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PubMed1979

An introduction to the evaluation of alcoholism outcome studies.

The results of outcome studies in the field of alcoholism have been challenged as not providing clear and definitive demonstrations of the effectiveness of alcoholism treatment. This has not been due to studies showing negative results, or to a lack of studies reporting positive results. The difficulty has been that the studies failed to satisfy the standards of experimentally minded methodologists. Many methodological problems with respect to patient, treatment, and criterion variables were described which will require a great deal of basic research for their solution. Others may not be soluble. Drawing a representative sample of alcoholics may not be feasible. Assigning patients at random to treatments and no treatment who are uninterested, who desire particular treatments, or who are in need of specific treatments is impractical and socially unacceptable. Matching or randomly assigning therapists to provide consistent, measured, and equal amounts of specific therapies is similarly unrealistic. Determining what constitutes a good therapeutic outcome may be more of a philosophic than a scientific issue. Applying experimental standards to human outcome studies is inappropriate. The state of the art with respect to evaluating the effectiveness of alcoholism treatment is not ready for experimental investigations or cost-benefits analyses. Despite all these problems, a review of 384 studies indicates that two-thirds of the patients improve following alcoholism treatment. Research studies are increasingly sophisticated. A great deal has been and is continuing to be learned about patient characteristics, treatment methods, and matching patients to treatments.

Alcoholism↗

PubMed1979

[Prediction of the effects of client-centered psychotherapy on the basis of an indications interview].

Several effects of client-centered therapy were predicted on the basis of a short intake-interview divided into two parts: an exploration-phase and a quasi-therapy-phase. Elements of the international behavior and elements of the intrapersonal exploration of the client were rated by neutral observers and served as predictor variables as well as ratings of the experiences in the two interview situations by the client himself. Our population were 29 out-patients of a psychiatric clinic. We could demonstrate, that on the basis of an 45-minutes intake-interview it is possible to make a rather good prediction of the therapy outcome -- measured by several clinically relevant personality scales -- though therapists and interviewer were not identical and though there was a waiting period of several weeks between the interview and the start of therapy and though the therapists were rather unexperienced.

Communication↗

PubMed2001

Operating conditions of psychiatric hospitals and early readmission--effects of high patient turnover.

OBJECTIVE: To study the association between hospitals' operating conditions and the risk of early readmission. The hypothesis was that high patient turnover might lead to a rise in the risk of readmission soon after discharge (within 30 days). METHOD: A multivariate model including hospital and patient variables was tested using Cox's regression analysis, adjusting for clustering effects. The material included data from 20 hospitals, with 5,520 patients in the final model. RESULTS: High patient turnover (annual discharges per bed) was significantly associated with an increased risk of readmission (hazard ratio (HR)= 3.37 (95% CI = 2.39-4.75)). In addition, being discharged from a ward with relatively low access to therapists increased the hazard further. CONCLUSION: High patient turnover at the discharging ward was found to increase the patients' hazard of early readmission. This observation supports the hypothesis of a link between the operation conditions of the hospitals and patient outcome on a short time-scale.

Adult↗

PubMed1985

Effect of load and carrying position on the electromyographic activity of the gluteus medius muscle during walking.

Physical therapists often teach people with hip osteoarthritis ways to decrease gluteus medius muscle activity of the stance limb during gait. The rationale for decreasing this muscle activity is that hip muscle contraction needed for frontal plane hip stabilization is responsible for a large component of the hip joint compressive forces during stance. The magnitude and carrying position of external loads during walking are both variables that influence requirements of gluteus medius muscle force. Therefore, the purpose of this study was to determine through EMG, the relative amounts of gluteus medius muscle electrical activity produced during the stance phase of gait when subjects used varying combinations of load size (10 and 20% of body weight) and carrying position of the hands (contralateral or ipsilateral to a given hip, or anterior or posterior to the chest). We studied 24 healthy subjects and used their EMG activity during the stance phase of gait as an indication of the relative amount of myogenic hip compression force. Results indicated statistical differences in EMG according to carrying condition with the contralateral position (with loads of 10 and 20% of body weight) producing the highest levels of EMG. We discuss the kinesiologic reasons for results and the prevention of hip osteoarthritis in occupational settings.

