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Kuo PB, Lehavot K, Thomas RM, Dashtestani K, Peterson AC, Korpak AM, Turner AP, Williams RM, Czerniecki JM, Norvell DC, Littman AJ. Gender differences in prosthesis-related outcomes among veterans: Results of a national survey of U.S. veterans. PM R 2024; 16:239-249. [PMID: 37343123 DOI: 10.1002/pmrj.13028] [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] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Women with lower extremity amputations (LEAs) tend to have poorer prosthesis-related outcomes than men, although the literature is sparse. To our knowledge, there are no prior studies examining prosthesis-related outcomes of women veterans with LEAs. OBJECTIVE To examine gender differences (overall and by type of amputation) among veterans who underwent LEAs between 2005 and 2018, received care at the Veterans Health Administration (VHA) prior to undergoing amputation, and were prescribed a prosthesis. It was hypothesized that compared to men, women would report lower satisfaction with prosthetic services, poorer prosthesis fit, lower prosthesis satisfaction, less prosthesis use, and worse self-reported mobility. Furthermore, it was hypothesized that gender differences in outcomes would be more pronounced among individuals with transfemoral than among those with transtibial amputations. DESIGN Cross-sectional survey. Linear regressions were used to assess overall gender differences in outcomes and gender differences based on type of amputation in a national sample of veterans. SETTING VHA medical centers. PARTICIPANTS The sample consisted of 449 veterans who self-identified their gender (women = 165, men = 284) with transtibial (n = 236), transfemoral (n = 135), and bilateral LEAs (n = 68) including all amputation etiologies. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Orthotics and Prosthetics User's Survey, Trinity Amputation and Prosthesis Experiences Scale, and Prosthetic Limb Users Survey of Mobility-Short Form were used to assess satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, prosthesis use, and self-reported mobility. RESULTS Women had poorer self-reported mobility than men (d = -0.26, 95% confidence interval -0.49 to -0.02, p < .05); this difference was small. There were no statistically significant gender differences in satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, daily hours of prosthesis use, or by amputation type. CONCLUSIONS Contrary to the hypothesis, prosthesis-related outcomes were similar between men and women with LEAs. Minimal differences may in part be due to receiving care from the VHA's integrated Amputation System of Care.
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Affiliation(s)
- Patty B Kuo
- VA Puget Sound Health Care System, Seattle, Washington, USA
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Keren Lehavot
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Rachel M Thomas
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, USA
| | - Krista Dashtestani
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, USA
| | - Alexander C Peterson
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Anna M Korpak
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rhonda M Williams
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joseph M Czerniecki
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Daniel C Norvell
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Alyson J Littman
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Reed DE, Lehinger EA, Cobos B, Williams RM, McGeary CA, McGeary DD. The mediating role of posttraumatic stress disorder symptoms in pain cognitions among Veterans with chronic pain. Mil Psychol 2024:1-10. [PMID: 38376946 DOI: 10.1080/08995605.2024.2309897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/13/2023] [Accepted: 01/07/2024] [Indexed: 02/22/2024]
Abstract
Symptoms of posttraumatic stress disorder (PTSD) are highly prevalent among Veterans with chronic pain. Considerable research has examined the intersection of chronic pain and PTSD symptoms. However, it remains unclear whether changes in PTSD may potentially serve a mechanistic role in improving unhelpful pain cognitions for individuals with chronic pain. The present research contributes to the foundational knowledge by addressing this question. Baseline data from a randomized controlled trial targeting pain-related disability for Veterans (n = 103; mean age 43.66; SD = 10.17) with musculoskeletal pain and depression and/or PTSD symptoms were used. Cross-sectional mediation analyses showed that PTSD symptoms mediated the relationship between pain severity and pain catastrophizing, and between pain severity and pain acceptance. After controlling for depression, the mediation involving pain catastrophizing remained significant, while the mediation for pain acceptance did not. Although limitations exist, results point to several treatment recommendations, including ensuring that depressive affect, PTSD-specific symptoms, and attention to both body and mind are included in treatment. Results also provide preliminary evidence for examining these associations longitudinally to improve our understanding of this population and corresponding treatment recommendations.
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Affiliation(s)
- David E Reed
- Department of Health Systems and Population Health, University of Washington, Seatle, Washington
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington
| | - Elizabeth A Lehinger
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Briana Cobos
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Psychiatry and Behavioral Sciences, University of Texas at San Antonio, San Antonio, Texas
| | - Rhonda M Williams
- Department of Rehabilitation Medicine, VA Puget Sound Health Care System, Seattle, Washington
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Anastas TM, Turner AP, Ho EJ, Day MA, Ehde DM, Jensen MP, Williams RM. Evaluating the benefits of a second pain treatment following a clinical trial. Rehabil Psychol 2024; 69:74-83. [PMID: 37338442 PMCID: PMC10728346 DOI: 10.1037/rep0000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To examine the value of including an open label phase after a clinical trial of pain treatments by examining participant characteristics and potential benefits. METHOD Secondary data analysis. Veterans with chronic pain who completed a randomized controlled trial (RCT) comparing hypnosis, mindfulness meditation, and pain education were invited to participate in an open label phase. Average and worst pain intensities, pain interference, and depression were assessed pre- and postopen label phase; global impressions of change and treatment satisfaction were assessed at postopen label phase only. RESULTS Of those who were offered the open label phase, 40% (n = 68) enrolled. Enrollees were likely to be older, to have attended more sessions in the RCT, to be satisfied with their first treatment, and to perceive improvement in their ability to manage pain after the RCT. In the open label phase, depression and worst pain decreased across all three treatment conditions. No other improvements were observed. However, most Veterans perceived improvements in pain intensity, ability to manage pain, and pain interference, and were satisfied with the second intervention. CONCLUSIONS There appears to be some value to adding an open label phase to the end of a trial of pain treatments. A substantial portion of study participants elected to participate and reported it to be beneficial. Exploring data from an open label phase can illuminate important aspects of patient experience, barriers to and facilitators of care, as well as treatment preferences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Tracy M Anastas
- Rehabilitation Care Service, VA Puget Sound Health Care System
| | - Aaron P Turner
- Rehabilitation Care Service, VA Puget Sound Health Care System
| | - Erica J Ho
- Rehabilitation Care Service, VA Puget Sound Health Care System
| | - Melissa A Day
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine
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Wilson M, Skeiky L, Muck RA, Miller MA, Hansen DA, Williams RM, Jensen MP, Van Dongen HPA. Sleep and Pain in Veterans with Chronic Pain: Effects of Psychological Pain Treatment and Temporal Associations. Nat Sci Sleep 2023; 15:1061-1077. [PMID: 38144708 PMCID: PMC10748706 DOI: 10.2147/nss.s418532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Chronic pain is highly prevalent in US military Veterans. Non-opioid and non-pharmacologic treatments are recommended when clinically appropriate, but research on the mechanisms underlying benefits of these treatments is lacking. Here, we examined the role of sleep in the effects of three non-pharmacologic pain treatments in Veterans. Specifically, we investigated whether treatment effects on sleep predicted treatment effects on pain occurring later, or vice versa. Methods Veterans enrolled in a randomized controlled trial were invited to participate in this supplementary sleep study. A total of 174 Veterans were randomized to one of three 8-session, in-person, group-based pain treatments: hypnosis, mindfulness meditation, or education control. Measurements included self-reported sleep disturbance, pain intensity, and pain catastrophizing; sleep duration was assessed with actigraphy. Sleep and pain measurements were obtained at baseline, posttreatment, and 3-month posttreatment follow-up. Results At baseline, average pain intensity was moderate (mean ± SD: 5.7 ± 1.7 on the 0-10 Numeric Rating Scale), pain catastrophizing was just below the clinically relevant threshold (mean ± SD: 28.6 ± 12.2 on the Pain Catastrophizing Scale), and subjective sleep disturbance exceeded the US population average (mean ± SD: 58.5 ± 8.1 on the Patient Reported Outcomes Measurement Information System Sleep Disturbance - Short Form). By contrast, objective sleep duration was consistent with the recommended daily sleep amount of 7-8 h for adults (mean ± SD: 8.3 ± 1.4 h). Across treatment conditions, pain intensity, pain catastrophizing, and subjective sleep disturbance were significantly less at posttreatment and 3-month follow-up than at baseline (p < 0.001). Actigraphic sleep duration did not differ significantly as a function of time. There was a high degree of covariation among the measures of pain intensity, pain catastrophizing, and sleep disturbance (p < 0.05). However, self-reported sleep disturbance was not significantly correlated with actigraphic sleep duration (|r| <= 0.13, p > 0.05). Sleep and pain variables observed at prior assessments predicted these same variables at subsequent assessments. There was no significant evidence that changes in pain preceded changes in sleep or that changes in sleep preceded changes in pain (all p > 0.05). Discussion For this study's Veterans, treatment-related changes in sleep and pain appeared to occur in parallel. The concomitant changes in sleep and pain suggest that therapies improving pain in Veterans may yield attendant benefits for the treatment of sleep, and possibly vice versa.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, WA, USA
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
| | - Lillian Skeiky
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - Rachael A Muck
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - Megan A Miller
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Devon A Hansen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
| | - Rhonda M Williams
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Translational Medicine and Physiology, Washington State University, Spokane, WA, USA
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Clark JMR, Keller AV, Maye JE, Jak AJ, O'Neil ME, Williams RM, Turner AP, Pagulayan KF, Twamley EW. Neuropsychological Correlates of PTSD and Depressive Symptom Improvement in Compensatory Cognitive Training for Veterans With a History of Mild Traumatic Brain Injury. Mil Med 2023:usad442. [PMID: 37966488 DOI: 10.1093/milmed/usad442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/08/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI), depression, and PTSD are highly prevalent in post-9/11 veterans. With the comorbidity of depression and PTSD in post-9/11 veterans with mTBI histories and their role in exacerbating cognitive and emotional dysfunction, interventions addressing cognitive and psychiatric functioning are critical. Compensatory Cognitive Training (CCT) is associated with improvements in prospective memory, attention, and executive functioning and has also yielded small-to-medium treatment effects on PTSD and depressive symptom severity. We sought to examine neuropsychological correlates of PTSD and depressive symptom improvement in veterans with a history of mTBI who received CCT. MATERIALS AND METHODS Thirty-seven post-9/11 veterans with mTBI histories and cognitive complaints received 10 weekly 120-minute CCT group sessions. Participants completed a baseline neuropsychological assessment, including tests of premorbid functioning, attention/working memory, processing speed, verbal learning/memory, and executive functioning, and completed psychiatric symptom measures (PTSD and depression) at baseline, post-treatment, and a 5-week follow-up. Paired samples t-tests were used to examine statistically significant changes in PTSD (total and symptom cluster scores) and depressive symptom scores over time. Pearson's correlations were calculated between neuropsychological scores and PTSD and depressive symptom change scores at post-treatment and follow-up. Neuropsychological measures identified as significantly correlated with psychiatric symptom change scores were entered as independent variables in multivariable regression analyses to examine their association with symptom change at post-treatment and follow-up. RESULTS Over 50% of CCT participants had clinically meaningful improvement in depressive symptoms (≥17.5% score reduction), and over 20% had clinically meaningful improvement in PTSD symptoms (≥10-point improvement) at post-treatment and follow-up. Examination of PTSD symptom cluster scores revealed a statistically significant improvement in avoidance/numbing at follow-up. Bivariate correlations indicated that worse baseline performance on Category Fluency was moderately associated with PTSD symptom improvement at post-treatment. Worse performance on both Category Fluency and Category Switching Accuracy was associated with improvement in depressive symptoms at post-treatment and follow-up. Worse performance on Trail-Making Number-Letter Switching was also associated with improvement in depressive symptoms at follow-up. Subsequent regression analyses revealed that worse processing speed and worse aspects of executive functioning at baseline were associated with depressive symptom improvement at post-treatment and follow-up. CONCLUSIONS Worse baseline performances on tests of processing speed and aspects of executive functioning were significantly associated with improvements in PTSD and depressive symptoms during the trial. Our results suggest that cognitive training may bolster skills that are helpful for PTSD and depressive symptom reduction and that those with worse baseline functioning may benefit more from treatment because they have more room to improve.
