An ICF-based assessment schedule to facilitate the assessment and reporting of functioning in manual medicine - low back pain as a case in point

PURPOSE

This paper outlines the first steps toward developing the ICF-based assessment schedule for manual medicine with a focus on low back pain (LBP). It reports on the results of a consensus process to develop the default and optional versions of the set of ICF categories (ManMed Set) the assessment schedule should cover, and gives insight in expert input toward building a toolbox of instruments for assessing the ManMed Set categories.

METHODS

A scoping review and qualitative study were conducted, each resulting in a list of ICF categories. These categories, along with the categories of the ICF Generic-30 Set, Comprehensive ICF Core Set for LBP, and from an existing Delphi study, served as the starting point for an established consensus process to decide on the ManMed Set.

RESULTS

After alternating plenary and working group sessions, an iterative ranking process and cut-off calculation, the multi-professional and international group of 20 experts in manual medicine included 23 categories in the default ManMed version (16 + the ICF Generic-7 Set categories) and 25 in the optional version.

CONCLUSIONS

Their development is a major step toward developing an assessment schedule that can be employed in standardizing the assessment and reporting of functioning in manual medicine, initially of LBP patients.Implications for rehabilitationThe ICF assessment schedule for manual medicine has potential use in supporting rehabilitation practice, such as for planning interventions, defining rehabilitation goals, and measuring and documenting functioning outcomes.It can be used to promote interdisciplinary coordination of care and facilitate communication between members of a multidisciplinary rehabilitation team within manual medicine and beyond.The ICF assessment schedule for manual medicine can facilitate rehabilitation and manual medicine research by providing evidence for optimizing rehabilitation practice.

Inducing positive emotions to reduce chronic pain: a randomized controlled trial of positive psychology exercises

PURPOSE

Positive emotions have been found to be analgesic and can be induced by positive psychology exercises. This study tested if positive psychology exercises provide beneficial effects on pain, responses to pain, physical (pain interference), and emotional function.

METHODS

Randomized parallel-group controlled single-blinded superiority-trial including community-dwelling individuals with chronic pain secondary to spinal cord injury. Participants in the intervention group were instructed to practice 4 personalized positive psychology exercises for 8 weeks. Participants in the control group were asked to be mindful and write about current life events.

RESULTS

108 (64%) completed the study. At post-treatment, the intervention participants reported significant reductions in pain intensity and improvements in pain catastrophizing and pain control, relative to baseline. Both groups reported significant decreases in pain interference and negative emotions. Significant between-group differences emerged for pain intensity at post-treatment. At 3-months follow-up, improvements maintained for the intervention group and improvements in positive emotions reached statistical significance. Between-group differences were identified for pain intensity at post-treatment.

CONCLUSION

Positive psychology exercises represent a potential effective complementary treatment that result in benefits on pain which can be readily implemented into daily living. Trials designed with an inactive control condition should be conducted to further address efficacy.

TRIAL REGISTRATION

Swiss ethics committee (EKNZ 2014-317)/clinicaltrials.gov (NCT02459028) Registration date: Ethics approval 25.10.2014/Study start date: May 2015 URL of the record: https://clinicaltrials.gov/ct2/show/NCT02459028?term=NCT02459028&cntry=CH&draw=2&rank=1IMPLICATIONS FOR REHABILITATIONPain engenders negative emotions (e.g., fear, anger, sadness) which can negatively affect psychological, social, and physical function.Positive emotions have been found to be analgesic and can be induced by practicing positive psychology exercises.The findings of the current randomized controlled trial provide support for practicing positive psychology exercises (beyond the effects of pain medication intake), in particular on the reduction of pain intensity, but also in improving pain catastrophizing and pain control.The majority of the positive psychology exercises are brief and self-administered positive activities that have no known negative side effects nor financial cost, can be tailored to a person's preferences in activities and can be readily implemented into daily living with chronic pain, complementing standard treatment of pain.

The Gestalt of functioning in autism spectrum disorder: Results of the international conference to develop final consensus International Classification of Functioning, Disability and Health core sets

Autism spectrum disorder is associated with diverse social, educational, and occupational challenges. To date, no standardized, internationally accepted tools exist to assess autism spectrum disorder–related functioning. World Health Organization’s International Classification of Functioning, Disability and Health can serve as foundation for developing such tools. This study aimed to identify a comprehensive, a common brief, and three age-appropriate brief autism spectrum disorder Core Sets. Four international preparatory studies yielded in total 164 second-level International Classification of Functioning, Disability and Health candidate categories. Based on this evidence, 20 international autism spectrum disorder experts applied an established iterative decision-making consensus process to select from the candidate categories the most relevant ones to constitute the autism spectrum disorder Core Sets. The consensus process generated 111 second-level International Classification of Functioning, Disability and Health categories in the Comprehensive Core Set for autism spectrum disorder—one body structure, 20 body functions, 59 activities and participation categories, and 31 environmental factors. The Common Brief Core Set comprised 60 categories, while the age-appropriate core sets included 73 categories in the preschool version (0- to 5-year-old children), 81 in the school-age version (6- to 16-year-old children and adolescents), and 79 in the older adolescent and adult version (⩾17-year-old individuals). The autism spectrum disorder Core Sets mark a milestone toward the standardized assessment of autism spectrum disorder–related functioning in educational, administrative, clinical, and research settings.

Participation rates, response bias and response behaviours in the community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI)

Background

Surveying persons with disabilities is challenging, as targeted subjects may experience specific barriers to survey participation. Here we report on participation rates and response behaviour in a community survey of people with spinal cord injury (SCI) in Switzerland. The cross-sectional survey was implemented as part of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) and represents the largest population-based SCI survey in Europe including nearly 2000 persons. Design features to enhance participation rates included the division of the questionnaire volume over three successive modules; recurrent and mixed-mode reminding of non-responders; and mixed-mode options for response.