Adult↗

PubMed2003

[Development of a robotic walking simulator for gait rehabilitation].

Restoration of gait is a major concern of rehabilitation after stroke or spinal cord injury. Modern concepts of motor learning favour a task-specific repetitive approach, i.e. "whoever wants to learn to walk again must walk." However, the physical demands this places on the therapist, is a limiting factor in the clinical routine setting. This article describes a robotic walking simulator for gait training that enables wheelchair-bound subjects to freely carry out repetitive practicing of an individually adapted gait pattern under simulation of the manual guidance of an experienced therapist. The technical principle applied makes use of programmable footplates with permanent foot/machine contact in combination with compliance control. The solution chosen comprises a planar parallel-serial hybrid kinematic system with three degrees of freedom that moves the feet in the sagittal plane. Gait analysis while floor walking and stair climbing, clinical practicability and safety aspects were the basis for the design. A variable compliance control enables man-machine interaction, ranging from purely position controlled movement to full compliance during swing phase above a virtual ground profile. In full compliance mode the robotic walking simulator behaves like a haptic device. The concept presented offers new prospects for individualized gait rehabilitation.

Artificial Intelligence↗

PubMedDate not supplied

The pathology of head and neck tumors: vasoformative tumors, part 9B.

There are three principal malignant vasoformative tumors that can be found in the head and neck--hemangiopericytoma, angiosarcoma, and Kaposi's sarcoma. All are uncommon and provide challenges for the pathologist and the therapist both. The histogenesis of each tumor is different. Kaposi's sarcoma has many features which suggest that it is an altered immune-response disease. Angiosarcoma is a malignancy of endothelium. Hemangiopericytoma is a tumor whose cell of origin is considered to be the perithelial pericyte. The general prognosis for patients with Kaposi's sarcoma is good. The biologic course of a hemangiopericytoma is variable and unpredictable, but there appears to be a site dependency. Angiosarcomas, particularly high grade lesions, are resistant to therapy.

Arteriovenous Fistula↗

PubMed2006

Therapists' experiences and perceptions of teamwork in neurological rehabilitation: reasoning behind the team approach, structure and composition of the team and teamworking processes.

BACKGROUND AND PURPOSE: Teamwork and the interdisciplinary team approach have been strongly advocated for use in the provision of neurological rehabilitation services. However, whether teamwork has been adopted, and in what form, has yet to be established. The present study investigated therapists' experiences and perceptions of the reasoning behind the team approach in neurological rehabilitation, the structure and composition of the team within which they worked and the team working process. METHOD: This article reports part of an exploratory qualitative study. Five occupational therapists and five physiotherapists from three teams: a rehabilitation centre; a community team; and a stroke unit based within the UK. Semi-structured interviews were undertaken with each participant and then transcribed. Content and thematic analysis of the qualitative interview data was carried out, with respondents validating both the transcription and analysis stages. RESULTS: Perceived composition and structure of the neurological rehabilitation team was variable across teams and between individual team members. There was disparity as to whether patients were included within the neurological team; the interdisciplinary team approach had not been consistently adopted and there were sub-teams and other team memberships in existence. Reasoning behind the team approach supported the perceived benefits of teamwork from a number of perspectives, and the activities reported as part of the team process were diverse. CONCLUSIONS: Different teams may choose to use different strategies depending on the aims and context of the team effort. In some instances interdisciplinary teamwork and patient-centred approaches were not adopted consistently and the process of teamwork itself is both complex and diverse.

Communication↗

PubMed1994

Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome.