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Affiliation(s)
- Jillian M R Clark
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- Mental Health Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Amber V Keller
- Research Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
| | - Jacqueline E Maye
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- Mental Health Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Amy J Jak
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- Mental Health Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Maya E O'Neil
- VA Portland Health Care System, Portland, OR 97239, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Rhonda M Williams
- VA Puget Sound Health Care System, Seattle, WA 98108, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA 98108, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Kathleen F Pagulayan
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- Research Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
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McGiffin JN, Ehde DM, Williams RM, Bonanno GA. Heterogeneous trajectories of depression and resilience following limb amputation. PM R 2023. [PMID: 37916584 DOI: 10.1002/pmrj.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To identify longitudinal trajectories of depression in the first 6 months following limb loss and to explore baseline predictors of trajectories, including pain and demographic factors. A secondary aim was to evaluate whether trajectories of depression were associated with elevated symptoms of posttraumatic stress (PTS) at 6 months. DESIGN Secondary longitudinal data analysis of an inception cohort study of persons with new-onset limb loss. Participants completed assessments at three intervals (initial, 3 months, and 6 months). SETTING Hospitalized care, acute rehabilitation, ambulatory care, and community. PARTICIPANTS Participants were recruited from consecutive cases of amputation surgery in a metropolitan hospital system over a period of 4 years (2002-2007). The final sample (n = 203) was predominantly White (79.3%) and male (78.8%) with an average age of 49.4 years (standard deviation [SD] = 14.6). MAIN OUTCOME MEASURE(S) Depression was assessed via the Patient Health Questionnaire-9 (PHQ-9); posttraumatic stress symptoms were measured via the PTSD checklist- Civilian Version (PCL-C). RESULTS Four trajectories of depression were identified via Latent Growth Mixture Modeling: Resilience (73.2%), Chronic Depression (11.2%), Emerging Depression (8.9%), and Recovery (6.7%). Average pain intensity significantly predicted trajectory membership. Membership in the Chronic Depression class predicted elevated 6-month PTS compared to all other classes; membership in the Resilience class predicted lower PTS than in the Chronic and Emerging Depression classes but did not differentiate from the Recovery trajectory. CONCLUSIONS Findings reveal that the course of depression post-amputation is heterogenous, with varying profiles of symptom development, maintenance, and remission. A majority of individuals were classified as Resilient, whereas a substantial minority of individuals developed clinically significant depression between 3 and 6 months (Emerging Depression), suggesting that early screening during acute care may be insufficient. We detected a significant prospective relation between depression trajectories and distal PTS, advancing the potential clinical utility of trajectory modeling as a risk surveillance tool.
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Affiliation(s)
- Jed N McGiffin
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rhonda M Williams
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- VA Puget Sound Health Care System, Seattle Division, Rehabilitation Care Services, Seattle, Washington, USA
| | - George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York City, New York, USA
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Reed DE, Williams RM, Engel CC, Zeliadt SB. Introducing the integrated model of co-occurring chronic pain and posttraumatic stress disorder: Adding meaning-making and existential concepts to current theory. Psychol Trauma 2023:2024-18624-001. [PMID: 37856393 DOI: 10.1037/tra0001591] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Making meaning out of the experience of chronic pain and posttraumatic stress disorder (PTSD) is a core process of recovery and symptom management of the comorbidity and a key active ingredient in the treatment for these conditions. Managing the effects of chronic pain and PTSD symptoms often evokes anxieties that could be considered existential (e.g., loss of meaning in life and concerns about one's identity). However, current theoretical models of co-occurring chronic pain and PTSD do not capture core meaning-making processes involved in either condition, resulting in the potential to overlook their centrality. The objective of the current work is to integrate current theoretical models of co-occurring chronic pain and PTSD with theory and science related to meaning-making and existential anxiety. METHOD A targeted literature review was used to develop a novel model of co-occurring chronic pain and PTSD. RESULTS The present work introduces the integrated model of co-occurring chronic pain and PTSD, which is a first attempt at integrating current theoretical perspectives of co-occurring chronic pain and PTSD with the literature on meaning-making and closely related existential perspectives. We outline model-specific hypotheses and describe model implications and future directions. CONCLUSIONS The model provides clinicians and researchers with a more thorough conceptualization of how chronic pain and PTSD interact, which symptoms to target, and which outcomes may be important for individuals who have both chronic pain and PTSD. As a result, the model has the potential to improve pain and PTSD outcomes, and perhaps health outcomes more broadly, within this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- David E Reed
- Department of Health Systems and Population Health, School of Public Health, University of Washington
| | - Rhonda M Williams
- Rehabilitation Care Service, VA Puget Sound Healthcare System, Seattle Division
| | - Charles C Engel
- Department of Health Systems and Population Health, School of Public Health, University of Washington
| | - Steven B Zeliadt
- Department of Health Systems and Population Health, School of Public Health, University of Washington
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Turner AP, Edwards KA, Jensen MP, Ehde DM, Day MA, Williams RM. Effects of hypnosis, mindfulness meditation, and education for chronic pain on substance use in veterans: A supplementary analysis of a randomized clinical trial. Rehabil Psychol 2023; 68:261-270. [PMID: 37289535 PMCID: PMC10524362 DOI: 10.1037/rep0000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE/OBJECTIVE To examine the impact of three behavioral interventions for chronic pain on substance use. RESEARCH METHOD/DESIGN Participants were 328 Veterans with chronic pain receiving care at one of two Veterans Affairs Medical Centers in the northwest United States. Participants were randomly assigned to one of three 8-week manualized in-person group treatments: (a) hypnosis (HYP), (b) mindfulness meditation (MM), or (c) active education control (ED). Substance use frequency was assessed using 10 individual items from the WHO-ASSIST, administered at baseline prior to randomization and at 3- and 6-month posttreatment. RESULTS Baseline substance use (i.e., any use) in the past 3 months was reported by 22% (tobacco), 27% (cannabis), and 61% (alcohol) of participants. Use of all other substances assessed was reported by < 7% of participants. Results showed that MM, as compared to ED, significantly reduced risk of daily cannabis use by 85% and 81% at the 3- and 6-month posttreatment follow-ups, respectively, after adjusting for baseline use. HYP, as compared to ED, significantly reduced risk of daily cannabis use by 82% at the 6-month posttreatment follow-up after adjusting for baseline use. There was no intervention effect on tobacco or alcohol use at either posttreatment follow-up. CONCLUSIONS/IMPLICATIONS HYP and MM for chronic pain may facilitate reductions in cannabis use, even when reducing such use is not a focus of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Aaron P. Turner
- Department of Rehabilitation Medicine, University of Washington
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Karlyn A. Edwards
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychology, University of New Mexico
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington
| | - Dawn M. Ehde
- Department of Rehabilitation Medicine, University of Washington
| | - Melissa A. Day
- Department of Rehabilitation Medicine, University of Washington
- School of Psychology, The University of Queensland, Australia
| | - Rhonda M. Williams
- Department of Rehabilitation Medicine, University of Washington
- VA Puget Sound Health Care System, Seattle, Washington, USA
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Edwards KA, Reed DE, Anderson D, Harding K, Turner AP, Soares B, Suri P, Williams RM. Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers. PM R 2023; 15:999-1011. [PMID: 36633497 DOI: 10.1002/pmrj.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Karlyn A Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, California, USA
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound Health Care, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Derek Anderson
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Kaitlin Harding
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Aaron P Turner
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Bosco Soares
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Pradeep Suri
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USA
| | - Rhonda M Williams
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Nguyen AV, Newman AK, Williams RM, Mendoza MA, Hakimian S, Day MA, Jensen MP. The Moderators Of Immediate Response To Hypnosis And Mindfulness Meditation: Secondary Analyses From A Clinical Trial. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Mendoza MA, Newman AK, Williams RM, Nguyen AV, Hakimian S, Day MA, Jensen MP. Moderating Effects Of EEG-Assessed Bandwidth Power And Hypnotizability On The Immediate Effects Of Four Psychological Treatments On Pain Reduction. The Journal of Pain 2023. [DOI: 10.1016/j.jpain.2023.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Littman AJ, Peterson AC, Korpak A, Czerniecki JM, Turner A, Norvell DC, Williams RM, Lehavot K. Differences in prosthetic prescription between men and women Veterans following transtibial or transfemoral lower extremity amputation: a longitudinal cohort study (2005-2018). Arch Phys Med Rehabil 2023:S0003-9993(23)00146-6. [PMID: 36906098 DOI: 10.1016/j.apmr.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/08/2022] [Revised: 01/26/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate whether prosthetic prescription differed by gender and the extent to which differences were mediated by measured factors. DESIGN Retrospective longitudinal cohort study using data from Veterans Health Administration (VHA) administrative databases. SETTING VHA patients throughout the United States. PARTICIPANTS The sample included 20,889 men and 324 women who had an incident transtibial or transfemoral amputation between 2005 and 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Time to prosthetic prescription (up to one year). We used parametric survival analysis (an accelerated failure time [AFT] model) to assess gender differences. We estimated mediation effects of amputation level, pain comorbidity burden, medical comorbidities, depression, and marital status on time to prescription. RESULTS In the 1 year after amputation, the proportion of women (54.3%) and men (55.7%) prescribed a prosthesis was similar. However, after controlling for age, race, ethnicity, enrollment priority, VHA region, and service-connected disability, the time to prosthetic prescription was significantly faster among men compared to women (Acceleration factor= 0.71, 95% CI 0.60-0.86). The difference in time to prosthetic prescription between men and women was significantly mediated by amputation level (19%), pain comorbidity burden (-13%), and marital status (5%), but not medical comorbidities or depression. CONCLUSION Though the proportion of patients with prosthetic prescription at 1-year post-amputation was similar between men and women, women received prosthetic prescriptions more slowly than men, suggesting that more work is needed to understand barriers to timely prosthetic prescriptions among women, and how to intervene to reduce those barriers.
