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PubMed1984

Voice changes after thyroidectomy: role of the external laryngeal nerve.

Hitherto voice changes have been regarded as an infrequent complication of thyroidectomy and damage to the recurrent laryngeal nerve has been given as their major cause. Voice function was assessed in 325 patients after thyroidectomy. Permanent changes occurred in 35 (25%) after subtotal thyroidectomy and in 19 (11%) after lobectomy. The commonest cause of voice change appeared to be injury to the external laryngeal nerves on one or both sides. Damage to the recurrent laryngeal nerve, which was routinely identified and protected, was rarely a cause. When the external laryngeal nerves were identified and preserved, permanent voice changes occurred in only 5% of cases; this was similar to the incidence of 3% in controls after endotracheal intubation alone. The course of the external laryngeal nerve is variable, and consequently mass ligation of the vessels at the top of the upper pole will damage it in a high proportion of cases. To minimise this serious complication these nerves should be identified and protected as well as the recurrent nerves and voice function should be assessed early in the postoperative period by laryngoscopy and by a speech therapist.

Adolescent↗

PubMed1995

[Psychotherapeutic counselling via telecommunication networks].

The article discusses the effects that video conferencing in psychotherapy (distant therapy) may have upon the interaction between client and therapist. Experiences from distant therapy in North Norway, as well as earlier studies, are discussed in relation to factors such as client power and control, regulation of intimacy, and verbalization. The experiences indicate that physical presence--which is intuitively perceived as the ideal in relation to which the distant therapy settings are assessed--should be treated instead as a variable which can have positive and/or negative effects on a given therapeutic process.

Child↗

PubMedDate not supplied

Loss of control and the chronic mentally ill in a rural day-treatment center.

PROBLEM: What do chronically mentally ill clients consider to be the core variable in maintaining health, and how do they go about doing this? METHODS: A grounded theory design with analysis of interviews of seven chronically mentally ill clients in a rural day-treatment center. FINDINGS: The core variable in maintaining health according to chronic mentally ill clients is preventing loss of control. A process was discovered that clients used to do this. CONCLUSIONS: Chronic mentally ill clients prevent loss of control by using informal relationships to adapt behaviors, attitudes, and feelings within a supportive environment. If this fails, they turn to formal sources of control such as therapists, case workers, or other mental health providers.

Adaptation, Psychological↗

PubMed1981

The belittled wife: social, legal and psychotherapeutic considerations.

Forty years ago Horney and Thompson each wrote about the inferior role of women in marriage based on sociocultural situations. The present day message of equality has had variable effects with the result that many women complain of the belittling opinions and actions of their male partners when they attempt to become self-assertive. Equality in marriage in Canada is more established in law than socially today. Dual career marriages often illustrate this dichotomy as the husband's career takes precedence over that of the wife. The therapist plays an important role in the resolution of the ambivalent feelings of both partners.

Canada↗

PubMedDate not supplied

The relationship between the profile of severity of addiction and the retention of patients in the ambulatory program of DDTP.

OBJECTIVES: The authors described some variables related to the retention of drug dependent veterans receiving outpatient treatment at San Juan V.A.M.C. and compared the profile of addiction severity with retention using a global dysfunction scale. METHODS: The clinical charts of 74 patients were examined at random using a 16-item questionnaire based on the ASI scale. The data was processed and analyzed using the Epi Info V6.2 computer program, utilizing chi square as the main statistics. RESULTS: The patient's retention in treatment for > or = to 3 months was associated with some specific variables such as: more than 12 years of education, being Catholic, divorced, living with parents, use of more than one drug of preference, having a negative urine toxicology result before treatment and after treatment, and showing a favorable change in urine toxicology results. In terms of severity of dysfunction, a considerable substance problem and an extreme legal problem were associated with a retention of > or = to 3 months, as well as no evidence of occupational problems. CONCLUSION: The strong correlation between specific variables and the retention of patients in treatment for > or = to 3 months should create awareness of the importance of available and effective treatments in the fight against substance abuse and mental health problems as well as to educate and integrate family members in patients treatment, since a supportive family member is one of the best tools that patients and therapist can have to help maintain patient's sobriety.