BACKGROUND AND PURPOSE: The relative effectiveness of an extension program and a manipulation program with flexion and extension exercises was examined in patients with low back syndrome. SUBJECTS: Forty-nine patients with less than a 3-month history of low back pain were seen at physical therapy clinics in western Pennsylvania, southern Mississippi, and eastern Missouri during a 6-month period. Twenty-seven of the 49 patients were classified a priori into a treatment-oriented category of extension/mobilization and were then randomly assigned to participate in an extension program or a program of manipulation followed by hand-heel rocks (flexion and extension). Two patients dropped out of the study (1 patient returned to work, and the other patient was unable to comply with the treatment schedule), and 1 patient was eliminated from the study because of magnified illness behavior. The remaining 24 patients (15 male, 9 female; mean age = 44 years, SD = 15, range = 14-73) were assigned randomly and equally to the two groups. Eight physical therapists participated in the study. METHODS: A randomized clinical trial comparing the two regimens was conducted for a 1-week period. Outcome was assessed using an Oswestry Low Back Pain Questionnaire initially (before treatment) and at 3 and 5 days posttreatment, and data were analyzed using a 2 x 3 (group x time) analysis of variance. RESULTS: A significant interaction of the group and time variables was demonstrated, indicating that the rate of positive response was greater in the manipulation/hand-heel rock group than in the extension group. CONCLUSION AND DISCUSSION: In this category of patients with low back pain, the use of manipulation as an adjunct to an ongoing exercise program appears to be warranted.

Acute Disease↗

PubMedDate not supplied

Relaxation therapy for hypertension: setting-specific effects.

We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication. The effect was assessed in multiple settings, including the relaxation therapist's office, the Hypertension Clinic, and the patient's natural environment, the latter using 24-hour automated ambulatory blood pressure measures. Nineteen patients were randomized either to temperature biofeedback-assisted relaxation or to an attention control, "stress education." Antihypertensive medication was kept constant. In the behavioral therapist's office, blood pressure decreased in equivalent amounts with both treatments. Hypertension Clinic nurse blood pressure remained stable or increased with both treatments, but again there was no difference between treatments. Ambulatory blood pressure increased with relaxation therapy and decreased with stress education, the effect being significant for diastolic pressure. The effects on ambulatory blood pressure were limited to the waking hours. The only variable that showed superior effects for relaxation therapy was physician-determined blood pressure. These results call into question the generalizability of the effects of relaxation therapy from one setting to another.

Adult↗

PubMed2002

[Treatment recommendations in psychosomatic rehabilitation -- empirical analyses based on the pension insurers' standardized discharge report].

BACKGROUND: The recommendations for aftercare listed in discharge reports represent a core component of communication between inpatient psychosomatic rehabilitation and ambulatory follow-up care. The standardized discharge report used by the pension insurance institutes makes use of a generic category system for systematization and simplification of recommendations for aftercare. Neither the practice of making recommendations for aftercare as observed by therapists and physicians responsible for treatment in the inpatient setting nor the appropriateness and differentiation of the category system has previously been systematically examined. A randomized sample of discharge reports was analyzed for this purpose. METHODS: A sample of 500 discharge reports from an inpatient-oriented psychosomatic rehabilitation setting were analyzed regarding the categories of recommended aftercare measures and their relationship with socio-demographic variables, clinical diagnosis and sociomedical variables. RESULTS: Outpatient psychotherapy represents the most frequently recommended aftercare treatment, being suggested in nearly 70% of the patients. Further substantial percentages were found in recommendations for areas including occupational rehabilitation, somatic-medical recommendations, and recommendations for health behaviour and self-help groups. In approximately one quarter of the patients, recommendations for aftercare were given that were coded under the category of "other suggestions". In younger and socio-medically burdened patients, recommendations for the fields of occupational rehabilitation and psychotherapy were more frequently given. In patients with a somatic illness or a somatoform disorder as the primary diagnosis, recommendations within the field of outpatient psychotherapy were found less frequently, while recommendations in the somatic-medical area were more commonly found. DISCUSSION: The results give some support for the clinical validity of the form of recommendations given for aftercare measures in an inpatient psychosomatic rehabilitation setting. At the same time, the analyses indicate excessive as well as insufficient differentiation in the generic category system for follow-up treatment recommendations, which could lead to a loss of valuable information at the interface between inpatient and outpatient treatments.

Adult↗

PubMed1994

The Multidisciplinary Approach to Occupational Low Back Pain and Disability.

Chronic disability generates most of the growing costs of occupational low back injuries. When back problems persist for more than a few months, traditional diagnostic and therapeutic approaches are rarely curative. Beyond the challenges of physical impairment, disabling back pain is commonly complicated by psychosocial issues, including depression, fear of reinjury, family discord, and vocational dissatisfaction. The biopsychosocial complexity of chronic disability often demands integrated care from physicians, physical and occupational therapists, psychologists, and vocational counselors. In the past decade, the care of back-injured workers has shifted emphasis from symptom palliation toward functional restoration. This evolution has been possible, in part, through improved quantification of physical capacities. Repeated objective measurements of function guide rehabilitation and recommendations for return to work and other activities. Published results of function-oriented multidisciplinary care depend on the outcome variables reported and the particular socioeconomic setting.

