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Delmonico RL, Tucker LY, Theodore BR, Camicia M, Filanosky C, Haarbauer-Krupa J. Mild Traumatic Brain Injuries and Risk for Affective and Behavioral Disorders. Pediatrics 2024; 153:e2023062340. [PMID: 38268428 PMCID: PMC10983778 DOI: 10.1542/peds.2023-062340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES Recent studies document an association between mild traumatic brain injuries (mTBIs) in children and postinjury psychiatric disorders. However. these studies were subject to limitations in the design, lack of long-term follow-up, and poorly defined psychiatric outcomes. This study determines the incidence and relative risk of postinjury new affective and behavior disorders 4 years after mTBIs. METHODS A cohort study of mTBI cases and matched comparisons within an integrated health care system. The mTBI group included patients ≤17 years of age, diagnosed with mTBI from 2000 to 2014 (N = 18 917). Comparisons included 2 unexposed patients (N = 37 834) per each mTBI-exposed patient, randomly selected and matched for age, sex, race/ethnicity, and date of medical visit (reference date to mTBI injury). Outcomes included a diagnosis of affective or behavioral disorders in the 4 years after mTBI or the reference date. RESULTS Adjusted risks for affective disorders were significantly higher across the first 3 years after injury for the mTBI group, especially during the second year, with a 34% increase in risk. Adjusted risks for behavioral disorders were significant at years 2 and 4, with up to a 37% increase in risk. The age group with the highest risk for postinjury affective and behavioral disorders was 10- to 13-year-old patients. CONCLUSIONS Sustaining an mTBI significantly increased the risks of having a new affective or behavioral disorder up to 4 years after injury. Initial and ongoing screening for affective and behavior disorders following an mTBI can identify persistent conditions that may pose barriers to recovery.
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Affiliation(s)
- Richard L Delmonico
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California
- The Permanente Medical Group, Oakland, California
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente, Oakland, California
| | - Brian R Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California
- The Permanente Medical Group, Oakland, California
| | - Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California
| | - Charles Filanosky
- The Permanente Medical Group, Oakland, California
- Napa-Solano Sports Concussion Clinic, Kaiser Permanente Vacaville Medical Center, Vacaville, California
| | - Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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2
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Camicia M, Lutz BJ, Theodore BR. The preparedness assessment for the transition home after stroke predicts key domains of caregiver health. Top Stroke Rehabil 2022; 30:384-392. [PMID: 35156562 DOI: 10.1080/10749357.2022.2038835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Caregivers of stroke survivors often experience adverse health effects due to poor preparation. OBJECTIVES We evaluate the concurrent and predictive validity of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) family caregiver assessment tool relative to important domains of caregiver health and stroke survivor outcomes. METHODS A convenience sample of caregivers (N = 183) was assessed on several health-related quality of life instruments prior to stroke survivor discharge (T1), and at 30-days (T2) and 90-days (T3) post-discharge. RESULTS Caregivers completed assessments at T1 (N = 183), T2 (N = 116, 63%), and T3 (N = 97, 53%). At T1, the PATH-s demonstrated concurrent validity with depressive symptoms (r = -0.26, p < .001), global health (r = 0.45 p < .001) and activation (r = 0.34, p < .001). The PATH-s also has predicted improvements in T2 outcomes including depressive symptoms (radj = -0.21, p < .05), global health (radj = 0.30, p < .01), perceived stress (radj = -0.30, p < .01), activation (radj = 0.21, p < .05), caregiving-specific health-related quality of life (r = 0.23, p < .05), and caregiver strain (r = -0.36, p < .001). At T3, higher scores on the PATH-s were a significant predictor for improvements in activation (radj = 0.24, p < .05). CONCLUSION The PATH-s demonstrates good concurrent and predictive validity and predicts important domains relevant to caregiver well-being. This can be used to identify gaps in caregiver preparedness so interventions can be tailored to optimize the transition home and mitigate adverse effects of caregiving.
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Affiliation(s)
- Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo, Vallejo, USA
| | - Barbara J. Lutz
- School of Nursing,University of North Carolina-Wilmington, Wilmington, USA
| | - Brian R. Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo, Vallejo, USA
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Camicia M, Lutz BJ, Stram D, Tucker LY, Ray C, Theodore BR. Improving Caregiver Health through Systematic Assessment and a Tailored Plan of Care. West J Nurs Res 2021; 44:307-318. [PMID: 34541990 DOI: 10.1177/01939459211045432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregivers often experience strain and negative effects on their well-being. We tested the effects of a caregiver assessment and tailored care plan for caregivers of patients transitioning home from an inpatient rehabilitation facility (IRF), a study involving two groups: usual care (n = 225) (preimplementation) and intervention (postimplementation) (n = 215). Caregivers in the intervention group were assessed using the 25-item self-reported Preparedness Assessment for the Transition Home during the IRF stay. A tailored care plan was implemented in response to the assessment. Caregivers in both groups completed the Modified Caregiver Strain Index and Global Health Scale at 30- and 90-day postdischarge. After adjusting for baseline and demographics, caregivers in the intervention group reported lower strain (p < .01) and better overall health (p < .05) at 30-day post-IRF discharge, relative to usual care. Implementing a systematic caregiver assessment and tailored care plan in the IRF may mitigate the adverse effects of caregiving.