Adult↗

PubMed2000

Knee isokinetic strength and body fat analysis in university students.

Many factors such as anthropometric variables influence strength performance. This study is to determine the relationship between knee isokinetic strength and body composition, and to compare the gender differences. Test-retest reliability had been performed within one week for all measurement methods before the formal study. Fifty-eight 20-25 year-old university students, 32 females and 26 males, participated in this study. Isokinetic strength of the knee flexion and extension was measured at two angular velocities of 60 degrees/sec and 120 degrees/sec. Body composition was measured by bioelectrical impedance analysis (BIA) and skinfold caliper. The others variables including height, body weight, body mass index (BMI), and waist to hip ratio were measured or calculated. The results showed that the intra-class correlation coefficients for isokinetic knee strength were between 0.83 and 0.93, and body composition and anthropometric variables were between 0.83 and 0.98. Isokinetic knee strength was significantly correlated with body height, body weight, BMI, waist and hip ratio and percent of body fat estimated by skinfold caliper (r = -0.56 to 0.64). The correlation between isokinetic strength with percent of body fat estimated by BIA (r = -0.60 to -0.74; p < 0.001) and with fat free mass (r = 0.64 to 0.78; p < 0.001) was even higher. Although male subjects had significantly greater mean values in body height, body weight, waist to hip ratio and isokinetic strength than female subjects, the MANCOVA showed that the effect of gender on knee isokinetic strength would be eliminated when the covariant variable, the percent of body fat measured by BIA and BMI was controlled in the analysis model. In conclusion, knee isokinetic strength was significantly negatively correlated with proportion of fat and positively correlated with fat free mass. The magnitude of strength difference between males and females could be explained by differences in body fat proportion and BMI in this study. Therapist would take the body fat composition, fat free mass, and BMI into consideration in knee muscle strength measurement. Less body fat and higher BMI will contain more fat free mass that produces more muscle strength.

Adipose Tissue↗

PubMed1982

Sexuality and the life-style of home dialysis patients.

This study was designed to assess the impact of chronic illness on the sexuality and life-style of a group of veterans with end stage renal disease. Thirty-two married home dialysis patients and 14 of their wives were interviewed by a sex therapist. An Index of Sexual Function (ISF) was developed to quantify 5 aspects of male genital function. The Index was correlated with the following: other major areas of sexuality including masculine self-concept, sex drive, sexual activity, sexual relationship, and sexual satisfaction; quality of life factors such as work, marital adjustment, and sociability; several demographic factors; and 15 medical variables. There were significant correlations between genital function and sexual satisfaction, the patient's attitude toward the importance of sex, sex drive, and positive feelings about the self. Better sexual function occurred in the patients with the least neuropathy; there was no correlation with other medical factors. Of the patients studies, 9 (28%) had full sexual function, 7 (22%) had moderate dysfunction, and 16 (50%) had severe dysfunction. Despite the genital dysfunction, marital and social adjustment of our patients compared favorably with studies of couples in the general population. After this study a sex counseling program was developed.

Adult↗

PubMed2003

Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy.

STUDY DESIGN: A blinded, prospective diagnostic test study was conducted. OBJECTIVES: To assess the reliability and accuracy of individual clinical examination items and self-report instruments for the diagnosis of cervical radiculopathy, and to identify and assess the accuracy of an optimum test-item cluster for the diagnosis of cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Although cervical radiculopathy remains largely a clinical diagnosis, the reliability and diagnostic accuracy of clinical examination items, individually or in combination, for cervical radiculopathy is largely unknown. METHODS: Patients with suspected cervical radiculopathy or carpal tunnel syndrome received standardized electrophysiologic examination of the symptomatic upper quarter followed by a standardized clinical examination by physical therapist examiners blinded to diagnosis. Diagnostic properties were assessed using a neural impairment reference criterion standard. RESULTS: The study involved 82 patients. More than two thirds of 34 clinical examination items had reliability coefficients rated at least fair or better, and 13 items had likelihood ratio point estimates above 2 or below 0.50. A single diagnostic test item cluster of four variables was identified and produced a positive likelihood ratio point estimate of 30.3. The 95% confidence intervals for all likelihood ratio point estimates in this study were wide. CONCLUSIONS: Many items of the clinical examination were found to be reliable and to have acceptable diagnostic properties, but the test item cluster identified was more useful for indicating cervical radiculopathy than any single test item. Upper limb tension Test A was the most useful test for ruling out cervical radiculopathy. Further investigation is required both to validate the test item cluster and to improve point estimate precision.