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Affiliation(s)
- Alyson J Littman
- Seattle Epidemiologic Research Information Center, VA Puget Sound Health Care System, Seattle, Washington; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| | - Alexander C Peterson
- Seattle Epidemiologic Research Information Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Anna Korpak
- Seattle Epidemiologic Research Information Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Joseph M Czerniecki
- VA Center for Limb Loss and Mobility (CLiMB), VA Puget Sound, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Aaron Turner
- VA Center for Limb Loss and Mobility (CLiMB), VA Puget Sound, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington
| | - Daniel C Norvell
- VA Center for Limb Loss and Mobility (CLiMB), VA Puget Sound, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Rhonda M Williams
- VA Center for Limb Loss and Mobility (CLiMB), VA Puget Sound, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington
| | - Keren Lehavot
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington; Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington
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Clark JMR, Mahmood Z, Jak AJ, Huckans M, O'Neil ME, Roost MS, Williams RM, Turner AP, Pagulayan KF, Storzbach D, Twamley EW. Neuropsychological Performance and Functional Capacity Following Mild Traumatic Brain Injury in Veterans. J Head Trauma Rehabil 2022; 37:E488-E495. [PMID: 36345556 DOI: 10.1097/htr.0000000000000748] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the relationship between neuropsychological functioning and performance-based functional capacity in veterans with a history of mild traumatic brain injury (mTBI), as well as the moderating effects of age and psychiatric symptoms on this relationship. SETTING Three Veterans Affairs medical centers. PARTICIPANTS One hundred nineteen Iraq/Afghanistan veterans with a history of mTBI and self-reported cognitive difficulties. DESIGN Cross-sectional, secondary data analysis of baseline measures in a randomized controlled trial. MAIN MEASURES The main outcome measure, functional capacity, was assessed using the objective and performance-based University of California San Diego Performance-based Skills Assessment-Brief. A global deficit score (GDS) was created as a composite score for performance on a battery of neuropsychological measures assessing domains of attention, processing speed, executive functioning, and verbal memory performance. Posttraumatic stress disorder (PTSD) symptom severity was assessed using the PTSD Checklist-Military Version, and depressive symptom severity was assessed using the Beck Depression Inventory, Second Edition. RESULTS Bivariate analyses indicated that worse neuropsychological performance (ie, higher GDS) and greater PTSD symptom severity were associated with worse communication abilities and worse overall functional capacity. Multiple linear regressions demonstrated that GDS and PTSD symptom severity explained 9% of the variance in communication and 10% of the variance in overall functional capacity; however, GDS emerged as the only significant predictor in both regressions. Age, PTSD, and depressive symptom severity did not moderate the relationship between GDS and overall functional capacity. Performance in the verbal learning and memory domain emerged as the strongest neuropsychological predictor of communication and overall functional capacity. CONCLUSIONS Worse neuropsychological functioning was moderately associated with worse performance-based functional capacity, even when accounting for PTSD symptom severity. Verbal learning and memory was the primary neuropsychological domain driving the relationship with functional capacity; improvement in verbal learning and memory may translate into improved functional capacity.
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Affiliation(s)
- Jillian M R Clark
- Center of Excellence for Stress and Mental Health (Drs Clark, Jak, and Twamley), Mental Health Service (Drs Clark and Jak), and Research Service (Ms Mahmood and Dr Twamley), VA San Diego Healthcare System, San Diego, California; Department of Psychiatry, University of California San Diego, La Jolla (Drs Jak and Twamley); SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California (Ms Mahmood); VA Portland Health Care System, Portland, Oregon (Drs Huckans, O'Neil, Roost, and Storzbach); Department of Psychiatry, Oregon Health & Science University, Portland (Drs Huckans, O'Neil, Roost); VA Puget Sound Health Care System, Seattle, Washington (Drs Williams, Turner, and Pagulayan); Departments of Rehabilitation Medicine (Drs Williams and Turner) and Psychiatry and Behavioral Sciences (Dr Pagulayan), University of Washington School of Medicine, Seattle
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Williams RM, Day MA, Ehde DM, Turner AP, Ciol MA, Gertz KJ, Patterson D, Hakimian S, Suri P, Jensen MP. Effects of hypnosis vs mindfulness meditation vs education on chronic pain intensity and secondary outcomes in veterans: a randomized clinical trial. Pain 2022; 163:1905-1918. [PMID: 35082248 DOI: 10.1097/j.pain.0000000000002586] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Effective, rigorously evaluated nonpharmacological treatments for chronic pain are needed. This study compared the effectiveness of training in hypnosis (HYP) and mindfulness meditation (MM) with an active education control (ED). Veterans (N = 328) were randomly assigned to 8 manualized, group-based, in-person sessions of HYP (n = 110), MM (n = 108), or ED (n = 110). Primary (average pain intensity [API]) and secondary outcomes were assessed at pretreatment, posttreatment, and 3 and 6 months posttreatment. Treatment effects were evaluated using linear regression, a generalized estimating equation approach, or a Fisher exact test, depending on the variable. There were no significant omnibus between-group differences in pretreatment to posttreatment change in API; however, pretreatment to posttreatment improvements in API and several secondary variables were seen for participants in all 3 conditions. Participation in MM resulted in greater decreases in API and pain interference at 6 months posttreatment relative to ED. Participation in HYP resulted in greater decreases in API, pain interference, and depressive symptoms at 3 and 6 months posttreatment compared with ED. No significant differences on outcomes between HYP and MM were detected at any time point. This study suggests that all 3 interventions provide posttreatment benefits on a range of outcomes, but the benefits of HYP and MM continue beyond the end of treatment, while the improvements associated with ED dissipate over time. Future research is needed to determine whether the between-group differences that emerged posttreatment are reliable, whether there are benefits of combining treatments, and to explore moderating and mediating factors.
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Affiliation(s)
- Rhonda M Williams
- VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Melissa A Day
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
- School of Psychology, University of Queensland, Queensland, Australia
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Kevin J Gertz
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - David Patterson
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Shahin Hakimian
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Pradeep Suri
- VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
- Clinical Learning, Evidence and Research (CLEAR) Center, University of Washington, Seattle, WA, United States
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
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Wilson M, Skeiky L, Muck RA, Honn KA, Williams RM, Jensen MP, Van Dongen HPA. Pain Catastrophizing Mediates the Relationship Between Pain Intensity and Sleep Disturbances in U.S. Veterans With Chronic Pain. Mil Med 2022; 188:usac065. [PMID: 35306565 PMCID: PMC10363005 DOI: 10.1093/milmed/usac065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/29/2022] [Accepted: 02/24/2022] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Veterans with chronic pain frequently report comorbid disruptions in sleep and psychological dysfunction. The purpose of this study was to investigate whether psychological function variables mediate the sleep-pain relationship. Knowledge regarding such contributing factors can inform the development and optimization of treatments for sleep disturbances and pain. MATERIALS AND METHODS In an IRB-approved, registered clinical trial, we collected objective sleep data from U.S. military Veterans with chronic pain (N = 184, ages 23-81) using wrist actigraphy for 7 days and self-reported survey data assessing sleep quality, pain intensity, and psychological function (depression, anxiety, post-traumatic stress disorder, and pain catastrophizing). We investigated the associations between objectively measured and self-reported sleep quality and self-reported pain intensity. In addition, using parallel mediation analyses, we examined whether psychological function variables mediated these associations. RESULTS Actigraphy showed suboptimal sleep duration (less than 7 hours) and sleep fragmentation for most participants. Self-reported poor sleep quality and pain intensity were significantly correlated. Pain catastrophizing was found to mediate the association between self-reported sleep quality and pain intensity. CONCLUSIONS Sleep disturbances in this sample of Veterans with chronic pain included insufficient sleep, fragmented sleep, and perceived poor sleep quality. Analyses suggest that poor perceived sleep quality and pain intensity are mediated via pain catastrophizing. The finding highlights the potential importance of pain catastrophizing in Veterans with chronic pain. Future longitudinal research is needed to determine the extent to which treatments that reduce pain catastrophizing might also improve both sleep and pain outcomes.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, WA 99202, USA
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
| | - Lillian Skeiky
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Rachael A Muck
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Kimberly A Honn
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
| | - Rhonda M Williams
- VA Puget Sound Health Care System, Seattle, WA 98108, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA 99202, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA
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16
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Reed DE, Bokhour BG, Gaj L, Barker AM, Douglas JH, DeFaccio R, Williams RM, Engel CC, Zeliadt SB. Whole Health Use and Interest Across Veterans With Co-Occurring Chronic Pain and PTSD: An Examination of the 18 VA Medical Center Flagship Sites. Glob Adv Health Med 2022; 11:21649561211065374. [PMID: 35174004 PMCID: PMC8841911 DOI: 10.1177/21649561211065374] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Veterans Healthcare Administration (VHA) conducted a large demonstration project of a holistic Whole Health approach to care in 18 medical centers, which included making complementary and integrative health (CIH) therapies more widely available. This evaluation examines patterns of service use among Veterans with chronic pain, comparing those with and without PTSD. Methods We assessed the use of Whole Health services in a cohort of Veterans with co-occurring chronic pain and PTSD (n = 1698; 28.9%), comparing them to Veterans with chronic musculoskeletal pain only (n = 4170; 71.1%). Data was gathered from VA electronic medical records and survey self-report. Whole Health services were divided into Core Whole Health services (e.g., Whole Health coaching) and CIH services (e.g., yoga). Logistic regression was used to determine whether Veterans with co-occurring chronic pain and PTSD utilized more Whole Health services compared to Veterans with chronic pain but without PTSD. Results A total of 40.1% of Veterans with chronic pain and PTSD utilized Core Whole Health services and 53.2% utilized CIH therapies, compared to 28.3% and 40.0%, respectively, for Veterans with only chronic pain. Adjusting for demographics and additional comorbidities, Veterans with comorbid chronic pain and PTSD were 1.24 ( 95% CI: 1.12, 1.35, P ≤ .001) times more likely than Veterans with chronic pain only to use Core Whole Health services, and 1.23 ( 95% CI: 1.14, 1.31, P ≤ .001) times more likely to use CIH therapies. Survey results also showed high interest levels in Core Whole Health services and CIH therapies among Veterans who were not already using these services. Conclusion Early implementation efforts in VHA led to high rates of use of Core Whole Health and CIH therapy use among Veterans with co-occurring chronic pain and PTSD. Future assessments should examine how well these additional services are meeting the needs of Veterans in both groups.