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Affiliation(s)
- Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA
| | - Barbara J Lutz
- School of Nursing, University of North Carolina-Wilmington, Wilmington, NC, USA
| | - Douglas Stram
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Lue-Yen Tucker
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cristine Ray
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA
| | - Brian R Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA
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Delmonico RL, Theodore BR, Sandel ME, Armstrong MA, Camicia M. Prevalence of depression and anxiety disorders following mild traumatic brain injury. PM R 2021; 14:753-763. [PMID: 34156769 DOI: 10.1002/pmrj.12657] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies have identified an association between traumatic brain injuries and the development of psychiatric disorders in general. However, these studies were subject to limitations that demonstrate the need for a study of a large, clearly defined mild traumatic brain injury (mTBI) population within an integrated healthcare system. OBJECTIVE To determine the prevalence and relative risk of postinjury affective disorders over 4 years following mTBI. DESIGN Cohort study of mTBI cases and matched controls, over a 4-year period. SETTING An integrated healthcare delivery system in California. PATIENTS A total of 9428 adult health plan members diagnosed with mTBI from 2000-2007 and enrolled in the year before injury, during which no TBI was ascertained. Control participants included 18,856 individuals selected based on the following criteria: Two unexposed health plan members per each mTBI-exposed patient were randomly selected and individually matched for age, gender, race/ethnicity, and medical comorbidities. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A diagnosis of affective disorder (depressive, anxiety, and adjustment disorders) in the 4 years after mTBI or the reference date, determined according to the International Classification of Diseases, Ninth Revision, Clinical Modification as well as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. RESULTS Affective disorders were most prominent during the first 12 months with 23% following mTBI and 14% in the control group. Four-year aggregate adjusted odds ratios for having an affective disorder following mTBI were 1.2 (95% CI: 1.1, 1.2; p < .001) and 1.5 (95% CI: 1.5, 1.6; p < .001) for patients with and without prior affective disorders, respectively. CONCLUSION mTBI was associated with a significantly increased risk of having subsequent affective disorders. Screening for and addressing affective disorders at earlier stages following the injury is an important step to avoid persisting conditions that may pose a barrier to full recovery.
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Affiliation(s)
- Richard L Delmonico
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
| | - Brian R Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
| | - M Elizabeth Sandel
- School of Medicine, University of California, Davis, Sacramento, California, USA
| | | | - Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
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Kim S, Capo-Lugo C, Reed WR, Vora A, Ehsanian R, Krishnan S, Hu X, Galantino ML, Mortera MH, Beattie A, Sasson N, Theodore BR, Erb M, Heyn P. Using a Survey to Characterize Rehabilitation Professionals' Perceptions and Use of Complementary, Integrative, and Alternative Medicine. J Altern Complement Med 2020; 26:663-665. [PMID: 32302490 DOI: 10.1089/acm.2019.0383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sonya Kim
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Carmen Capo-Lugo
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - William R Reed
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ariana Vora
- Department of PM&R, Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Reza Ehsanian
- Division of PM&R, Department of Neurosurgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Mary Lou Galantino
- School of Health Sciences, Doctoral Physical Therapy Program, Stockton University, Galloway, NJ, USA.,Physiotherapy Department, University of Witwatersrand, Johannesburg, South Africa.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marianne H Mortera
- Department of Occupational Therapy, NYU Steinhardt, New York University, New York, NY, USA
| | - Aaron Beattie
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Nicole Sasson
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA.,Department of Physical Medicine & Rehabilitation, VA-New York Harbor Healthcare System, New York, NY, USA
| | - Brian R Theodore
- Kaiser Permanente, Kaiser Foundation Rehabilitation Center, Vallejo, CA, USA
| | - Matt Erb
- The Center for Mind-Body Medicine, Washington DC, USA
| | - Patricia Heyn
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
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Langford DJ, Theodore BR, Balsiger D, Tran C, Doorenbos AZ, Tauben DJ, Sullivan MD. Number and Type of Post-Traumatic Stress Disorder Symptom Domains Are Associated With Patient-Reported Outcomes in Patients With Chronic Pain. J Pain 2018; 19:506-514. [PMID: 29307748 DOI: 10.1016/j.jpain.2017.12.262] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/05/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Abstract