Methods

We describe participation rates of the SwiSCI community survey (absolute and cumulative cooperation, contact, response, and attrition rates) and report on response rates in relation to recruitment efforts. Potential non-response bias and the association between responders’ characteristics and response behaviour (response speed: reminding until participation; response mode: paper-pencil vs. online completion) were assessed using regression modelling.

Results

Over the successive modules, absolute response rates were 61.1, 80.6 and 87.3 % which resulted in cumulative response rates of 49.3 and 42.6 % for the second and third modules. Written reminders effectively increased response rates, with the first reminder showing the largest impact. Telephone reminders, partly with direct telephone interviewing, enhanced response rate to the first module, but were essentially redundant in subsequent modules. Non-response to the main module was related to current age, membership of Swiss Paraplegic Association (SPA) and time since injury, but not to gender, lesion level and preferred language of response. Response speed increased with household income, but was not associated to other sociodemographic factors, lesion characteristics or health indicators. We found significant associations between online completion and male gender, younger age, higher education, higher income, SPA membership, tetraplegia, longer time since injury, higher quality of life, and more participation restrictions.

Conclusion

In this sample with little non-response bias, recurrent and mixed-mode reminding and mixed-mode options for response were key features of optimizing survey design.

Impact of different immunosuppressive regimens on antigen-presenting blood cells in kidney transplant patients

BACKGROUND

Alloantigen-specific and unspecific immune processes contribute to chronic renal graft dysfunction. Despite 'optimized immunosuppressive therapy' (IS), the role of chronic cell activation still remains open.

METHODS

69 kidney transplant recipients (NTX) were assessed for monocyte surface antigens CD14 (LPS receptor) and CD16 (Fc-gamma-III receptor) by flow cytometry including the percentage amount of the proinflammatory CD14+CD16+ subset. 14 non-dialysis patients with chronic renal failure (CRF) and 24 healthy persons served as controls.

RESULTS

All 14 patients suffering from CRF revealed higher CRP serum levels compared to healthy controls (p = 0.01). NTX patients had a (not significant) tendency to higher CRP concentrations (p > 0.05). The mean expression of CD14 on monocytes (mCD14) was lower in patients with CRF and in NTX patients (p = 0.024-p = 0.026). NTX patients revealed low expression of monocytic CD14 with no difference between the single IS therapy groups. The proinflammatory monocyte subpopulation positive for CD14 and CD16 was elevated both in uremic and NTX patients (p < 0.002), despite long-lasting IS therapy.

CONCLUSIONS

Continuing IS therapy, even under 'optimized' drug-monitoring conditions, does not sufficiently prevent or suppress a microinflammatory (and potential fibrotic growth-promoting) status in NTX patients.

[Interstitial nephritis with acute renal failure in Ascaris lumbricoides infection]

A girl aged 14 years, 8 months presented with painful swelling of cervical lymph nodes. On frozen section malignancy could be ruled out. There were nonspecific inflammatory changes. In the presence of a prominent eosinophilic reaction the possibility of a drug reaction had been suggested. Because of decreasing renal function, dialysis was started 1 day after lymph node extirpation. A renal biopsy revealed acute interstitial nephritis-again with eosinophils. At this point parasitosis was discussed. There was a slightly elevated titer for filariasis. Shortly thereafter, also eggs of Ascaris lumbricoides were found in the feces. A pulmonary infiltrate made its appearance, with eosinophils in the pleural fluid. About 20 days later, after dialysis and anti-Ascaris therapy, the patient was discharged with no further complaints. Repeated controls revealed no further complaints, especially no more Ascaris lumbricoides. This case had two special aspects: (1) initial presentation with painful cervical lymph node swelling, and (2) subsequent acute renal failure. The literature revealed only four patients with Ascaris lumbricoides infection and acute interstitial nephritis, all described by one author (Zollinger). Perhaps a special hyperergic situation in this patient was responsible for the renal involvement; however, this complication should be watched for in all cases Ascaris lumbricoides infections.

[The quality of life of older patients under the conditions of long-term dialysis]

A questionnaire enquiry was undertaken to assess aspects of quality of life of 100 older patients (60 women, 40 men; mean age 73.2 [65-88] years) who underwent haemodialysis for an average of 35.6 +/- 28.3 months. The majority of patients (85%) showed a positive attitude towards the haemodialysis treatment, but 14 signified that they would not again submit to this form of treatment. The replies of these patients in other ways, too, corresponded to a depressive state (P less than 0.001) with problems of coping with therapeutic measures (P less than 0.005). Reasons for this were, first, severe physical impairment by additional disease and, secondly, psychosocial factors. Nine of the 14 patients were women living alone who showed signs of loneliness. It would seem that a "negative" attitude towards haemodialysis is largely determined by a patient's social environment.

[Gynaecological problems in women patients on dialysis treatment and in women following renal transplants (author's transl)]

Women patients on permanent dialysis treatment or after transplants display on the whole an increased rate of malignomas; however, it has so far not been possible to assess the relevant incidence in a uniform manner. Hence, regular gynaecological examination should be the rule in order to detect and treat carcinoma risk changes in the genital region. Within the framework of a special gynaecological consultation for renal patients we found in 81 women patients under dialysis treatment one patient with carcinoma of the cervix and one patient with corpus carcinoma. In two cases a cystic ovarial tumour was operated on. To date the 21 patients who had undergone renal transplant surgery did not show any malignant change in the genital region. Choice of contraceptives should rule out the intrauterine device because of the increased hazard of infection under immunosuppressive treatment. Ovulation inhibitors with higher oestrogen doses represent an additional hypertensive risk. Treatment with low-dosage gestagens should produce the lowest rate of side effects.