Adult↗

PubMed1981

Pain control: mastery through group experience.

This paper describes a group program which is part of the therapeutic management of out-patients with chronic pain at the multidisciplinary Pain Clinic in Hamilton, Ontario (McMaster Division, Chedoke-McMaster Hospital). The programme seeks to assist chronic pain sufferers in developing more adaptive coping styles. Groups of 12--14 patients meet for 9 weeks, 3 h/week, under the co-leadership of a physiotherapist and an occupational therapist with backgrounds in psychology and psychiatry. Seventy-five patients with diverse aetiologies of chronic pain have completed these "pain control classes". Outcome was assessed on the basis of several parameters. Results indicate a considerable reduction in depression, pain perception and analgesic intake. Conversely, employment figures increased from 20 to 48% after completion of the program. 21% were considered failures. Significant variables differentiating successes from failures were sex, marital status, work incentive, employment and absence of litigation or Workmen's Compensation claims.

Adult↗

PubMed1994

Abuse and disabuse of the drug metaphor in psychotherapy research: hold on to the baby as you throw out the bath.

Stiles and Shapiro (1994) argue that trivial correlations between process variables and treatment outcome point to inherent methodological limitations of correlational designs in process-outcome research. In coming to such a far-reaching (erroneous) conclusion, Stiles and Shapiro are throwing out the baby with the bath. Correlational designs are perfectly appropriate for testing process-outcome correlations if process measures are adequately conceptualized. Examples of case-specific measures of therapist responsiveness are reviewed to illustrate the power of correlational designs.

Humans↗

PubMed1997

Therapeutic alliance and transference: an exploratory study of their empirical relationship.

Transference and the formation of a therapeutic alliance were studied in 126 patients from the Berlin psychotherapy project. The working hypothesis was that the internalized mother and father image would have an influence on the therapeutic alliance. The therapist rated the development of the therapeutic alliance at two points in time. When the parents' images and the therapist image were compared by using difference and similarity measures, four mother and four father types could be constructed of which some showed significant differences in the formation of therapeutic alliance. The introduction and the discussion are focused on the question as to what extent the psychoanalytic assumptions of transference can be useful in empirical therapy research for the construction of new variables and the explanation of social interactions between the two partners.

Adult↗

PubMed1997

Anger, impulsivity and suicide risk.

BACKGROUND: To examine the relationship between anger, impulsivity and suicidality. METHODS: Thirty psychiatric inpatients admitted for suicidal behavior were compared with 30 nonsuicidal psychiatric inpatients and 32 healthy controls on measures of anger, impulsivity and suicide risk. RESULTS: The three groups were similar on demographic variables, but the suicidal group scored higher on the suicide risk scale, impulsivity scale and anger scale. Anger and impulsivity correlated significantly with suicide risk. High anger and impulsivity contributed synergistically to the suicide risk. Whereas anger was specific to both psychiatric groups, suicidals and nonsuicidals, only impulsivity was specific to the suicidal group. CONCLUSIONS: These findings may have important implications for therapists and primary prevention workers, and may pave the way for the recognition of risk factors and for effective intervention in patients with a high suicide risk.

Adult↗

PubMed1999

Development of the Joint Protection Behavior Assessment.