Post-traumatic stress disorder (PTSD) commonly accompanies complex chronic pain, yet PTSD is often overlooked in chronic pain management. Using the 4-item Primary Care (PC)-PTSD screening tool, we evaluated the relationship between the number and type of PC-PTSD symptoms endorsed and a set of patient-reported outcomes, including: pain intensity and interference, function, mood, quality of life, and substance abuse risk in a consecutive sample of patients with chronic pain (n = 4,402). Patients completed PainTracker, a Web-based patient-reported outcome tool that provides a multidimensional evaluation of chronic pain, as part of their intake evaluation at a specialty pain clinic in a community setting. Twenty-seven percent of the sample met PC-PTSD screening criteria for PTSD by endorsing 3 of the 4 symptom domains. Significant ordinal trends were observed between increasing number of PTSD symptoms and all outcomes evaluated. The occurrence of even 1 PTSD symptom was associated with overall poorer outcomes, suggesting that subsyndromal PTSD is clinically significant in the context of chronic pain. Among the 4 PTSD domains assessed, "numbness/detachment" was most strongly associated with negative pain outcomes in relative weight analysis. Results from this cross-sectional study suggest that a range of pain-related outcomes may be significantly related to comorbid PTSD. PERSPECTIVE We present evidence that PTSD symptoms are significantly related to a broad set of pain-related patient-reported outcomes. These findings highlight the need to evaluate for PTSD symptoms in patients with chronic pain, especially feelings of numbness or detachment from others, to improve understanding and management of chronic pain.
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Affiliation(s)
- Dale J Langford
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington.
| | - Brian R Theodore
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Danica Balsiger
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Christine Tran
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Ardith Z Doorenbos
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - David J Tauben
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Mark D Sullivan
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
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Abstract
BACKGROUND The United States has a complex healthcare system that is undergoing substantial reformations. There is a need for high-quality, economic evaluations of nursing practice. An updated review of completed economic evaluations relevant to the field of nursing within the U.S. healthcare system is timely and needed. OBJECTIVES The purpose of this study was to evaluate and describe the quantity and quality of economic evaluations in nursing-relevant research performed in the United States between 1997 and 2015. METHODS Four databases were searched. Titles, abstracts, and full-text content were reviewed to identify studies that analyzed both costs and outcomes, relevant to nursing, performed in the United States, and used the quality-adjusted life year to measure effectiveness. For included studies, data were extracted from full-text articles using criteria from U.S. Public Health Service's Panel on Cost-Effectiveness in Health and Medicine. RESULTS Twenty-eight studies met the inclusion criteria. Most (n = 25, 89%) were published in the last decade of the analysis, from 2006 to 2015. Assessment of quality, based on selected items from the panel guidelines, found that the evaluations did not consistently use the recommended societal perspective, use multiple resource utilization categories, use constant dollars, discount future costs and outcomes, use a lifetime horizon, or include an indication of uncertainty in results. The only resource utilization category consistently included across studies was healthcare resources. DISCUSSION Only 28 nursing-related studies meeting the inclusion criteria were identified as meeting robust health economic evaluation methodological criteria, and most did not include all important guideline items. Despite increases in absolute numbers of published studies over the past decade, economic evaluation has been underutilized in U.S. nursing-relevant research in the past two decades.
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Affiliation(s)
- Wendy A Cook
- Wendy A. Cook, PhD, RN, CCNS, is U.S. Navy Nurse Corps Nurse Scientist, Naval Medical Center San Diego, California, and Affiliate Assistant Professor, School of Nursing, University of Washington, Seattle. Megan L. Morrison, PhD, ARNP, FNP-BC, ACHPN, is Palliative and Supportive Care Attending Nurse Practitioner, Northwest Hospital and Medical Center, Seattle, Washington. Linda H. Eaton, PhD, RN, AOCN, is Project Director, Pain and Symptom Management in Rural Communities, School of Nursing, University of Washington, Seattle, and Post-Doctoral Research Fellow, University of Utah College of Nursing, Salt Lake City. Brian R. Theodore, PhD, is Research Assistant Professor, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle. Ardith Z. Doorenbos, PhD, RN, FAAN, is Professor, School of Nursing and School of Medicine, University of Washington, Seattle
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8
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Theodore BR, Mayer TG, Gatchel RJ. Cost-effectiveness of early versus delayed functional restoration for chronic disabling occupational musculoskeletal disorders. J Occup Rehabil 2015; 25:303-15. [PMID: 25194706 DOI: 10.1007/s10926-014-9539-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR. METHODS A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4-8 months of disability, N = 373), intermediate duration (ID: 9-18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness. RESULTS At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88%), work retention (overall 80%), and additional healthcare utilization (overall, 2.2% of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64% in medical costs, and up to 80% in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56% lower when administered early. Overall, ER resulted in estimated cost savings of up to 72% (or almost $170,000 per claim). CONCLUSIONS Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of "last resort".