Journal Article↗

PubMed2004

Functional predictors of school participation by children with disabilities.

This study examined the functional requirements that significantly predicted participation of US elementary school children with a variety of disabling conditions (N = 266), in seven different school settings: Transportation, Transitions, Regular classroom, Special classroom, Mealtime, Bathroom, and Playground. Performance on a number of setting-relevant tasks was expected to be predictive of meaningful participation in each school environment. Stepwise multiple regression analyses were conducted to identify the order of importance of the relevant variables as well as the smaller set of functional tasks that best predicted children's participation in each setting. The results revealed that successful participation in the different elementary school settings was strongly associated with performance of both physical and cognitive/behavioural activities. Furthermore, each setting had a unique set of predictors, suggesting that some aspects of function are context-specific. Findings from this study may inform therapists about the most relevant areas of function that support social and physical participation of children with disabilities who are included in regular schools.

Activities of Daily Living↗

PubMed2006

Interrater reliability of the history and physical examination in patients with mechanical neck pain.

OBJECTIVE: To examine the interrater reliability of the history and physical examination in patients with mechanical neck pain. DESIGN: Single-group repeated measures for interrater reliability. SETTING: Outpatient physical therapy clinic. PARTICIPANTS: Twenty-two patients with mechanical neck pain underwent a standardized history and physical examination by a physical therapist. INTERVENTION: Following a 5-minute break, a second therapist who was blind to the findings of examiner 1 performed the second standardized history and physical examination. MAIN OUTCOME MEASURES: The Cohen kappa and weighted kappa were used to calculate the interrater reliability of ordinal level data from the history and physical examination. Intraclass correlation coefficients model 2,1 (ICC(2,1)) and the 95% confidence intervals were calculated to determine the interrater reliability for continuous variables. RESULTS: The kappa coefficients ranged from -.06 to .90 for the variables obtained from the history. Reliability values for categorical data collected during the physical examination ranged from no to substantial agreement depending on the particular test and measure. ICC(2,1) for cervical range of motion (ROM) measurements ranged between .66 and .78. CONCLUSIONS: We have reported the interrater reliability of the history and physical examination in a group of patients with a primary report of neck pain. The reliability variables varied considerably for manual assessment techniques and were significantly higher for the examination of muscle length and cervical ROM. Ultimately, it will be up to each clinician to determine if a particular test or measure poses adequate reliability to assist in the clinical decision making process.

Adult↗

PubMed1991

Attitudes toward problem drinkers, revisited: patient-therapist factors contributing to the differential treatment of patients with alcohol problems.

Although there are many treatment alternative open to people with drinking problems, health professionals still exhibit negative attitudes towards alcoholics. In a previous study, the author demonstrated that those patients who were self-labelled alcoholics were treated in a less preferential manner than those who did not identify as such. This study used both overt and unobtrusive measures to determine whether negative attitudes of intake interviewers towards problem drinkers were elicited by the patients' self-label as an alcoholic or by other variables related to perceived treatment outcome. Pre- and postinterview data on patient likability, doctor's eagerness to work with the patient, interview content, treatment disposition, and patient compliance were collected from first-time patients, and from their interviewers, in the walk-in psychiatry and alcohol treatment units of a large, urban teaching hospital. The results elucidate how stereotypes interact with patient characteristics to influence both professional behavior and patient compliance.

Alcohol Drinking↗

PubMed2002

Satisfaction with physiotherapy among patients at a general hospital in Kuwait.

