is reconfigurable for several human joints. Special consideration has been given to the human-machine interaction in the adaptive control algorithms that can modify the behavior of the device to account for strength gains or muscle fatigue.

Computer-Aided Design↗

PubMed1985

[Influence of treatment course on the success of psychopharmacotherapy].

Psychiatric illness course is not characterized by total regularity. More often there is marked individual variability. This is an obstacle to making a valid prognosis and applying broadly based indication rules. Still today predictors of illness course as well as indication criteria for treatment are little elaborate and often faile in the individual case. The most reliable instrument for planning and assessing psychiatric treatment is the treatment course itself. The therapist as a participating observer can more easily check tendencies of illness course and adapt therapeutic strategies. Characteristics of treatment course in guiding further treatment are examplified by means of neuroleptic treatment in the acute and maintenance phase of schizophrenic psychoses.

Antipsychotic Agents↗

PubMed2004

Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study.

This prospective 18-month study was designed to assess long-term compliance with a program of exercise aimed to prevent osteoporosis after an educational intervention and to uncover determinants of compliance. A total of 135 postmenopausal women were recruited by flyers or instructed by their physicians to participate in an educational session added to usual medical care. After a baseline visit and dual-energy X-ray absorptiometry, volunteers participated in a 1-day educational session consisting of a lecture and discussion on guidelines for appropriate physical activity and training in a home-based exercise program taught by a physical therapist. Scheduled follow-up visits were 1, 6, and 18 months after the educational session. Compliance with the exercise program was defined as an exercise practice rate 50% or greater than the prescribed training. The 18-month compliance rate was 17.8% (24/135). The main reason for withdrawal from the program was lack of motivation. Two variables predicted compliance: contraindication for hormone replacement therapy (odds ratio [OR] = 0.13; 95% confidence interval [95% CI], 0.04 to 0.46) and general physical function scores from an SF-36 questionnaire (OR=1.26; 95% CI, 1.03 to 1.5). To a lesser extent, osteoporosis risk, defined as a femoral T-score < or =-2.5, predicted compliance (OR=0.34; 95% CI, 0.10 to 1.16). Despite the addition of an educational session to usual medical care to inform participants about the benefits of exercise, only a minority of postmenopausal women adhered to a home-based exercise program after 18 months.

Exercise Therapy↗

PubMed1988

Reliability of quantitative muscle testing in healthy children and in children with Duchenne muscular dystrophy using a hand-held dynamometer.

The purpose of this study was to examine intratester and test-retest reliability using a hand-held dynamometer for the measurement of isometric muscle strength in 28 healthy children and children with Duchenne muscular dystrophy. The Dystrophic Group consisted of 14 children diagnosed with Duchenne muscular dystrophy, and the Healthy Group consisted of 14 age-matched children with no history of orthopedic or neuromuscular disorders. One physical therapist tested hip and knee extension, elbow flexion, and shoulder abduction in each child bilaterally. A two-way analysis of variance for repeated measures was used to analyze differences between measurements taken within and across the testing sessions. Pearson product-moment correlation coefficients were determined on mean values across the testing sessions for each variable. No significant differences (p greater than .05) between measurements taken within or across testing sessions were found in either the Dystrophic Group or the Healthy Group. Correlation coefficients for the Dystrophic Group ranged from .83 to .99 for the variables tested. Correlation coefficients for the Healthy Group ranged from .74 to .99. The results suggest that the hand-held dynamometer can be used as a reliable instrument in measuring the isometric strength of selected muscles in children.

Activities of Daily Living↗

PubMed1999

Developmental and etiological characteristics of children with sexual behavior problems: treatment implications.

OBJECTIVE: Baseline data are reported on the demographics, psychological adjustment, victimization, and perpetration histories of 127 6- to 12-year-old children who have engaged in developmentally unexpected sexual behaviors. Information regarding the children's caregivers, and their extended families, is also presented. Data were collected during intake of the families into a longitudinal treatment outcome study. METHOD: A comprehensive battery of psychometric devices and a structured interview were completed with 127 children with sexual behavior problems and their primary caregivers at intake to a treatment outcome study. RESULTS: More than half of the children engaging in developmentally unexpected sexual behaviors had been abused both sexually and physically by more than two different perpetrators. One-third of the people who had maltreated these children were less than 18 years old. These children had acted out against an average of two other children. High levels of distress in the children and their caregivers were evident across a number of psychometric and historical variables. CONCLUSION: Children with sexual behavior problems exhibited a number of functional impairments commonly associated with maltreatment, including learning and psychiatric disorders. Their caregivers and families manifested several characteristics that deter children's recovery from maltreatment, including an impaired attachment between parent and child. The scope of the children's problems requires that treatment extend beyond the therapist's office to include schools and other agencies or individuals with whom the child and families have regular contact.