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Theodore BR, Whittington J, Towle C, Tauben DJ, Endicott-Popovsky B, Cahana A, Doorenbos AZ. Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation. Pain Med 2015; 16:1045-56. [PMID: 25616057 DOI: 10.1111/pme.12688] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. METHODS Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. RESULTS Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. CONCLUSIONS U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits.
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Affiliation(s)
| | | | | | | | | | - Alex Cahana
- Department of Anesthesiology and Pain Medicine
| | - Ardith Z Doorenbos
- Department of Anesthesiology and Pain Medicine.,Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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Eaton LH, Gordon DB, Wyant S, Theodore BR, Meins AR, Rue T, Towle C, Tauben D, Doorenbos AZ. Development and implementation of a telehealth-enhanced intervention for pain and symptom management. Contemp Clin Trials 2014; 38:213-20. [PMID: 24846620 DOI: 10.1016/j.cct.2014.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/07/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
Managing chronic pain effectively is often challenging for health care providers and patients. Telehealth technologies can bridge geographic distance and improve patients' quality of care in communities where access to pain specialists has previously been unavailable. This paper describes the development and evaluation of a telehealth intervention (TelePain) designed to address the need for pain specialist consultation regarding pain and symptom management issues in non-academic medical centers. We describe the theoretical foundation and development of a multifaceted intervention using a cluster randomized clinical trial design. Health care providers and their patients with chronic pain are enrolled in the study. Patient participants receive the intervention (report of symptoms and receipt of a pain graph) weekly for 8 weeks and are contacted at 12 weeks for completion of post-intervention follow-up measures. Their providers attend TelePain sessions which involve a didactic presentation on an evidence-based topic related to pain management followed by patient case presentations and discussion by community clinicians. Symptom management recommendations for each patient case are made by a panel of pain specialists representing internal medicine, addiction medicine, rehabilitation medicine, anesthesiology, psychiatry, and nursing. The outcomes assessed in this randomized trial focus on pain intensity, pain's interference on function and sleep, and anxiety, depression, and cost-effectiveness. Some of the challenges and lessons that we have learned early in implementing the TelePain intervention are also reported.
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Affiliation(s)
- Linda H Eaton
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA.
| | - Debra B Gordon
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA; School of Medicine, University of Washington, Box 356340, Seattle, WA, USA.
| | - Sheryl Wyant
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA.
| | - Brian R Theodore
- School of Medicine, University of Washington, Box 356340, Seattle, WA, USA.
| | - Alexa R Meins
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA.
| | - Tessa Rue
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA.
| | - Cara Towle
- School of Medicine, University of Washington, Box 356340, Seattle, WA, USA.
| | - David Tauben
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA.
| | - Ardith Z Doorenbos
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA; School of Medicine, University of Washington, Box 356340, Seattle, WA, USA.
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Mayer TG, Gatchel RJ, Brede E, Theodore BR. Lumbar surgery in work-related chronic low back pain: can a continuum of care enhance outcomes? Spine J 2014; 14:263-73. [PMID: 24231782 PMCID: PMC4005883 DOI: 10.1016/j.spinee.2013.10.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Systematic reviews of lumbar fusion outcomes in purely workers' compensation (WC) patient populations have indicated mixed results for efficacy. Recent studies on lumbar fusions in the WC setting have reported return-to-work rates of 26% to 36%, reoperation rates of 22% to 27%, and high rates of persistent opioid use 2 years after surgery. Other types of lumbar surgery in WC populations are also acknowledged to have poorer outcomes than in non-WC. The possibility of improving outcomes by employing a biopsychosocial model with a continuum of care, including postoperative functional restoration in this "at risk" population, has been suggested as a possible solution. PURPOSE To compare objective socioeconomic and patient-reported outcomes for WC patients with different lumbar surgeries followed by functional restoration, relative to matched comparison patients without surgery. STUDY DESIGN/SETTING A prospective cohort study of chronic disabling occupational lumbar disorder (CDOLD) patients with WC claims treated in an interdisciplinary functional restoration program. PATIENT SAMPLE A consecutive cohort of 564 patients with prerehabilitation surgery completed a functional restoration and was divided into groups based on surgery type: lumbar fusion (F group, N=331) and nonfusion lumbar spine surgery (NF group, N=233). An unoperated comparison group was matched for length of disability (U group, N=349). OUTCOME MEASURES Validated patient-reported measures of pain, disability, and