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Affiliation(s)
- David E. Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA, United States
| | - Lauren Gaj
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
| | - Anna M. Barker
- Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
| | - Jamie H. Douglas
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States
| | - Rian DeFaccio
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States
| | - Rhonda M. Williams
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Charles C. Engel
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Steven B. Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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Day MA, Matthews N, Mattingley JB, Ehde DM, Turner AP, Williams RM, Jensen MP. Change in Brain Oscillations as a Mechanism of Mindfulness-Meditation, Cognitive Therapy, and Mindfulness-Based Cognitive Therapy for Chronic Low Back Pain. Pain Med 2021; 22:1804-1813. [PMID: 33561289 DOI: 10.1093/pm/pnab049] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Psychological treatments for chronic low back pain (CLBP) are effective. However, limited research has investigated their neurophysiological mechanisms. This study examined electroencephalography- (EEG-) assessed brain oscillation changes as potential mechanisms of cognitive therapy (CT), mindfulness-meditation (MM), and mindfulness-based cognitive therapy (MBCT) for CLBP. The a priori bandwidths of interest were changes in theta, alpha and beta power, measured at pre- and post-treatment. DESIGN A secondary analysis of a clinical trial. SETTING University of Queensland Psychology Clinic. SUBJECTS Adults (N = 57) with CLBP who completed pre- and post-treatment EEG and pain outcome assessments. METHODS EEG data were examined for five regions of interest (ROIs); the primary outcome was pain intensity. RESULTS A significant reduction in theta (P=.015) and alpha (P=.006) power in the left frontal ROI across all treatments was found, although change in theta and alpha power in this region was not differentially associated with outcome across treatments. There were significant reductions in beta power in all five ROIs across all treatments (P≤.013). Beta power reduction in the central ROI showed a significant association with reduced pain intensity in MBCT only (P=.028). Changes in other regions were not statistically significant. CONCLUSIONS These findings provide support for the capacity of psychological CLBP treatments to induce changes in brain activity. The reduced beta power in all five ROIs indicated that all three treatments engendered a state of lowered cortical arousal. The growing body of research in this area could potentially inform novel directions towards remedying central nervous system abnormalities associated with CLBP.
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Affiliation(s)
- Melissa A Day
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Natasha Matthews
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Jason B Mattingley
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Aaron P Turner
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Rehabilitation Care Service/Polytrauma, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rhonda M Williams
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Rehabilitation Care Service/Polytrauma, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Day MA, Williams RM, Turner AP, Ehde DM, Jensen MP. Transdiagnostic Cognitive Processes in Chronic Pain and Comorbid PTSD and Depression in Veterans. Ann Behav Med 2021; 56:157-167. [PMID: 34038509 DOI: 10.1093/abm/kaab033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/13/2022] Open
Abstract
BACKGROUND Chronic pain in Veterans is a major problem compounded by comorbid posttraumatic stress disorder (PTSD) and depression. Adopting a transdiagnostic framework to understanding "shared territory" among these diagnoses has the potential to inform our understanding of the underlying cognitive processes and mechanisms that transverse diagnostic boundaries. PURPOSE To examine the associations between pain-related cognitive processes (diversion, distancing, absorption, and openness), pain intensity, PTSD and depressive symptoms, and the extent to which Veterans with chronic pain with and without comorbid PTSD and depression engage in different/similar pain-related cognitive processes. METHODS Secondary analysis of pretreatment data with a subsample (n = 147) of Veterans with chronic pain from a larger clinical trial. Pretreatment PCL-5 and PROMIS Depression scales were used to categorize participants into three groups: (a) Pain-only; (b) Pain-PTSD; and (c) Pain-PTSD-DEP. RESULTS Compared to the Pain-only group, the Pain-PTSD and Pain-PTSD-DEP groups reported significantly greater pain intensity, PTSD and depressive symptoms, and ruminative pain absorption. The Pain-PTSD-DEP group had significantly lower pain diversion and pain openness scores. When diversion and openness were used within the Pain-PTSD-DEP group, however, they were both associated with lower pain intensity and openness was additionally associated with lower PTSD scores. However, in the Pain-PTSD group, pain openness was associated with higher depression scores. CONCLUSIONS Across increasing complexity of comorbidity profiles (i.e., one vs. two comorbid conditions), ruminative absorption with pain emerged as a cognitive process that transverses diagnoses and contributes to worse outcomes. Nonjudgmental acceptance may not be universally beneficial, potentially depending upon the nature of comorbidity profiles.
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Affiliation(s)
- Melissa A Day
- School of Psychology, University of Queensland, 330 McElwain Building, Brisbane, QLD 4072, Australia.,Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rhonda M Williams
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
| | - Aaron P Turner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.,VA Puget Sound Health Care System, Seattle, WA, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Turner AP, Wegener ST, Williams RM, Ehde DM, Norvell DC, Yanez ND, Czerniecki JM, Study Group V. Self-Management to Improve Function After Amputation: A Randomized Controlled Trial of the VETPALS Intervention. Arch Phys Med Rehabil 2021; 102:1274-1282. [PMID: 33811854 DOI: 10.1016/j.apmr.2021.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To (1) evaluate the effects of a group-based self-management treatment intervention (VETPALS) on physical and psychosocial functioning (primary outcomes) and quality of life (secondary outcome) in individuals with amputation and (2) examine the feasibility and acceptability of the intervention in a large national health care system. DESIGN Randomized controlled trial with masked outcome assessment. SETTING Five Veterans Affairs medical centers geographically dispersed across the United States. PARTICIPANTS 147 individuals with amputation during the past 2 years due to chronic limb threatening ischemia (N=147). INTERVENTIONS Participants were randomized into VETPALS (N =71) or education control (N=76). VETPALS consisted of a 4-hour workshop and 4 additional 2-hour sessions addressing self-management skills, health and activity, managing emotions, communication and social support, and maintaining goals and gains. Education control consisted of the provision of amputation-related educational materials and provider follow-up if requested. MAIN OUTCOME MEASURES Primary outcomes were physical functioning (Short Musculoskeletal Functional Assessment) and psychosocial functioning (Patient Health Questionnaire-9). Secondary outcomes were quality of life (global) and quality of life (satisfaction with health) from the World Health Organization Quality of Life Scale (brief). Assessment was conducted at baseline, 6 weeks (treatment completion), and 6 months (follow-up). RESULTS Participants randomized to VETPALS reported significantly improved psychosocial functioning and quality of life (satisfaction with health) relative to controls at 6 months (B=1.84; 95% confidence interval, 0.37,3.31 and B=-0.61; 95% confidence interval, -1.11,-0.12, respectively). There were no differences in physical functioning over time between VETPALS and education control at either time point. Follow-up multiple imputation sensitivity analyses produced an identical pattern of results. Among VETPALS participants, treatment initiation was low (56%), but treatment retention (93% attended 4 of 5 classes) and overall satisfaction (100% reported very helpful or better and would recommend to a friend) were high. CONCLUSIONS Group-based self-management improves psychosocial functioning for individuals with amputation due to chronic limb threatening ischemia. In-person participation is challenging for this population, but individuals who successfully initiate treatment typically persist and are highly satisfied.
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Affiliation(s)
- Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Rhonda M Williams
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Daniel C Norvell
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - N David Yanez
- Department of Anesthesia, Yale University, New Haven, CT
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Vetpals Study Group
- Louis Stokes VA Medical Center, Cleveland, OH; James A. Haley Veterans' Hospital, Tampa, FL; Michael E. Debakey VA Medical Center, Houston, TX; VA Puget Sound Health Care System, Seattle, WA; Minneapolis VA Medical Center, Minneapolis, MN; Department of Rehabilitation Science and Biomedical Engineering, University of Minnesota, Minneapolis, MN
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20
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Turner AP, Jensen MP, Day MA, Williams RM. Behavioral activation and behavioral inhibition: An examination of function in chronic pain. Rehabil Psychol 2020; 66:57-64. [PMID: 32150432 DOI: 10.1037/rep0000316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The objective of the study was to examine the BIS-BAS model of chronic pain. This model posits that 2 neurophysiological systems-the behavioral inhibition system (BIS) sensitized to and activated by punishment cues and the behavioral activation system (BAS) sensitized to and activated by reward cues-make independent and concurrent contributions to 2 domains of pain-related function: pain interference and positive function despite pain. The study additionally hypothesized that BIS and BAS sensitivity would have different associations with these 2 different aspects of pain-related function. BIS activation would be more strongly correlated with pain interference and BAS would be more strongly correlated with positive function despite pain. Research Method/Design: This was a cohort study consisting of the baseline assessments of 328 veterans enrolled in a large clinical trial examining 3 psychosocial interventions for chronic pain. RESULTS In multivariable regression adjusting for demographic factors and pain intensity, BIS was associated with greater pain interference and less positive function despite pain. BAS was associated with greater positive function despite pain but to a lesser degree than BIS. CONCLUSIONS As hypothesized, BIS and BAS both contributed to pain-related function; however, BIS displayed stronger associations with both pain interference and positive function despite pain. Thus, the hypothesis that BIS-BAS relationships would differ based on the nature of the functional outcome (BIS resulting in poorer function because of pain and BAS better function despite pain) was only partially supported. Findings of the current study suggest the role of BIS in chronic pain may be more pervasive across functional outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Aaron P Turner
- Rehabilitation Care Service, VA Puget Sound Health Care System
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | | | - Rhonda M Williams
- VA Puget Sound Health Care System, and Department of Rehabilitation Medicine, University of Washington
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Williams RM, Ehde DM, Day M, Turner AP, Hakimian S, Gertz K, Ciol M, McCall A, Kincaid C, Pettet MW, Patterson D, Suri P, Jensen MP. The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans. Contemp Clin Trials 2020; 90:105935. [PMID: 31926321 PMCID: PMC7072005 DOI: 10.1016/j.cct.2020.105935] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions. METHODS Participants will include up to 343 Veterans with chronic pain due to a broad range of etiologies, randomly assigned to one of three 8-week manualized in-person group treatments: (1) Hypnosis (HYP), (2) Mindfulness Meditation (MM), or (3) Education Control (EDU). PROJECTED OUTCOMES The primary aim of the study is to compare the effectiveness of HYP and MM to EDU on average pain intensity measured pre- and post-treatment. Additional study aims will explore the effectiveness of HYP and MM compared to EDU on secondary outcomes (i.e., pain interference, sleep, depression, anxiety and PTSD), and the maintenance of effects at 3- and 6-months post-treatment. Participants will have electroencephalogram (EEG) assessments at pre- and post-treatment to determine if the power of specific brain oscillations moderate the effectiveness of HYP and MM (Study Aim 2) and examine brain oscillations as possible mediators of treatment effects (exploratory aim). Additional planned exploratory analyses will be performed to identify possible treatment mediators (i.e., pain acceptance, catastrophizing, mindfulness) and moderators (e.g., hypnotizability, treatment expectations, pain type, cognitive function). SETTING The study treatments will be administered at a large Veterans Affairs Medical Center in the northwest United States. The treatments will be integrated within clinical infrastructure and delivered by licensed and credentialed health care professionals.