Analysis of Variance↗

PubMed1985

Psychotherapeutically oriented treatment of schizophrenia: results of 5-year-follow-up.

The authors have developed a psychotherapeutic approach to schizophrenia within the community psychiatric health care system. The orientation is psychodynamic but global in the meaning that the therapeutic plans are made on the basis of case-specific need of the patients and of their families and include both individual psychotherapy, family therapy and therapeutic communities. The material is composed of 100 successive patients of the schizophrenia group aged 16 - 44 years and for the first time admitted for treatment into the different units of the Turku Mental Health District in 1976 - 77. A multiprofessional staff was acting as therapists, supported by a continuous and intensive on-the-job -training and supervision. The results preliminary reported in this paper are based on a follow-up study 5 years after admission to treatment. 56 patients could be included in the psychotherapy group given at least some mode of psychotherapy in an adequate amount. The background variables of patients selected for various modes of therapy as well as the prognostic results are studied with the aid of logistic regression analyses. The findings indicate that the development of a global psychotherapeutic orientation is possible in the field of community psychiatry and yields results that demonstrate its meaningfulness. The implementation of psychotherapy had clearly positive explanatory connections with a favourable prognosis, and although these connections were not equally strong as the connections of some central clinical and psychosocial variables, they were obvious and manifold.

Adolescent↗

PubMed2006

Physiotherapy in Afghanistan: an analysis of current challenges.

INTRODUCTION: Afghanistan has high levels of disability due to prolonged conflict. An important part of the reconstruction process in Afghanistan is strengthening health service capacity and, within this, rehabilitation services. AIMS: To identify training needs of, and key issues affecting, Afghan physiotherapists. METHODS: 20 interviews and clinical accompaniment of 15 physiotherapists/physiotherapy assistants (APA) carried out in the second quarter of 2003. Analysis was using a grounded theory approach. RESULTS: Five themes emerged: (1) Low professional profile of physiotherapy; (2) Difficult working conditions; (3) Difficulty identifying personal training needs; (4) Difficulty with clinical reasoning at undergraduate level; (5) Variable levels of clinical competence. DISCUSSION: Many of the challenges facing Afghan physiotherapists are not unique to Afghanistan but are exacerbated by a lack of government recognition of the profession. War has isolated Afghan physiotherapists from completed professional links and consequently the undergraduate curriculum had not matched developments in other comparable countries. This has contributed to the difficulties therapists' experience with current clinical reasoning and accessing new practice developments. Culture also influences attitudes towards training and has restricted female travel and access to education. CONCLUSIONS: Core training needs include disability sensitization, reflective practice and clinical reasoning. The physiotherapy curriculum needs updating and links with ongoing research need to be established to keep abreast of new developments.

Afghanistan↗

PubMed2004

Linking process and outcome in the community reinforcement approach for treating cocaine dependence: a preliminary report.

This preliminary study evaluated the relationship between therapy process variables (mechanistic processes and interpersonal processes), and treatment outcome (i.e., retention and cocaine abstinence) among 16 cocaine-dependent pregnant or postpartum women treated with the Community Reinforcement Approach (CRA). Two new rating scales were developed for this purpose. The Mechanisms of Action Rating Scale (MARS) assesses five CRA mechanistic domains (Big Picture goals, functional analyses of behavior, nondrug-related activities, skills training, and homework). The Interpersonal Variables Rating Scale (IVRS) measures three nonspecific or interpersonal dimensions of psychotherapy (i.e., empathy, response to resistance, and therapeutic alliance). These rating scales were used to rate one, early treatment, videotaped CRA session for each subject. Results indicated that: 1) sessions with patients who achieved three or more consecutive weeks of cocaine abstinence were rated significantly higher on therapist empathy and positive responses to resistance, and total IVRS scores (all of which indicate positive interpersonal processes); and 2) Big Picture goals, positive therapeutic alliance, and total IVRS scores were significantly and positively correlated with number of consecutive weeks of cocaine-negative urine toxicology tests. Only MARS homework scores were significantly and positively associated with number of study weeks completed. Finally, the pattern of interrelationships among the MARS subdomains suggests the coherence of the multifaceted CRA treatment. The findings of this preliminary study suggest the importance of monitoring both mechanistic and interpersonal processes during CRA treatment of cocaine dependence.