depression were administered pre- and postrehabilitation. Socioeconomic outcomes were collected via a structured 1-year "after" interview. METHODS All patients completed an intensive, medically supervised functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach. The writing of this article was supported in part by National Institutes of Health Grant 1K05-MH-71892; no conflicts of interest are noted among the authors. RESULTS The F group had a longer length of disability compared with the NF and U groups (M=31.6, 21.7, and 25.9 months, respectively, p<.001). There were relatively few statistically significant differences for any socioeconomically relevant outcome among groups, with virtually identical postrehabilitation return-to-work (F=81%, NF=84%, U=85%, p=.409). The groups differed significantly after surgery on diagnosis of major depressive disorder and opioid dependence disorder as well as patient-reported depressive symptoms and pain intensity prerehabilitation. However, no significant differences in patient-reported outcomes were found postrehabilitation. Prerehabilitation opioid dependence disorder significantly predicted lower rates of work return and work retention as well as higher rates of treatment-seeking behavior. Higher levels of prerehabilitation perceived disability and depressive symptoms were significant risk factors for poorer work return and retention outcomes. CONCLUSIONS Lumbar surgery in the WC system (particularly lumbar fusion) have the potential achieve positive outcomes that are comparable to CDOLD patients treated nonoperatively. This study suggests that surgeons have the opportunity to improve lumbar surgery outcomes in the WC system, even for complex fusion CDOLD patients with multiple prior operations, if they control postoperative opioid dependence and prevent an excessive length of disability. Through early referral of patients (who fail to respond to usual postoperative care) to interdisciplinary rehabilitation, the surgeon determining this continuum of care may accelerate recovery and achieve socioeconomic outcomes of relevance to the patient and WC jurisdiction through the combination of surgery and postoperative rehabilitation.
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Affiliation(s)
- Tom G. Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Robert J. Gatchel
- Department of Psychology, College of Science, University of Texas at Arlington, Arlington, TX; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Brian R. Theodore
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
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12
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Cahana A, Dansie EJ, Theodore BR, Wilson HD, Turk DC. Redesigning delivery of opioids to optimize pain management, improve outcomes, and contain costs. Pain Med 2012; 14:36-42. [PMID: 23279325 DOI: 10.1111/pme.12013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Chronic pain is a public health concern, and in the last decade, there has been a dramatic increase in the use and abuse of prescription opioids for chronic non-cancer pain. METHODS We present an overview of a five-component model of pain management implemented at the University of Washington Division of Pain Medicine designed to facilitate recent state guidelines to reduce the risks associated with long-term use of prescription opioids. RESULTS Central to the model described are guidelines for best clinical practice, a collaborative care approach, telehealth solutions, comprehensive prescription-monitoring, and measurement-based care. DISCUSSION The model presented is a patient-centered, efficient, and cost-effective approach to the management of chronic pain.
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Affiliation(s)
- Alex Cahana
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Robinson JP, Theodore BR, Dansie EJ, Wilson HD, Turk DC. The role of fear of movement in subacute whiplash-associated disorders grades I and II. Pain 2012; 154:393-401. [PMID: 23318127 DOI: 10.1016/j.pain.2012.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/22/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
Fear and avoidance of activity may play a role in fostering disability in whiplash-associated disorders (WAD). This study examined the role of fear after WAD and assessed the effectiveness of 3 treatments targeting fear. People still symptomatic from WAD grade I-II injuries approximately 3months previously (n=191) completed questionnaires (eg, Neck Disability Index [NDI]) and were randomized to 1 of the treatments: (1) informational booklet (IB) describing WAD and the importance of resuming activities, (2) IB+didactic discussions (DD) with clinicians reinforcing the booklet, and (3) IB+imaginal and direct exposure desensitization (ET) to feared activities. DD and ET participants received three 2-hour treatment sessions. Absolute improvements in NDI were in predicted direction (ET=14.7, DD=11.9, IB=9.9). ETs reported significantly less posttreatment pain severity compared with the IB (Mean=1.5 vs 2.3, P<.001, d=0.6) and DD (M=1.5 vs 2.0, P=.039, d=0.6) groups. Reduction in fear was the most important predictor of improvement in NDI (β=0.30, P<.001), followed by reductions in pain (β=0.20, P=.003) and depression (β=0.18, P=.004). The mediational analysis confirmed that fear reduction significantly mediated the effect of treatment group on outcome. Results highlight the importance of fear in individuals with subacute WAD and suggest the importance of addressing fear via exposure therapy and/or educational interventions to improve function.