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Affiliation(s)
- Rhonda M Williams
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America; University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America.
| | - Dawn M Ehde
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Melissa Day
- The University of Queensland, School of Psychology, Faculty of Health & Behavioral Sciences, St. Lucia Campus, Brisbane, QLD 4072, Australia
| | - Aaron P Turner
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America; University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Shahin Hakimian
- University of Washington School of Medicine, Department of Neurology, Harborview Medical Center, 325 Ninth Ave, Box 359745, Seattle, WA 98104, United States of America
| | - Kevin Gertz
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Marcia Ciol
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Alisha McCall
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America
| | - Carrie Kincaid
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America
| | - Mark W Pettet
- University of Washington, Integrated Brain Imaging Center, Department of Radiology, 1959 NE Pacific St., Box 357115, Seattle, WA 98195, United States of America
| | - David Patterson
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Pradeep Suri
- VA Puget Sound Health Care System, 1660 S. Columbian Way, RCS-117, Seattle, WA 98108, United States of America; University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
| | - Mark P Jensen
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Ninth & Jefferson Building, Box 359612, Seattle, WA 98104, United States of America
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22
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McKernan LC, Finn MTM, Patterson DR, Williams RM, Jensen MP. Clinical Hypnosis for Chronic Pain in Outpatient Integrative Medicine: An Implementation and Training Model. J Altern Complement Med 2020; 26:107-112. [PMID: 31904997 DOI: 10.1089/acm.2019.0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Introduction: Clinical hypnosis for pain management cultivates specific skills to enhance general self-regulation and address pain. Hypnosis is well suited to integrative medicine settings; however, questions persist about its feasibility. This article describes a financially viable hypnosis practice model implemented in an integrative medicine clinic, providing initial feasibility data about rates of referral, participation, reimbursement, and provider retention. The specific processes required to establish and implement hypnosis services were detailed, including instruction in billing, reimbursement data, and a training model to enhance reach of services. Materials and methods: Insurer reimbursement data and operational costs were examined from three hypnosis groups conducted between September 2017 and March 2018. Furthermore, information on referral patterns and enrollment in treatment was collected from program initiation in September 2017 to January 2019. Provider retention in training with the expansion of supervision in the program's second year was also examined. Results: Of 258 individuals referred to hypnosis, 124 (48%) enrolled in group treatment. Analysis of insurer reimbursement over a subset of enrollees from three completed groups (N = 26) indicated an average collection of $95.85 per patient per session, equating to $706.86 per patient for the eight-session treatment. This extrapolates to $4,926.82 in total per seven-person group for the entirety of the eight-session treatment. After an annual training workshop, provider retention significantly increased (to 81% of eligible trained providers) with the initiation of twice-monthly clinical supervision focusing on transitioning from training to practice. Conclusion: This analysis indicates that a training- and practice-based research model of clinical hypnosis is feasible and financially sustainable in an integrative medicine setting.
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Affiliation(s)
- Lindsey C McKernan
- Department of Psychiatry and Behavioral Sciences and Vanderbilt University Medical Center, Nashville, TN.,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.,Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael T M Finn
- Department of Psychiatry and Behavioral Sciences and Vanderbilt University Medical Center, Nashville, TN.,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.,Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - David R Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Rhonda M Williams
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.,VA Puget Sound Healthcare System, Seattle, WA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Arewasikporn A, Roepke AM, Turner AP, Alschuler KN, Williams RM, Amtmann D, Molton IR. Goal Pursuit, Goal Adjustment, and Pain in Middle-Aged Adults Aging With Physical Disability. J Aging Health 2019; 31:214S-240S. [PMID: 31718416 DOI: 10.1177/0898264319827142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/15/2022]
Abstract
Objective: Aging with physical disability disrupts one's ability to achieve valued goals due to changes in symptoms and function. It is unclear how to cope optimally in this context. This study examined whether two possible strategies-tenacious goal pursuit (TGP) and flexible goal adjustment (FGA)-were associated with reduced pain interference and depressive symptoms and greater well-being, and protected against pain intensity, and FGA was more protective with increasing age and worse physical function. Method: Middle-aged adults with muscular dystrophy, multiple sclerosis, post-polio syndrome, or spinal cord injury (N = 874; MAGE = 58.3 years, range = 46-68; MDISEASEDURATION = 26.2 years, range = 2-67) completed two questionnaires, a year apart. Results: TGP and FGA use was associated with greater well-being. FGA use predicted decreased depressive symptoms. Concurrent use of both predicted decreased pain interference. Discussion: Adults with disability employ a variety of goal management strategies. Findings support TGP and FGA as potential intervention targets for healthy aging with disabilities.
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Affiliation(s)
- Anne Arewasikporn
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Ann Marie Roepke
- Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Aaron P Turner
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Rhonda M Williams
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Dagmar Amtmann
- University of Washington School of Medicine, Seattle, USA
| | - Ivan R Molton
- University of Washington School of Medicine, Seattle, USA
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24
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Roepke AM, Turner AP, Henderson AW, Goldberg SB, Norvell DC, Czerniecki JM, Williams RM. A Prospective Longitudinal Study of Trajectories of Depressive Symptoms After Dysvascular Amputation. Arch Phys Med Rehabil 2018; 100:1426-1433.e1. [PMID: 30605638 DOI: 10.1016/j.apmr.2018.11.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/22/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Characterize the course of depressive symptoms during the first year after dysvascular amputation and identify factors that predict symptom trajectories. DESIGN Prospective cohort study of individuals undergoing lower extremity amputation (LEA), surveyed at 4 time points (perioperative period, 6 weeks, 4 months, and 12 months postamputation). Multilevel modeling was used to describe and predict trajectories. SETTING Four Veterans Affairs medical centers, a university hospital, and a level I trauma center. PARTICIPANTS Participants (N=141; 74% retention) were a consecutive sample, eligible if they were undergoing their first unilateral LEA secondary to dysvascular disease. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Patient Health Questionnaire-9. RESULTS Approximately 40% of participants endorsed at least moderate depressive symptoms at perioperative baseline. Individuals with greater depressive symptoms in the perioperative period concurrently reported greater pain, poorer self-rated health, and prior mental health treatment. In the first 6 weeks after amputation there was a substantial improvement in depressive symptoms, especially among individuals with greater symptoms at baseline. Depressive symptoms were generally stable after 6 weeks. None of the covariates assessed significantly predicted trajectories of depressive symptom improvement. CONCLUSIONS Watchful waiting may be the most appropriate course of action for many patients in the first 6 weeks after amputation. After 6 weeks, however, symptom levels tend to stabilize, suggesting that active intervention is called for if patients remain depressed at this point. Some patients may benefit from more proactive intervention, such as those with prior mental health treatment histories.
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Affiliation(s)
- Ann Marie Roepke
- Veterans Affairs Puget Sound Health Care System, Rehabilitation Care Service, Seattle, WA
| | - Aaron P Turner
- Veterans Affairs Puget Sound Health Care System, Rehabilitation Care Service, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Alison W Henderson
- Veterans Affairs Puget Sound Health Care System, Rehabilitation Care Service, Seattle, WA.
| | - Simon B Goldberg
- Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Seattle, WA
| | | | - Joseph M Czerniecki
- Veterans Affairs Puget Sound Health Care System, Rehabilitation Care Service, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Rhonda M Williams
- Veterans Affairs Puget Sound Health Care System, Rehabilitation Care Service, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Park C, Clark EM, R Williams B, Schulz E, Williams RM, Holt CL. MEANING PREDICTS DECLINES IN DEPRESSIVE SYMPTOMS BUT DOESN’T BUFFER STRESS IN A NATIONAL SAMPLE OF AFRICAN AMERICANS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Park
- University of Connecticut, Storrs, Connecticut, United States
| | - E M Clark
- Saint Louis University, St. Louis, Missouri, USA
| | - B R Williams
- Birmingham/Atlanta Geriatric Research, Education and Clinical Center (GRECC) Birmingham VA Medical Center, Birmingham AL USA; Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham AL USA
| | - E Schulz
- OTR/L, CFLE, Department of Occupational Therapy, A.T. Still University, Arizona School of Health Sciences, Mesa, AZ, USA
| | - R M Williams
- University of Maryland College Park, College Park, Maryland, USA
| | - C L Holt
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD USA
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Gollins S, Massalha S, Mullard A, Williams RM, Lloyd A, Morris J, Garcia-Alonso A. A Prospective Phase I/II Study of Docetaxel, Cisplatin and Continuous Capecitabine in Advanced Oesophago-Gastric Cancer (NWCOG-3). Clin Oncol (R Coll Radiol) 2018; 30:409-417. [PMID: 29573846 DOI: 10.1016/j.clon.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/15/2017] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
AIMS This open-label prospective phase I/II dose-escalation study determined the maximum tolerated dose (MTD) and then evaluated response, safety and feasibility of a novel combination of docetaxel, cisplatinum and capecitabine (DCC) in chemotherapy-naive patients with advanced oesophago-gastric carcinoma. MATERIALS AND METHODS Patients with adenocarcinoma or squamous cell carcinoma of the oesophagus or stomach, of good performance status, deemed too advanced for curative treatment, were given systematically increasing doses of 3 weekly DCC to ascertain the MTD. Phase II administered up to six cycles of DCC at the MTD, assessing response and toxicity. RESULTS Between November 2007 and November 2012, 15 patients were recruited into phase I and 41 into phase II. The MDT was a 21 day cycle of docetaxel 60 mg/m2 IV day 1, cisplatinum 60 mg/m2 IV day 1 and oral capecitabine 1000 mg/m2 daily in two divided doses for days 1-21. The most common phase II grade 3-4 toxicities were neutropenia 88% (10% febrile neutropenia), fatigue 15%, sensory neuropathy 10% and non-neutropenic infection 10%. The overall response rate was 51%, median progression-free survival was 7.4 months (confidence interval 6.7-9.4) and median overall survival was 10.9 months (confidence interval 7.7-13.7). CONCLUSION DCC was tolerable and feasible with promising efficacy, and may be suitable for future investigation in both first-line metastatic and neoadjuvant settings.