OBJECTIVE: To develop an observational assessment of the use of joint protection (JP) methods by people with rheumatoid arthritis (RA). METHODS: Subjects with and without RA were videotaped performing a kitchen activity to identify the range of JP and non-JP methods used. Behavior codes were developed for these. Seven rheumatology occupational therapists reviewed and scored behaviors as correct, partially correct, or incorrect JP methods. Test-retest and interrater agreement studies were conducted. RESULTS: The Joint Protection Behavior Assessment (JPBA) demonstrated good content validity (kappa = 0.46 to 1.00), test-retest reliability (P < 0.0001), and interobserver agreement (kappa = 0.68 to 0.88). Construct validity was supported by significant correlations with hand impairment and function variables. CONCLUSION: The JPBA is a reliable and valid assessment of the use of JP methods by people with mild to moderate hand and upper limb joint involvement, which can be used to evaluate the effectiveness of JP education programs.

Activities of Daily Living↗

PubMed2004

[Alcohol dependence syndrome and before-discharge intervention method (BDIM)--Report 2. Statistical analysis of BDIM].

The present author has developed the structured Before-Discharge Intervention Method (BDIM), a modified version of the intervention methods by Johnson and Picard in an effort to achieve the patient's awareness of his/her problem drinking. The BDIM first involves the patient's family members and helps them recover from co-dependence on the patient's alcoholism and secondly, instructs them to write structured letters to the patient. Each letter should include a few episodes of recent and past drinking problems, and family members' concern and love for the patient, and family members' hope for his/her patient's abstinence. Family members read the letter with emotion and tears in a joint therapist, patient, family members session. We have reported the two-year-post-treatment outcome of group I (the BDIM-treated group) and group II (the BDIM-untreated group) here. Patients living with their spouse or significant other in group I of the series of new patients did significantly better than their counterpart in group II on two treatment outcome variables, that is, family members' attendance at hospital follow-up sessions and/or self-help group meetings, abstinence of the patients who and whose family members attended hospital follow-up sessions and/or self-help group meetings. Patients living with their spouse or significant other in group I of the series of all patients did significantly better than their counterpart in group II on three treatment outcome variables, that is, patients' attendance at hospital follow-up sessions and/or self-help group meetings, family members' attendance at hospital follow-up sessions and/or self-help group meetings, abstinence of the patients who attended hospital follow-up sessions and/or self-help group meetings. But we noted no other statistically significant difference between groups I and II in any of the other two subgroups of discharged patients or in any of the treatment outcome variables. In group I in the series of new patients, 49% of the patients who lived with their spouse and/or significant other attended hospital follow-up sessions and/or self-help group meetings, and 41% of them showed abstinence. In group I in the series of all patients, 49% of inpatients who lived with their spouse and/or significant other attended hospital follow-up sessions and/or self-help group meetings, and 40% of them showed abstinence. We grant that the current study was not conducted in a random patient assignment design and, therefore, needs to be interpreted with some caution. Further research is appropriate.

Alcoholics Anonymous↗

PubMed1978

Behavioral treatment parameters with primary dysmenorrhea.

Fourteen women with primary dysmenorrhea were administered four sessions of systematic desensitization (SD) by either a male or a female therapist. The following measures were taken during the flow periods before and after treatment and at a 6-month follow-up: menstrual symptom checklist, medication usage, invalid hours, and menstrual attitudes. At pretreatment, menstrually distressed women had significantly higher scores on all measures compared to a normative group and an explicitly nondistressed group. At posttreatment, treated women's scores on the dependent variables were significantly reduced. All indices were reduced to a "nondistressed level" at posttreatment and at 6-month follow-up. Type of dysmenorrhea (congestive vs. spasmodic), trait anxiety level, and therepist sex did not predict differential responsiveness to SD. SD did not affect frontailis EMG, peripheral blood flow, or pain threshold. A Retrospective Symptom Scale of menstrual distress was found to be highly reliable, valid, and sensitive.

Adolescent↗

PubMed2001

Fear-avoidance behavior and anticipation of pain in patients with chronic low back pain: a randomized controlled study.