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Affiliation(s)
- James P Robinson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Abstract
OBJECTIVE The criterion commonly used to determine whether radiofrequency neurotomy may be recommended is based on patient-reported, short-term pain relief following facet block injections. This study evaluated the concordance between two commonly used outcomes for pain relief: the pain numerical rating scale (NRS) and the global perceived improvement (GPI) scale. DESIGN This is a retrospective cohort study. METHODS Data were obtained from a consecutive cohort of patients through a review of the electronic medical records, with the following inclusion criteria: medial branch facet blocks at either cervical or lumbar spinal regions. OUTCOME MEASURES Pain NRS (baseline, postprocedure, and hourly up to 6 hours) and GPI scale are expressed as percent improvement at 6 hours, relative to baseline. RESULTS The percent improvement in pain NRS corresponded to 49%, 43%, 34%, 21%, and 36% for baseline vs immediately post-block, 1 hour, 3 hours, 6 hours and average of all postscores, respectively. Average GPI reported at 6 hours was 44%, and differed significantly only to the baseline vs 6 hours percent improvement on the NRS (P < 0.01). Multiple regression analysis indicated that there were no demographic or baseline factors that accounted for the discrepancy between GPI vs NRS. CONCLUSIONS Asking patients about their pain relief in retrospect can be misleading. It is possible that patients' report on the GPI is weighed by their total experience of pain reduction and retrospective recall. Therefore, when choosing to address percent improvement on NRS measures, it is important to take into account multiple instances of NRS measures following treatment.
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Affiliation(s)
- Brian R Theodore
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
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Gofeld M, Restrepo-Garces CE, Theodore BR, Faclier G. Pulsed radiofrequency of suprascapular nerve for chronic shoulder pain: a randomized double-blind active placebo-controlled study. Pain Pract 2012; 13:96-103. [PMID: 22554345 DOI: 10.1111/j.1533-2500.2012.00560.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The suprascapular nerve block is frequently implemented to treat chronic shoulder pain. Although effective the nerve blockade provides only a short-term relief, and more compelling apaproaches have been investigated. Pulsed radiofrequency (pRF) has been anecdotally reported as safe and reliable method. However, formal efficacy study has not been published. Ostensibly evidence-based validation of a new method is necessary for both scholastic and practical purposes. METHODS This study was designed as a randomized active placebo-control double-blind trial. Because of encountered difficulties in recruitment and high rate of dropout, the study was redesigned as to allow a smaller sample size and statistical analyses were performed utilizing the last observation carry forward method. Lidocaine injections alone or with combination of the pRF were performed. Participants were followed up during 6 months, and multiple subjective and objective outcome variables were recorded. RESULTS Thirteen of 22 participants completed 6 months follow-up. Dropout rate was higher in the lidocaine group. A significant linear trend (P < 0.05) for improvement on the numeric rating scale, Shoulder Pain and Disability Index and Constant-Murley score was observed in the pRF group, but not in the lidocaine group. Patients in the pRF group were on average more satisfied than the lidocaine group at 1 month (P = 0.041) and at 3 months (P = 0.035). DISCUSSION Considering limitations of the study design and statistics, it seems plausible to attribute better results in the pRF group to unique properties of this physical modality.
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Affiliation(s)
- Michael Gofeld
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington 98105, USA.
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Robinson JP, Theodore BR, Wilson HD, Waldo PG, Turk DC. Determination of fibromyalgia syndrome after whiplash injuries: methodologic issues. Pain 2011; 152:1311-1316. [PMID: 21419574 DOI: 10.1016/j.pain.2011.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/29/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
Problems in diagnosing fibromyalgia syndrome (FM) among motor vehicle collision (MVC) patients with whiplash (WL) include the following: the predominance of tender points (TPs) in the neck/shoulder girdle region; the 3-month duration of widespread pain criterion; and, the stability of diagnosis. The present study examined the prevalence of FM in a cohort (N = 326) patients with persistent neck pain 3 months after WL injury who were enrolled in a treatment program. Physical examinations were performed at baseline and at the end of treatment. Results indicated that WL patients had a greater proportion of neck/shoulder girdle TPs, relative to distal TPs. Compared with a matched cohort of treatment-seeking FM patients, WL patients indicated less distal TPs (mean = 7.3 TPs vs. mean = 5.6 TPs, P < .001), but were equivalent on neck/shoulder girdle TPs (mean = 9.0 TPs vs. 9.2 TPs, NS). Baseline prevalence of FM for the WL cohort based on ACR criteria was 14% (95% CI = 10%-18%), adjusted TP criterion discounting for neck/shoulder tenderness indicated a prevalence of FM of 8% (95% CI = 5%-11%). Finally, 63% of patients meeting American College of Rheumatology FM criteria at baseline did not meet this criterion at post-treatment (∼6-months after an MVC). In conclusion, present criteria used in determining FM may result in spuriously inflated rates of diagnosis among WL patients because of persistent localized tenderness after an MVC. Furthermore, the transient nature of FM "symptoms" among WL patients should be taken into account before making a final diagnosis. The present criteria used in determining fibromyalgia may result in spuriously inflated rates of diagnosis among whiplash patients because of persistent localized tenderness after motor vehicle collisions.