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Affiliation(s)
- S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK.
| | - S Massalha
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, UK
| | - A Mullard
- Ysbyty Gwynedd, Penrhosgarnedd, Bangor, UK
| | | | - A Lloyd
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK
| | - J Morris
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK
| | - A Garcia-Alonso
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK
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Brier MJ, Williams RM, Turner AP, Henderson AW, Roepke AM, Norvell DC, Henson H, Czerniecki JM. Quality of Relationships With Caregivers, Depression, and Life Satisfaction After Dysvascular Lower Extremity Amputation. Arch Phys Med Rehabil 2017; 99:452-458. [PMID: 28987901 DOI: 10.1016/j.apmr.2017.09.110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/26/2017] [Accepted: 09/08/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first dysvascular lower extremity amputation (LEA). DESIGN Cross-sectional cohort study using self-report surveys. SETTING Department of Veterans Affairs, academic medical center, and level I trauma center. PARTICIPANTS Individuals undergoing their first major LEA because of complications of peripheral arterial disease (PAD) or diabetes who have a caregiver and completed measures of caregiver support and conflict (N=137; 94.9% men). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Patient Health Questionnaire-9 to assess depression and the Satisfaction With Life Scale to assess life satisfaction. RESULTS In multiple regression analyses, controlling for global levels of perceived support, self-rated health, age, and mobility, caregiver-specific support was found to be associated with higher levels of life satisfaction and caregiver-specific conflict was found to be associated with lower levels of life satisfaction and higher levels of depressive symptoms. CONCLUSIONS The specific relationship between individuals with limb loss and their caregivers may be an important determinant of well-being. Conflict with caregivers, which has received little attention thus far in the limb loss literature, appears to play a particularly important role. Individuals with limb loss may benefit from interventions with their caregivers that both enhance support and reduce conflict.
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Affiliation(s)
- Moriah J Brier
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA.
| | - Rhonda M Williams
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Aaron P Turner
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Alison W Henderson
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA
| | - Ann Marie Roepke
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA
| | | | - Helene Henson
- Physical Medicine and Rehabilitation, Houston VA Medical Center, Houston, TX
| | - Joseph M Czerniecki
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Norvell DC, Williams RM, Turner AP, Czerniecki JM. The development and validation of a novel outcome measure to quantify mobility in the dysvascular lower extremity amputee: the amputee single item mobility measure. Clin Rehabil 2017; 30:878-89. [PMID: 27496697 PMCID: PMC4978165 DOI: 10.1177/0269215516644308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 03/20/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study describes the development and psychometric evaluation of a novel patient-reported single-item mobility measure. DESIGN Prospective cohort study. SETTING Four Veteran's Administration Medical Centers. SUBJECTS Individuals undergoing their first major unilateral lower extremity amputation; 198 met inclusion criteria; of these, 113 (57%) enrolled. INTERVENTIONS None. MAIN MEASURES The Amputee Single Item Mobility Measure, a single item measure with scores ranging from 0 to 6, was developed by an expert panel, and concurrently administered with the Locomotor Capabilities Index-5 (LCI-5) and other outcome measures at six weeks, four months, and 12 months post-amputation. Criterion and construct validity, responsiveness, and floor/ceiling effects were evaluated. Responsiveness was assessed using the standardized response mean. RESULTS The overall mean 12-month Amputee Single Item Mobility Measure score was 3.39 ±1.4. Scores for transmetatarsal, transtibial, and transfemoral amputees were 4.2 (±1.3), 3.2 (±1.5), and 2.9 (±1.1), respectively. Amputee Single Item Mobility Measure scores demonstrated "large" and statistically significant correlations with the LCI-5 scores at six weeks (r = 0.72), four months (r = 0.81), and 12 months (r = 0.86). At four months and 12 months, the correlation between Amputee Single Item Mobility Measure scores and hours of prosthetic use were r = 0.69 and r = 0.66, respectively, and between Amputee Single Item Mobility Measure scores and Trinity Amputation and Prosthesis Experience Scales functional restriction scores were r = 0.45 and r = 0.67, respectively. Amputee Single Item Mobility Measure scores increased significantly from six weeks to 12 months post-amputation. Minimal floor/ceiling effects were demonstrated. CONCLUSIONS In the unilateral dysvascular amputee, the Amputee Single Item Mobility Measure has strong criterion and construct validity, excellent responsiveness, and does not exhibit floor/ceiling effects.
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Affiliation(s)
| | - Rhonda M Williams
- VA Puget Sound Health Care System, Seattle, WA, USA Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA, USA Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, Seattle, WA, USA Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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30
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Anderson DR, Roubinov DS, Turner AP, Williams RM, Norvell DC, Czerniecki JM. Perceived social support moderates the relationship between activities of daily living and depression after lower limb loss. Rehabil Psychol 2017; 62:214-220. [PMID: 28406651 PMCID: PMC7560942 DOI: 10.1037/rep0000133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study examined the moderating influence of perceived social support on the prospective relationship between baseline levels of activities of daily living (ADL) and depressive symptoms during the 1st year following amputation. METHOD Participants included 73 veterans with new/first unilateral lower extremity amputation due to vascular disease or diabetes. Baseline levels of perceived social support, ADL function, and mobility were assessed by retrospective recall 6 weeks after amputation. Depressive symptoms were measured at 6 weeks and 12 months following surgery. RESULTS Perceived social support moderated the relationship between baseline ADL functioning and depressive symptoms at 12 months (β = -0.27, p < .001) after controlling for 6-week depressive symptoms and sociodemographic and physical/functional variables. Lower levels of baseline ADL function were associated with depressive symptoms at 12 months among those who reported lower levels of perceived social support. CONCLUSION These data allowed us to identify those participants with both low ADL function at baseline and low social support as being at higher risk for depression symptoms postamputation. The findings support the stress buffering hypothesis and suggest that perceived social support may be an important modifiable target of intervention among individuals with lower levels of functioning. (PsycINFO Database Record
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Czerniecki JM, Turner AP, Williams RM, Thompson ML, Landry G, Hakimi K, Speckman R, Norvell DC. The development and validation of the AMPREDICT model for predicting mobility outcome after dysvascular lower extremity amputation. J Vasc Surg 2016; 65:162-171.e3. [PMID: 27751738 DOI: 10.1016/j.jvs.2016.08.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was the development of AMPREDICT-Mobility, a tool to predict the probability of independence in either basic or advanced (iBASIC or iADVANCED) mobility 1 year after dysvascular major lower extremity amputation. METHODS Two prospective cohort studies during consecutive 4-year periods (2005-2009 and 2010-2014) were conducted at seven medical centers. Multiple demographic and biopsychosocial predictors were collected in the periamputation period among individuals undergoing their first major amputation because of complications of peripheral arterial disease or diabetes. The primary outcomes were iBASIC and iADVANCED mobility, as measured by the Locomotor Capabilities Index. Combined data from both studies were used for model development and internal validation. Backwards stepwise logistic regression was used to develop the final prediction models. The discrimination and calibration of each model were assessed. Internal validity of each model was assessed with bootstrap sampling. RESULTS Twelve-month follow-up was reached by 157 of 200 (79%) participants. Among these, 54 (34%) did not achieve iBASIC mobility, 103 (66%) achieved at least iBASIC mobility, and 51 (32%) also achieved iADVANCED mobility. Predictive factors associated with reduced odds of achieving iBASIC mobility were increasing age, chronic obstructive pulmonary disease, dialysis, diabetes, prior history of treatment for depression or anxiety, and very poor to fair self-rated health. Those who were white, were married, and had at least a high-school degree had a higher probability of achieving iBASIC mobility. The odds of achieving iBASIC mobility increased with increasing body mass index up to 30 kg/m2 and decreased with increasing body mass index thereafter. The prediction model of iADVANCED mobility included the same predictors with the exception of diabetes, chronic obstructive pulmonary disease, and education level. Both models showed strong discrimination with C statistics of 0.85 and 0.82, respectively. The mean difference in predicted probabilities for those who did and did not achieve iBASIC and iADVANCED mobility was 33% and 29%, respectively. Tests for calibration and observed vs predicted plots suggested good fit for both models; however, the precision of the estimates of the predicted probabilities was modest. Internal validation through bootstrapping demonstrated some overoptimism of the original model development, with the optimism-adjusted C statistic for iBASIC and iADVANCED mobility being 0.74 and 0.71, respectively, and the discrimination slope 19% and 16%, respectively. CONCLUSIONS AMPREDICT-Mobility is a user-friendly prediction tool that can inform the patient undergoing a dysvascular amputation and the patient's provider about the probability of independence in either basic or advanced mobility at each major lower extremity amputation level.
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Affiliation(s)
- Joseph M Czerniecki
- VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash
| | - Aaron P Turner
- VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash
| | - Rhonda M Williams
- VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash
| | - Mary Lou Thompson
- Department of Biostatistics, University of Washington, Seattle, Wash
| | - Greg Landry
- Division of Vascular Surgery, Department of Surgery, Oregon Health and Science University, Portland, Ore
| | - Kevin Hakimi
- VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash
| | - Rebecca Speckman
- VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash
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Henderson AW, Turner AP, Williams RM, Norvell DC, Hakimi KN, Czerniecki JM. Sexual activity after dysvascular lower extremity amputation. Rehabil Psychol 2016; 61:260-8. [PMID: 27253221 DOI: 10.1037/rep0000087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study examined the prevalence and correlates of sexual activity among individuals experiencing their first dysvascular lower extremity amputation. DESIGN A prospective cohort was recruited from 4 Veterans Affairs Medical Centers. Of 198 potential participants who met inclusion criteria, 113 (57%) agreed to participate within 7 days of amputation (baseline) and 6 weeks, 4 months, and 12 months post-amputation; 105 completed the sexual activity items at baseline. Measures included self-reported frequency of sexual activity; desire for more or less sexual activity; importance of sexual activity to satisfaction with life; Patient Health Questionnaire-9; Locomotor Capability Index-5; pain intensity/frequency; quality of life. RESULTS Depending on the time period post-amputation, 11%-24% reported engaging in any sexual activity, although a majority indicated that sexual activity is very important to their satisfaction with life. Frequency of sexual activity increased between 6 weeks and 4 and 12 months post-amputation. In univariate analyses, older age was associated with decreased sexual activity at all time points; at 4 and 12 months, greater mobility was associated with increased sexual activity. In multivariable models, mobility was associated with sexual activity at 4 and 12 months; age and race remained associated with sexual activity at 4 and 12 months, respectively. At all time points, frequency and importance of sexual activity were significantly associated with one another. CONCLUSIONS Although a minority of individuals engaged in any sexual activity during the study period, it remained an important factor in overall satisfaction with life. Younger age and improved mobility were associated with increased sexual activity. Rehabilitation specialists are encouraged to address sexuality and, if relevant, incorporate it into rehabilitation goals. (PsycINFO Database Record
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Mace EK, Aalseth CE, Day AR, Hoppe EW, Keillor ME, Moran JJ, Panisko ME, Seifert A, Tatishvili G, Williams RM. First results of a simultaneous measurement of tritium and (14)C in an ultra-low-background proportional counter for environmental sources of methane. J Environ Radioact 2016; 155-156:122-129. [PMID: 26990077 DOI: 10.1016/j.jenvrad.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
Simultaneous measurement of tritium and (14)C would provide an added tool for tracing organic compounds through environmental systems and is possible via beta energy spectroscopy of sample-derived methane in internal-source gas proportional counters. Since the mid-1960's atmospheric tritium and (14)C have fallen dramatically as the isotopic injections from aboveground nuclear testing have been diluted into the ocean and biosphere. In this work, the feasibility of simultaneous tritium and (14)C measurements via proportional counters is revisited in light of significant changes in both the atmospheric and biosphere isotopics and the development of new ultra-low-background gas proportional counting capabilities for small samples (roughly 50 cc methane). A Geant4 Monte Carlo model of a Pacific Northwest National Laboratory (PNNL) proportional counter response to tritium and (14)C is used to analyze small samples of two different methane sources to illustrate the range of applicability of contemporary simultaneous measurements and their limitations. Because the two methane sources examined were not sample size limited, we could compare the small-sample measurements performed at PNNL with analysis of larger samples performed at a commercial laboratory. These first results show that the dual-isotope simultaneous measurement is well matched for methane samples that are atmospheric or have an elevated source of tritium (i.e. landfill gas). However, for samples with low/modern tritium isotopics (rainwater), commercial separation and counting is a better fit.