OBJECTIVE AND DESIGN: In a randomized controlled study, we investigated whether pain anticipation and fear-avoidance beliefs will lead to behavioral avoidance. PATIENTS: Fifty patients with chronic low back pain (CLBP) performed a simple leg-flexion task. Before the test, members of a control group were informed that the movement would not result in any increase of pain, whereas experimental group participants were told that a slight increase of pain could occur. OUTCOME MEASURES: All patients completed the Fear-Avoidance-Beliefs Questionnaire (FABQ) and the Pain Disability Index (PDI). As dependent variables, different behavioral performance parameters were registered by a computerized protocol: number of flexion movements, mean range of motion, and mean work ratio. Furthermore, patients were asked about their pain intensity as well as their fear (at the moment) and finally were asked to judge the unpleasantness of the experiment (using visual analogue scales for each of the three variables). RESULTS: Inducing pain anticipation (by instruction) led to significantly lower levels of behavioral performance as well as increased pain intensity and fear during the test. Behavioral performance was significantly correlated with fear-avoidance beliefs. CONCLUSIONS: Results confirm that pain anticipation and fear-avoidance beliefs significantly influence the behavior of patients with low back pain in that they motivate avoidance behavior. Therapists must be aware of the powerful effects of cognitive processes, which can give rise to fear of pain and, consequently, avoidance behavior.

Clinical Trial↗

PubMed1985

Effects of psychotherapy in schizophrenia. A retrospective study.

Effects of individual long-term psychotherapy carried out by a single therapist with 14 schizophrenic male patients were studied 6 and 8 years after the start of therapy. The outcome measures were: time spent in hospital, ability to work, social contacts and symptoms, plus a total outcome score. The psychotherapy patients were compared with a control group of schizophrenic patients treated by conventional methods. The two groups were matched with regard to prognostically important variables (age, sex, time in hospital, ability to work) in order to obtain comparable groups. At the first follow-up video-taped personal interviews focusing on the patient's status the year before the investigation were performed, followed by ratings by "blind raters". The psychotherapy patients had significantly more favourable scores on scales for hospitalization, work, symptoms and total outcome in spite of very low prescribed doses of neuroleptics in the last year. At the second follow-up these differences were maintained. In addition, a difference between the two groups in the variable 'social contacts' had emerged.

Adolescent↗

PubMed1999

Reliability of McConnell's classification of patellar orientation in symptomatic and asymptomatic subjects.

STUDY DESIGN: Test-retest reliability study with blinded testers. OBJECTIVES: To determine the intratester reliability of the McConnell classification system and to determine whether the intertester reliability of this system would be improved by one-on-one training of the testers, increasing the variability and numbers of subjects, blinding the testers to the absence or presence of patellofemoral pain syndrome, and adhering to the McConnell classification system as it is taught in the "McConnell Patellofemoral Treatment Plan" continuing education course. BACKGROUND: The McConnell classification system is currently used by physical therapy clinicians to quantify static patellar orientation. The measurements generated from this system purportedly guide the therapist in the application of patellofemoral tape and in assessment of the efficacy of treatment interventions on changing patellar orientation. METHODS AND MEASURES: Fifty-six subjects (age range, 21-65 years) provided a total of 101 knees for assessment. Seventy-six knees did not produce symptoms. A researcher who did not participate in the measuring process determined that 17 subjects had patellofemoral pain syndrome in 25 knees. Two testers concurrently measured static patellar orientation (anterior/posterior and medial/lateral tilt, medial/lateral glide, and patellar rotation) on subjects, using the McConnell classification system. Repeat measures were performed 3-7 days later. A kappa (kappa) statistic was used to assess the degree of agreement within each tester and between testers. RESULTS: The kappa coefficients for intratester reliability varied from -0.06 to 0.35. Intertester reliability ranged from -0.03 to 0.19. CONCLUSION: The McConnell classification system, in its current form, does not appear to be very reliable. Intratester reliability ranged from poor to fair, and intertester reliability was poor to slight. This system should not be used as a measurement tool or as a basis for treatment decisions.

Adult↗