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Affiliation(s)
- James P Robinson
- Department of Physical Medicine, Rehabilitation, University of Washington, Seattle, WA, USA Department of Anesthesiology, Pain Medicine, University of Washington, Seattle, WA, USA West Swanzey, P.O. Box 603, NH 03469, USA
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Theodore BR. Methodological problems associated with the present conceptualization of the minimum clinically important difference and substantial clinical benefit. Spine J 2010; 10:507-9. [PMID: 20494811 DOI: 10.1016/j.spinee.2010.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 04/07/2010] [Indexed: 02/03/2023]
Affiliation(s)
- Brian R Theodore
- Department of Anesthesiology & Pain Medicine, University of Washington, PO Box 356540, Seattle, WA 98195, USA.
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Atli A, Theodore BR, Turk DC, Loeser JD. Intrathecal opioid therapy for chronic nonmalignant pain: a retrospective cohort study with 3-year follow-up. Pain Med 2010; 11:1010-6. [PMID: 20492572 DOI: 10.1111/j.1526-4637.2010.00876.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was the analysis of outcomes after intrathecal opioid treatment. Design. Retrospective chart review cohort study. Setting. Tertiary care university hospital and clinic. Patients. Adults of both sexes were included. Interventions. The intervention consisted of the implantation of intrathecal catheter and subcutaneous programmable pump to deliver opioids. OUTCOME MEASURES These included intrathecal and oral opioid consumption, self-reported pain levels, and complications. RESULTS We observed reduction of visual analog scale scores, decrease in oral opioid consumption. Stable long-term (3 year) pain reports. We also noted gradual increases in intrathecal opioid consumption. Pre-implant opioid consumption was inversely correlated with treatment success. The complication rate was approximately 20%. CONCLUSIONS We conclude that intrathecal opioids without adjunctive intrathecal medications have a favorable outcome. Some patients are able to eliminate oral opioids. Results seem stable for prolonged periods, although some increase in intrathecal opioids dosing may be required.
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Affiliation(s)
- Aysel Atli
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington 98195, USA
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Gatchel RJ, Theodore BR. Resultados Basados en la Evidencia para la Investigación y Práctica ClÃnica del Dolor. Pain Pract 2009. [DOI: 10.1111/j.1533-2500.2009.00325.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Howard KJ, Mayer TG, Theodore BR, Gatchel RJ. Patients With Chronic Disabling Occupational Musculoskeletal Disorder Failing to Complete Functional Restoration: Analysis of Treatment-Resistant Personality Characteristics. Arch Phys Med Rehabil 2009; 90:778-85. [DOI: 10.1016/j.apmr.2008.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 10/17/2008] [Accepted: 11/08/2008] [Indexed: 10/20/2022]
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Dersh J, Mayer T, Theodore BR, Polatin P, Gatchel RJ. Do psychiatric disorders first appear preinjury or postinjury in chronic disabling occupational spinal disorders? Spine (Phila Pa 1976) 2007; 32:1045-51. [PMID: 17450081 DOI: 10.1097/01.brs.0000261027.28779.52] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An epidemiologic prevalence study. OBJECTIVES To clarify the temporal association between work-related injury claims and psychiatric disorders in patients with chronic disabling occupational spinal disorders (CDOSDs). SUMMARY OF BACKGROUND DATA Few empirical data are available regarding the "chicken-or-egg" question of which occurs first: the injury or incident culminating in the painful CDOSD or the psychiatric disturbance. METHODS Subjects attended a tertiary interdisciplinary rehabilitation program. Psychiatric disorders were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID-DSM-IV). Psychiatric disorders were characterized as preexisting if they manifested themselves before the work-related injury claim (whether or not they resolved, continued, or reoccurred after injury). They were determined postinjury diagnoses only if they manifested for the first time after the injury claim. RESULTS A total of 38.7% of the present cohort had at least one preexisting major psychiatric disorder, while 98.9% developed one or more psychiatric disorders for the first time after injury onset (57.9% when pain disorder was excluded). The percentage of patients with preexisting psychiatric disorders was lower than general population base rates (48%). The first onset of certain psychiatric disorders was found to be elevated in patients only after the work-related injury; these included Pain Disorder (95.7%), Major Depressive Disorder (49.7%), and Opioid Dependence (15%). Moreover, 5 times as many patients with MDD, and 10 times as many with opioid dependence, developed these disorders for the first time after the injury. CONCLUSIONS In general, psychiatric disturbance is not a risk factor for developing a CDOSD. Psychiatric disorders are much more likely to develop after the onset of the work injury, indicating that such injuries and accompanying stressors are likely to be precipitants, rather than consequences, of psychopathology.