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Affiliation(s)
- E K Mace
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA.
| | - C E Aalseth
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - A R Day
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - E W Hoppe
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - M E Keillor
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - J J Moran
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - M E Panisko
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - A Seifert
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - G Tatishvili
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
| | - R M Williams
- Pacific Northwest National Laboratory, 902 Battelle Blvd, P.O. Box 999, MSIN J4-65, Richland, WA 99352, USA
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Le VH, Inai M, Williams RM, Kan T. Ecteinascidins. A review of the chemistry, biology and clinical utility of potent tetrahydroisoquinoline antitumor antibiotics. Nat Prod Rep 2015; 32:328-47. [PMID: 25273374 PMCID: PMC4806878 DOI: 10.1039/c4np00051j] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The ecteinascidin family comprises a number of biologically active compounds, containing two to three tetrahydroisoquinoline subunits. Although isolated from marine tunicates, these compounds share a common pentacyclic core with several antimicrobial compounds found in terrestrial bacteria. Among the tetrahydroisoquinoline natural products, ecteinascidin 743 (Et-743) stands out as the most potent antitumor antibiotics that it is recently approved for treatment of a number of soft tissue sarcomas. In this article, we will review the backgrounds, the mechanism of action, the biosynthesis, and the synthetic studies of Et-743. Also, the development of Et-743 as an antitumor drug is discussed.
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Affiliation(s)
- V H Le
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523, USA.
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Roubinov DS, Turner AP, Williams RM. Coping among individuals with multiple sclerosis: Evaluating a goodness-of-fit model. Rehabil Psychol 2015; 60:162-8. [DOI: 10.1037/rep0000032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Williams RM, Turner AP, Norvell DC, Henderson AW, Hakimi KN, Czerniecki JM. The role of expectations in pain after dysvascular lower extremity amputation. Rehabil Psychol 2014; 59:459-63. [PMID: 25313581 DOI: 10.1037/rep0000014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective was to determine the relationship between pain expectations assessed prior to surgery and satisfaction with pain 4 and 12 months after major dysvascular lower extremity amputation. RESEARCH METHOD The study included a prospective cohort of male (n = 19) veterans experiencing their first lower extremity amputation due to complications of diabetes mellitus or peripheral arterial disease. Measures included presurgical expectations of pain at 4 and 12 months postamputation, actual average pain and satisfaction with pain at 4 and 12 months postamputation, and agreement between expected and actual pain. RESULTS Sixty-eight percent of participants expected to experience no or minimal pain at 4 months; 95% expected to experience no or minimal pain at 12 months. Thirty-two percent and 58% of participants had more pain than they expected at 4 and 12 months, respectively. Participants whose pain expectations were met reported higher satisfaction with their actual level of pain at 12 months postamputation, even after adjusting for current pain levels. CONCLUSION The results underscore the potential value of fostering realistic expectations about the degree to which amputation may impact average pain.
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Affiliation(s)
| | | | | | - Alison W Henderson
- VA Research Center of Excellence for Limb Loss Prevention and Prosthetic Engineering
| | | | - Joseph M Czerniecki
- Rehabilitation Care Service/VA Research Center of Excellence for Limb Loss and Prosthetic Engineering
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Sullivan-Singh SJ, Sawyer K, Ehde DM, Bell KR, Temkin N, Dikmen S, Williams RM, Hoffman JM. Comorbidity of Pain and Depression Among Persons With Traumatic Brain Injury. Arch Phys Med Rehabil 2014; 95:1100-5. [DOI: 10.1016/j.apmr.2014.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/01/2014] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
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Bambara JK, Turner AP, Williams RM, Haselkorn JK. Social support and depressive symptoms among caregivers of veterans with multiple sclerosis. Rehabil Psychol 2014; 59:230-5. [PMID: 24730574 DOI: 10.1037/a0036312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The primary aim of this study was to examine the relationship between perceived social support and depressive symptoms among family caregivers of veterans with multiple sclerosis (MS). A secondary aim of this study was to examine the relationship between caregiver perceived social support and caregiver demographic variables, veteran health-related variables, and caregiver depressive symptoms. RESEARCH METHOD/DESIGN As part of a larger study, 42 family caregivers of veterans with MS completed questionnaires by telephone. Hierarchical regression was used to examine the relationship between caregiver depressive symptoms and perceived social support. RESULTS Greater MS disease severity and poorer overall veteran health were associated with higher levels of depressive symptoms among caregivers. Caregiver perceived social support was associated with depressive symptoms after controlling for veterans' MS disease severity and overall physical health. CONCLUSIONS/IMPLICATIONS Psychosocial interventions aimed at enhancing social support among caregivers of veterans with MS in multiple life domains, such as work, finances, housing, social life, marriage, and family, may be important for family caregiver mood management, particularly as MS disease severity increases.
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Thankamony A, Tossavainen PH, Sleigh A, Acerini C, Elleri D, Dalton RN, Jackson NC, Umpleby AM, Williams RM, Dunger DB. Short-term administration of pegvisomant improves hepatic insulin sensitivity and reduces soleus muscle intramyocellular lipid content in young adults with type 1 diabetes. J Clin Endocrinol Metab 2014; 99:639-47. [PMID: 24423298 DOI: 10.1210/jc.2013-3264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT Data on the metabolic effects of GH derived from studies using GH suppression by pharmacological agents may not reflect selective actions. OBJECTIVE The purpose of this study was to evaluate the effects of GH antagonism on glucose and lipid metabolism using pegvisomant, a selective GH receptor antagonist in patients with type 1 diabetes (T1D). DESIGN AND PARTICIPANTS In a randomized, placebo-controlled, crossover study, 10 young adults with T1D were evaluated at baseline and after 4 weeks of treatment with either 10 mg of pegvisomant or placebo. The assessments included an overnight euglycemic steady state followed by a hyperinsulinemic euglycemic clamp and used glucose and glycerol cold stable isotopes. OUTCOME MEASURES Hepatic and peripheral insulin sensitivity (IS), lipid turnover, and intramyocellular lipid (IMCL) were measured. RESULTS Compared with placebo, pegvisomant treatment resulted in lower IGF-I levels (P < .001). During the overnight steady state, insulin requirements for euglycemia (P = .019), insulin levels (P = .008), and glucose production rates (Ra) (P = .033) were reduced. During the clamp study, glucose infusion rates (P = .031) increased and glucose Ra (P = .015) decreased whereas glucose disposal rates were unchanged. Free fatty acid levels were similar during the steady state but were lower during the clamp (P = .040) after pegvisomant. Soleus muscle IMCL decreased after treatment (P = .024); however, no change in tibialis anterior muscle was observed. CONCLUSIONS The study demonstrates that GH antagonism in T1D results in improved hepatic insulin sensitivity. Lack of consistent changes in free fatty acid levels may suggest a direct effect of GH on IS. Unchanged peripheral IS despite reductions in IMCL indicate that GH-induced alterations in IMCL may not be causally linked to glucose metabolism.
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Affiliation(s)
- A Thankamony
- Department of Paediatrics (A.T., P.H.T., C.A., D.E., R.M.W., D.B.D.), University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Wolfson Brain Imaging Centre (A.S.), University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Paediatrics (P.H.T.), University of Oulu, 90029 OYS, Oulu, Finland; WellChild Laboratory (R.N.D.), King's College London, Evelina Children's Hospital, London SE1 7EH, United Kingdom; Diabetes and Metabolic Medicine (N.C.J., A.M.U.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7WG, United Kingdom; and National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre (D.B.D.), Cambridge, CB2 0QQ, United Kingdom
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Williams RM, Turner AP, Green M, Norvell DC, Henderson AW, Hakimi KN, Blake DJ, Czerniecki JM. Changes in cognitive function from presurgery to 4 months postsurgery in individuals undergoing dysvascular amputation. Arch Phys Med Rehabil 2013; 95:663-9. [PMID: 24316326 DOI: 10.1016/j.apmr.2013.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/12/2013] [Accepted: 11/18/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe cognition among individuals with new amputations at 3 time points: presurgical, 6 weeks postamputation, and 4 months postamputation. DESIGN Prospective cohort. SETTING Medical centers. PARTICIPANTS Referred sample Veterans who were primarily men (N=80) experiencing their first lower extremity amputation as a result of complications of diabetes mellitus or peripheral arterial disease. Patients were screened for the absence of gross cognitive impairment using the Short Portable Mental Status Questionnaire (SPMSQ). Of those 87 individuals who were eligible, 64% enrolled; 29 were enrolled presurgically and have cognitive data for all 3 time points, and 58 were enrolled postamputation. Eighty of the 87 individuals enrolled by 6 weeks remained enrolled at 4 months. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic and general health information, general mental status (SPMSQ), and 4 brief, well-established neuropsychological measures. RESULTS Most mean neuropsychological test scores fell in the low average or average range. For most participants, overall cognitive status improved from pre- to postsurgery and then remained stable between 6 weeks and 4 months. There were significant improvements between pre- and postsurgical test scores in verbal learning and memory, and these remained unchanged between 6 weeks and 4 months. Better 4 month cognitive performance was associated with higher perceived general health. CONCLUSIONS Overall cognitive performance is poorest presurgically. Though there is improvement between pre- and postamputation, cognition appears generally stable between 6 weeks and 4 months.