Alcoholism↗

PubMed2005

The influence of gender and age on hamstring muscle length in healthy adults.

STUDY DESIGN: Cross-sectional descriptive study. OBJECTIVES: To examine the factors of gender and age, stratified by 10-year increments, on hamstring muscle length (HML) as measured by passive straight-leg raise (PSLR) and popliteal angle (PA). BACKGROUND: Differences in HML between men and women have not been examined for a large group of healthy adults over a wide range of ages. The usefulness of these data is to provide some typical values of HML for future reference. METHODS AND MEASURES: Two hundred fourteen adults (108 women, 106 men; age range, 20-79 years) with no known history of hip or knee joint disease and no history of recent hamstring strain participated in the study. PSLR (trunk-thigh angle) and PA (thigh-leg angle) were estimated with a goniometer. A 2-way analysis of variance (ANOVA) was used to analyze the effects of 2 independent variables (gender and age) on 2 dependent variables (PSLR and PA). Statistical significance was established at alpha<.05. RESULTS: HML differed significantly (P<.001) between genders for both methods of measurement, with females demonstrating greater flexibility than their male counterparts. The difference between genders was 8 degrees for PSLR and 11 degrees for PA. HML was not influenced by age. CONCLUSIONS: This study provides physical therapists with typical values of HML in healthy men and women.

Adult↗

PubMed2004

Practice variability in management of acute respiratory distress syndrome: bringing evidence and clinician education to the bedside using a web-based teaching tool.

BACKGROUND: Clinical practice often lags behind publication of evidence-based research and national consensus guidelines. OBJECTIVE: To assess practice variability in the clinical management of acute respiratory distress syndrome (ARDS) and test an evidence-based, online clinician-education tool designed to improve intensive-care clinicians' understanding of current evidence about ARDS management. METHODS: We surveyed 117 intensive care clinicians (16 critical care physician specialists, 28 resident physicians, 50 critical care nurses, and 23 respiratory therapists) with an online questionnaire in our tertiary academic institution. Fifty of the original respondents (12 residents, 26 critical care nurses, and 12 respiratory therapists) also responded to a repeat survey that included context-sensitive hypertext links to a summary of critically appraised primary articles regarding ARDS management, to determine if the responses changed after the clinicians had read the evidence-based summary information. RESULTS: Critical care physician specialists were most likely to choose the low-tidal-volume (low-VT) ventilation strategy and protocol-based ventilator weaning and were least likely to choose neuromuscular blockade or parenteral nutrition (p < 0.05). In a paired comparison, individual respondents were more likely to choose treatment options that are based on stronger evidence (low-VT, daily interruption in sedation, and protocol weaning [p < 0.01]). We also reviewed the medical records of 100 patients who were mechanically ventilated for > 48 h, during the 6 months before and after the survey, from which we identified 45 ARDS patients. Following the clinician-education intervention, ARDS patients were less likely to receive potentially injurious high-VT ventilation (mean day-3 VT 10.3 +/- 2.3 mL/kg before vs 8.9 +/- 1.7 mL/kg after, p = 0.02). CONCLUSION: Web-based teaching tools are useful to educate intensive-care practitioners and to promote evidence-based practice.

Attitude of Health Personnel↗

PubMed2006

Clinical measurement of posterior shoulder flexibility.

The objectives of this study were to determine both the intra-rater reliability and the smallest real difference necessary to detect meaningful clinical changes over an 8-12 week period for three clinical measures of posterior shoulder flexibility. Posterior shoulder tightness has been associated with abnormal humeral head translations that narrow the subacromial space and contribute to impingement. Posterior shoulder stretching to normalize joint kinematics is often used when treating individuals with subacromial impingement. Currently there is no measurement of posterior shoulder flexibility that has been demonstrated to be reliable or responsive in patients over a treatment interval. Construction workers with overhead work exposure were recruited to an impingement group (n=37), and an asymptomatic group (n=22). Three flexibility measurements were taken on each subject at baseline and 8-12 weeks later by the same physical therapist. Intra-rater reliability was determined using intra-class correlation coefficients (ICCs) and standard errors of measurement (SEM). The smallest real difference value (SRD) determined the smallest detectable intervention-related measurement change over time. ICCs for the three measurements ranged from poor (0.40) to good (0.79). The SEM and SRD values reflected high test-retest variability in all three measurements. None of the three measures were proven to be highly stable indicators of posterior shoulder flexibility over this time period, nor were they able to detect small changes over this interval due to the high trial to trial variance in a non-intervention sample. Caution should be used when interpreting these clinical measurements over prolonged time periods.

Analysis of Variance↗