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Pool GJ, Schwegler AF, Theodore BR, Fuchs PN. Role of gender norms and group identification on hypothetical and experimental pain tolerance. Pain 2006; 129:122-9. [PMID: 17156919 DOI: 10.1016/j.pain.2006.10.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 08/28/2006] [Accepted: 10/09/2006] [Indexed: 11/24/2022]
Abstract
Previous research indicates that men typically tolerate more pain in experimental settings than women. One likely explanation for these group differences in pain tolerance is conformity to traditional, gender group social norms (i.e., the ideal man is masculine and tolerates more pain; the ideal woman is feminine and tolerates less pain). According to self-categorization theory, norms guide behavior to the degree that group members adopt the group identity. Therefore, high-identifying men are expected to conform to gender norms and tolerate more pain than high-identifying women who conform to different gender norms as a guide for their behavior. We conducted two studies to investigate whether gender group identification moderates individuals' conformity to pain tolerance and reporting norms. In the first study, participants indicated their gender identification and expected tolerance of a hypothetical painful stimulus. As anticipated, high-identifying men reported significantly greater pain tolerance than high-identifying women. No differences existed between low-identifying men and women. To determine if self-reported pain tolerance in a role-playing scenario corresponds to actual pain tolerance in an experimental setting, the second study examined pain tolerance to a noxious stimulus induced by electrical stimulation of the index finger. The experimental outcome revealed that high-identifying men tolerated more painful stimulation than high-identifying women. Further, high-identifying men tolerated more pain than low-identifying men. These results highlight the influence of social norms on behavior and suggest the need to further explore the role of norms in pain reporting behaviors.
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Affiliation(s)
- Gregory J Pool
- Department of Psychology, St. Mary's University, San Antonio, TX 78228, USA.
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Abstract
BACKGROUND The QuickDASH, an abbreviated form of the Disabilities of the Arm, Shoulder and Hand Questionnaire, uses a graded-adjectives ordinal measurement response scale. In order to improve the sensitivity of the measure and to make it compatible with widely used measures of pain and disability, a visual analog scale version was developed. The present study investigated the reliability of the new version over time when used for the evaluation of patients undergoing treatment. METHODS A test-retest model with a two-day interval was used to evaluate a sample of thirty-eight consecutive patients in an interdisciplinary tertiary rehabilitation setting who were identified as having an upper extremity disorder. RESULTS The intraclass correlation coefficient indicating test-retest reliability was 0.90 for the eleven-item QuickDASH visual analog scale questionnaire (without the work component) and 0.94 for the fifteen-item questionnaire (with the work component), neither of which was significantly different from the results reported for the original questionnaire. CONCLUSIONS The QuickDASH visual analog scale questionnaire has acceptable reliability over time, and it can be used as an alternative to the original QuickDASH.
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Affiliation(s)
- Leonard N Matheson
- Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park, St. Louis, MO 63108, USA
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Gatchel RJ, Mayer TG, Theodore BR. The pain disability questionnaire: relationship to one-year functional and psychosocial rehabilitation outcomes. J Occup Rehabil 2006; 16:75-94. [PMID: 16752090 DOI: 10.1007/s10926-005-9005-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The Pain Disability Questionnaire (PDQ) is a new functional assessment instrument designed for evaluating chronic disabling musculoskeletal disorders. It is useful for assessing function/disability as affected by pain. This is the first study to assess the predictive validity of the PDQ in its relationship to 1-year post-treatment work- and health-related outcomes in a chronic disabling occupational musculoskeletal disorder (CDOMD) population. DESIGN A prospective cohort of CDOMD patients (n=150) completed a prescribed functional restoration rehabilitation program, with PDQ and other psychosocial measures evaluated before and immediately after treatment. A structured telephonic interview for objective work- and health-related outcomes took place 1-year following treatment. RESULTS Lower rates of work retention were associated with more severe pre-treatment PDQ scores. Higher post-treatment PDQ were associated with decreased return-to-work rates, decreased work retention and a greater percentage seeking health care from a new provider. In addition, PDQ scores were also associated with psychosocial measures such as depression and perceived pain intensity, as well as alternative measures of disability. CONCLUSIONS Results demonstrated the ability of this simple and psychometrically-sound disability rating scale for systematic functional assessment in predicting treatment outcomes in patients with CDOMD. Results support the further use of the PDQ as a standard treatment outcomes measure in this area of musculoskeletal disorders.
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Affiliation(s)
- Robert J Gatchel
- Department of Psychology, College of Science, University of Texas at Arlington, Arlington, TX, USA
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