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Webster JB, Hakimi KN, Williams RM, Turner AP, Norvell DC, Czerniecki JM. Prosthetic fitting, use, and satisfaction following lower-limb amputation: a prospective study. ACTA ACUST UNITED AC 2013; 49:1493-504. [PMID: 23516053 DOI: 10.1682/jrrd.2012.01.0001] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function.
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Affiliation(s)
- Joseph B Webster
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
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Rosenberg DE, Turner AP, Littman AJ, Williams RM, Norvell DC, Hakimi KM, Czerniecki JM. Body mass index patterns following dysvascular lower extremity amputation. Disabil Rehabil 2013; 35:1269-75. [PMID: 23094934 PMCID: PMC7546544 DOI: 10.3109/09638288.2012.726690] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Using preliminary data, we examined: (i) patterns of body mass index (BMI) over the year following amputation by amputation level and (ii) the association between BMI and mobility and prosthetic device use. METHOD Patients from three medical centers undergoing dysvascular amputation (N = 87; M age = 62) participated in interviews pre-surgically and at 6 weeks, 4 months, and 12 months following amputation. The main outcome was self-reported BMI, adjusting for limb weight lost due to amputation. Additional outcomes were mobility and time spent using and walking in a prosthetic device. RESULTS Adjusted BMI slightly decreased at 6 weeks (pre-surgery M = 31.2; 6 weeks M = 30.3) and 4 months (M = 30.7) but exceeded baseline levels by 12 months (M = 31.7). There were no significant BMI differences by amputation level. In multivariable analyses, higher pre-surgical BMI was associated with fewer hours of prosthetic device walking at month 4 (β = -0.49) and poorer overall mobility at month 12 (β = -0.22). CONCLUSIONS BMI increased at one year following amputation surgery. Higher pre-surgical BMI was associated with poorer mobility and prosthetic device use. Interventions are needed to prevent excess weight gain in the year following amputation. IMPLICATIONS FOR REHABILITATION • People undergoing lower-extremity amputation have high rates of overweight and obesity and continue to gain weight in the year following amputation. • Objective assessment of body mass index (both with and without a prosthetic device) and waist circumference would help future research efforts. • Targeting weight loss post-amputation could improve the health of people with lower-extremity amputations.
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Affiliation(s)
- Dori E. Rosenberg
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Group Health Cooperative, Group Health Research Institute, Seattle, WA, USA
| | - Aaron P. Turner
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Alyson J. Littman
- Seattle Epidemiologic Research and Information Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Rhonda M. Williams
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Kevin M. Hakimi
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M. Czerniecki
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Czerniecki JM, Turner AP, Williams RM, Hakimi KN, Norvell DC. Mobility changes in individuals with dysvascular amputation from the presurgical period to 12 months postamputation. Arch Phys Med Rehabil 2012; 93:1766-73. [PMID: 22543258 DOI: 10.1016/j.apmr.2012.04.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 04/13/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To describe changes in ambulation among individuals with lower-extremity amputation secondary to peripheral artery disease and/or diabetes prior to surgery through 12 months after surgery. To compare differences in ambulation by amputation level and to examine risk factors for change in ambulation over time. DESIGN Prospective cohort study. SETTING Two Veterans Affairs medical centers, 1 university hospital, and a level I trauma center. PARTICIPANTS Patients with peripheral artery disease or diabetes (N=239) undergoing a first unilateral major amputation were screened for participation between September 2005 and December 2008. Among these, 57% (n=136) met study criteria, and of these, 64% (n=87) participated. INTERVENTIONS Standard of care at each facility. MAIN OUTCOME MEASURES Ambulatory function measured using the Locomotor Capability Index-5. RESULTS Seventy-five of the 87 (86%) subjects enrolled finished their 12-month follow-up interview. Ambulatory mobility declined during the period immediately prior to surgery (premorbid) and remained low at 6 weeks postsurgery. On average, ambulation improved after surgery but did not return to premorbid levels. In the final multivariate model, age and history of lower-extremity arterial reconstruction were significantly associated with a poorer ambulatory trajectory over time, while other factors, such as amputation level, prior alcohol use, and length of disability prior to amputation, were not. CONCLUSIONS The findings highlight the importance of considering premorbid ambulatory function. Informing providers and patients about the trajectory and time course of changes in ambulation can enhance patient education, patient expectations, and treatment planning.
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Czerniecki JM, Turner AP, Williams RM, Hakimi KN, Norvell DC. The effect of rehabilitation in a comprehensive inpatient rehabilitation unit on mobility outcome after dysvascular lower extremity amputation. Arch Phys Med Rehabil 2012; 93:1384-91. [PMID: 22465582 DOI: 10.1016/j.apmr.2012.03.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/03/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To (1) compare the total volume of rehabilitation therapy for patients ever attending a comprehensive inpatient rehabilitation unit (CIRU) versus never during the 12 months after amputation; (2) determine whether rehabilitation in a CIRU at any time in the first year after amputation results in greater mobility success compared with other types of rehabilitation environments of care; and (3) determine for those patients treated in a CIRU, which specific patient characteristics were associated with improved mobility outcome. DESIGN Prospective cohort study. SETTING Two Veterans Affairs medical centers. PARTICIPANTS Patients (N=199) with peripheral vascular disease or diabetes undergoing a first unilateral major amputation were screened for participation between September 2005 and December 2008. Among these, 113 (57%) met study criteria; of these, 72 (64%) participated. INTERVENTION Ever attending a CIRU versus never attending a CIRU in first 12 months after amputation. MAIN OUTCOME MEASURES Number of rehabilitation therapy visits, Locomotor Capability Index scores, and mobility success. RESULTS The mean number of all therapy visits for patients ever attending a CIRU was significantly greater than that for those never attending over a 12-month period (48.6 vs 22.6; P=.001). Mean total time per any rehabilitation visit was .83±.27 hours for those ever attending and .60±.20 hours for those never attending (P<.001). Patients who ever were treated in a CIRU were 17% more likely to achieve mobility success than those who were not, controlling for amputation level, major depressive episode, alcohol use, social support, total number of rehabilitation visits, and hospital site (risk difference=.17; 95% confidence interval, .09-.25; P<.001). CONCLUSIONS Rehabilitation in a CIRU resulted in improved mobility success for veterans undergoing major lower extremity amputation secondary to peripheral vascular disease or diabetes. Among those admitted to a CIRU, younger patients with greater social support, healthy weight, and without chronic obstructive pulmonary disease had the greatest probability of mobility success.
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Abstract
Many multiphoton imaging applications would benefit from a larger field of view; however, large field of views (>mm) require low magnification objectives which have low light collection efficiencies. We demonstrate a light collection system mounted on a low magnification objective that increases fluorescence collection by as much as 20-fold in scattering tissues. This peripheral detector results in an effective numerical aperture of collection >0.8 with a 3-4 mm field of view.
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Affiliation(s)
- J D McMullen
- School of Applied and Engineering Physics, Cornell University, Ithaca, NY, USA
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Webster JB, Hakimi KN, Williams RM, Turner AP, Norvell DC, Czerniecki JM. Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study. J Rehabil Res Dev 2012; 49:1453-1504. [PMID: 33116349 PMCID: PMC7590920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function.
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Affiliation(s)
- Joseph B. Webster
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Kevin N. Hakimi
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Rhonda M. Williams
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Aaron P. Turner
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Joseph M. Czerniecki
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Affiliation(s)
- A K Annamalai
- Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Norvell DC, Turner AP, Williams RM, Hakimi KN, Czerniecki JM. Defining successful mobility after lower extremity amputation for complications of peripheral vascular disease and diabetes. J Vasc Surg 2011; 54:412-9. [PMID: 21531528 DOI: 10.1016/j.jvs.2011.01.046] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/13/2011] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Information about longer-term functional outcomes following lower extremity amputation for peripheral vascular disease and diabetes remains limited. This study examined factors associated with mobility success during the first year following amputation. METHODS Prospective cohort study of 87 amputees experiencing a first major unilateral amputation surgery. Seventy-five (86%) participants completed 12-month follow-up interview. RESULTS Twenty-eight subjects (37%) achieved mobility success, defined as returning to or exceeding a baseline level of mobility on the locomotor capability index (LCI-5). Forty-three subjects (57%) were satisfied with their mobility. Individuals who were 65 years of age and older (risk difference [RD] = -0.52; 95% confidence interval [CI]: -0.75, -0.29), reported a current alcohol use disorder (RD = -0.37; 95% CI: -0.48, -0.26), had a history of hypertension (RD = -0.23; 95% CI: -0.43, -0.03) or treatment for anxiety or depression (RD = -0.39; 95% CI: -0.50, -0.28) were less likely to achieve mobility success. Mobility success was associated with mobility satisfaction (RD = 0.36; 95% CI: 0.20, 0.53) and satisfaction with life (RD = 0.28; 95% CI: 0.06, 0.50). Although higher absolute mobility at 12 months was also associated with mobility satisfaction and overall life satisfaction, 50% of individuals who achieved success with low to moderate 12-month mobility function reported they were satisfied with their mobility. CONCLUSION Defining success after amputation in relation to an individual's specific mobility prior to the development of limb impairment which led to amputation provides a useful, patient-centered measure that takes other aspects of health, function, and impairment into account.
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Abstract
PURPOSE To examine the association between perceived social support and self-reported depression among Veterans of the US Armed Forces ('Veterans') with multiple sclerosis (MS), and differences in this relationship between specific support subtypes (tangible, positive social interaction, emotional/informational and affective). METHOD Participants were Veterans with MS (N = 451) receiving medical services through the Veterans Health Administration who completed mailed surveys. Hierarchical regression examined the extent to which global perceived social support concurrently predicted depression among a predominantly male sample of individuals with MS. Exploratory correlational analyses examined the relationship between specific subtypes of perceived social support and depression. RESULTS Greater global perceived social support was associated with less depression after controlling for sociodemographic and disease-related variables. In follow-up analyses examining specific subtypes of support, greater positive social interaction, greater emotional/informational support, and greater affective support were related to less depression. There was no relationship between perceived tangible support and depression. CONCLUSIONS Interventions aimed at increasing positive social interactions, expressed affection and emotional/information support may be particularly helpful for individuals with MS and their caregivers.
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Reynolds CA, Oyama MA, Rush JE, Rozanski EA, Singletary GE, Brown DC, Cunningham SM, Fox PR, Bond B, Adin DB, Williams RM, MacDonald KA, Malakoff R, Sleeper MM, Schober KE, Petrie JP, Hogan DF. Perceptions of Quality of Life and Priorities of Owners of Cats with Heart Disease. J Vet Intern Med 2010; 24:1421-6. [PMID: 20738770 DOI: 10.1111/j.1939-1676.2010.0583.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- C A Reynolds
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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