OBJECTIVE: A pilot survey was conducted with adult patients attending the Physiotherapy Department at the Farwaniah Hospital, Kuwait, during the year 2000, to validate a questionnaire measuring outpatients' satisfaction with different aspects of physiotherapy care and associated socio-demographic factors. METHODS: This study was carried out in the Department of Physiotherapy, Farwaniah Hospital, State of Kuwait, during a time period of 5-months. A structured questionnaire was developed to include questions relating to ease of contact for appointments, the organizational settings, quality of therapeutic services, overall satisfaction with the department, and willingness to re-utilize or to recommend the department in the future, along with socio-demographic data and the duration of the disease. RESULTS: A total of 144 questionnaires were completed by a group of mostly women (64%) married (70%) participants, with a mean age of 40 years. Kuwaitis were 59% of the group, and less than 50% had a secondary education or more. A vast majority of participants perceived the department was easy to contact. Those with lower such perception were relatively older patients. On all other dimensions of satisfaction, the response was generally positive, regardless of socio-demographic variables or duration of disease. Less educated patients had a slightly lower tendency to recommend the department in the future (51%) than more educated ones (60%). CONCLUSION: Patients in Kuwait tend to express high levels of satisfaction with health services, an attitude, which may be biased by cultural reluctance to express public negative views. Alternatively, it may be influenced by the relatively sustained interaction between patients and their therapists. It is important to provide more orientation to older, less educated patients who may feel lost within a process they do not fully comprehend.

Adolescent↗

PubMed1991

Attitudes of a group of South African speech and hearing therapists towards patients with acquired immunodeficiency syndrome (AIDS).

The present study investigated the attitudes, knowledge and fears of a group of 31 speech-language pathologists and audiologists working in 13 hospital settings, concerning patients with AIDS/HIV. Individuals completed an anonymous, self-administered questionnaire assessing self-perceived level of knowledge, actual knowledge of modes of transmission of the AIDS virus and protection procedures, and attitudes and fears associated with treatment of AIDS/HIV patients. Qualitative data concerning responses to this epidemic were also obtained and statistical analyses were completed to determine the relationship between the above mentioned variables. Results indicate that the higher the respondents' level of actual knowledge, the more they reportedly feared the disease. No correlation was found between respondents' level of actual knowledge and their attitudes. Information needs were identified which have important implications for future education. In addition, proposed policy guidelines for speech-language pathologists and audiologists in contact with AIDS/HIV patients, based on the above results of the study are provided.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Treatment of bulimia nervosa: when CBT fails.

Controlled studies have established manual-based cognitive-behavioral therapy (CBT) is the first-line treatment of choice for bulimia nervosa. Nevertheless, its effectiveness is limited. On average, only 50% of patients cease being eating and purging. Of the remainder, some show partial improvement, whereas a small number derive no benefit at all. In treating nonresponders to CBT one option would be to use antidepressant medication. A second would be to adopt interpersonal psychotherapy (IPT), an alternative psychological therapy with empirical support. However, both options have failed to reduce binge eating following unsuccessful CBT. Treating nonresponders is hampered by the lack of treatment-specific predictor variables. Comorbid personality disorder is associated with a poorer response not only to CBT but also alternative therapies. There is no evidence that psychodynamic therapy is effective with complex cases with associated psychopathology. A third option is to use more expanded or intensive CBT. An example of the latter would be concentrated exposure within an inpatient setting. The relative merits of adhering to manual-based treatment versus allowing therapists free reign in individual case formulation are discussed.

Bulimia↗

PubMed2006

A general look at female orgasm and anorgasmia.

Male and female genital anatomy evolves from the same embryonic tissue. Is it therefore possible that males and females have the same potential for orgasmic response? Have forces external to a woman's biology influenced her potential enjoyment of this bodily function, or is female orgasm a by-product of that early sameness and variable because it has no or very little functional or evolutionary benefit? In modern times, we continue to study the anatomy and physiology of female sexual responses. The journey now is to understand the similarities and differences between the male and female sexual responses and be respectful of both. Female sexual response models and the classification of female sexual dysfunctions direct the thoughts and treatments of sexual and relationship therapists. The ultimate aim is to allow each woman to have the best possible sex life and orgasm, namely the one she wants. The psychophysiological treatments for female orgasmic dysfunction are on the whole successful. However, in anorgasmia proven to be biological in aetiology, following menopause for example, physiological changes occur that cannot be resolved by these strategies alone. We need to be supportive of the pharmaceutical industry finding medication that we can appropriately and responsibly use for the good of women with sexual difficulties, because good sexuality is a very important quality of life issue for very many women.

Coitus↗