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Kim CH, Choi Y, Chung CK, Kim KJ, Shin DA, Park YK, Kwon WK, Yang SH, Lee CH, Park SB, Kim ES, Hong H, Cho Y. Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study. Sci Rep 2021; 11:3931. [PMID: 33594185 PMCID: PMC7887235 DOI: 10.1038/s41598-021-83471-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Brain and Cognitive Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University Health System, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.,Department of Neurosurgery, Korea University College of Medicine, Korea-daero 73, Seongbuk-gu, Seoul, 02841, South Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.,Department of Neurosurgery, Korea University College of Medicine, Korea-daero 73, Seongbuk-gu, Seoul, 02841, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chang Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Boramae Hospital, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Eun Sang Kim
- Department of Neurosurgery, Spine Center, School of Medicine, Samsung Medical Center Sungkyunkwan University, Seoul, Korea
| | - Hyunsook Hong
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yongeun Cho
- Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Neurosurgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
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Abstract
SummaryAssessments of early response to antidepressant therapy based on condition severity have been contradictory due to the poor measurement properties of the instruments employed and the inappropriateness of condition severity as a criterion of improvement. It is argued that a more valid approach would involve the assessment of improvements in quality of life (QoL) associated with effective therapy. QoL instruments should reflect the views of the patients themselves, the only group able to comment authoritatively on whether they feel benefit from treatment. Research shows that it is the perceptions of the patients that determine whether treatment is sought, how far clinical advice is followed and whether treatment is discontinued. It is argued that the Quality of Life in Depression Scale is the only instrument available that has the required conceptual basis and psychometric properties to investigate the onset of response to antidepressant therapy.
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Model and Processes of Acceptance and Commitment Therapy (ACT) for Chronic Pain Including a Closer Look at the Self. Curr Pain Headache Rep 2016; 20:12. [PMID: 26803836 DOI: 10.1007/s11916-016-0541-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acceptance and commitment therapy (ACT) is one of the so called "third-wave" cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the psychological flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to "self" appears underappreciated. Indeed, a positive or healthy sense of self seems essential to our well-being, and there have been numerous studies of the self in chronic pain. At the same time, these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of chronic pain with a specific emphasis on the parts of the model that address self-related processes.
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Abstract
STUDY DESIGN Secondary analysis of randomized and nonrandomized prospective cohorts. OBJECTIVE To examine the effect of patient treatment expectations on treatment outcomes for patients with intervertebral disc herniation. SUMMARY OF BACKGROUND DATA Patient expectations about treatment effectiveness may have important relationships with clinical outcomes. METHODS Subgroup and reanalysis of the Spine Patient Outcomes Research Trial, a randomized trial and comprehensive cohort study enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Overall, 501 randomized and 744 observational patients (1244 total) who were surgical candidates with radiculopathy and imaging confirmed lumbar intervertebral disc herniation were enrolled. The primary study compared surgical discectomy to usual nonoperative care; this subgroup analysis reassessed outcomes on the basis of treatment expectations at baseline. Expectations about symptomatic and functional improvement for both surgery and nonoperative care were assessed on 5-point scales (1="No Chance (0%)" to 5="Certain (100%)"). Outcomes were assessed using longitudinal regression models analyzed by treatment received. RESULTS Among 1244 IDH SPORT participants, 1168 provided data on both outcomes and baseline expectations and were included in the current analysis: 467 from the randomized and 701 from the observational cohort. Low expectations of outcomes with surgery predicted poorer outcome regardless of treatment. High expectations of outcomes with nonoperative care predicted better nonoperative outcomes but did not affect surgical results. These differences were of similar magnitude to the difference in outcomes between surgery and nonoperative care. CONCLUSION High expectations of treatment benefit had clinically significant positive associations with outcomes. LEVEL OF EVIDENCE 2.
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In search of the person in pain: A systematic review of conceptualization, assessment methods, and evidence for self and identity in chronic pain. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2015. [DOI: 10.1016/j.jcbs.2015.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Patient preferences and expectations for care: determinants in patients with lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 2008; 33:2663-8. [PMID: 18981962 PMCID: PMC2768262 DOI: 10.1097/brs.0b013e31818cb0db] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective observational cohort. OBJECTIVE To describe the baseline characteristics of patients with a diagnosis of intervertebral disc herniation who had different treatment preferences and the relationship of specific expectations with those preferences. SUMMARY OF BACKGROUND DATA Data were gathered from the observational cohort of the Spine Patient Outcomes Research Trial (SPORT). Patients in the observational cohort met eligibility requirements identical to those of the randomized cohort, but declined randomization, receiving instead the treatment of their choice. METHODS Baseline preference and expectation data were acquired at the time of enrollment of the patient, before exposure to the informed consent process. Univariate analyses were performed using a t test for continuous variables and chi for categorical variables. Multivariate analyses were also performed with ANCOVA for continuous variables and logistic regression for categorical variables. Multiple logistic regression models were developed in a forward stepwise fashion using blocks of variables. RESULTS More patients preferred operative care: 67% preferred surgery, 28% preferred nonoperative treatment, and 6% were unsure; 53% of those preferring surgery stated a definite preference, whereas only 18% of those preferring nonoperative care had a definite preference. Patients preferring surgery were younger, had lower levels of education, and higher levels of unemployment/disability. This group also reported higher pain, worse physical and mental functioning, more back pain related disability, a longer duration of symptoms, and more opiate use. Gender, race, comorbidities, and use of other therapies did not differ significantly across preference groups. Patients' expectations regarding improvement with nonoperative care was the strongest predictor of preference. CONCLUSION Patient expectations, particularly regarding the benefit of nonoperative treatment, are the primary determinant of surgery preference among patients with lumbar intervertebral disc herniation. Demographic, functional status, and prior treatment experience had significant associations with patients' expectations and preferences.
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Feine JS, Lund JP. Measuring chewing ability in randomized controlled trials with edentulous populations wearing implant prostheses*. J Oral Rehabil 2006; 33:301-8. [PMID: 16629885 DOI: 10.1111/j.1365-2842.2006.01614.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this article, the authors review methods commonly used to measure the masticatory ability of patients wearing conventional and implant prostheses. Measurement approaches are viewed in two broad categories: laboratory based and patient based. The laboratory based measures discussed are mastication time, particle size, force measurements, patterns of jaw movement and electromyographic (EMG) bursts and total EMG activity. Patient based measures include satisfaction and chewing difficulty. Oral health-related quality of life measures and diet/nutrition variables are briefly mentioned. Patient-based outcomes are recommended as the most appropriate variables of masticatory efficiency.
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Affiliation(s)
- J S Feine
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
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Paul S, Sneed N. Patient perceptions of quality of life and treatment in an outpatient congestive heart failure clinic. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2002; 8:74-6, 77-9. [PMID: 11927780 DOI: 10.1111/j.1527-5299.2002.00279.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In an effort to better understand patients' definitions of quality of life (QOL) and to determine which tools would be most appropriate for use in future studies, a descriptive study was done in a university-based congestive heart failure clinic. Participants were asked a series of five open-ended questions regarding their perceptions of QOL during recorded interviews. Most patients equated QOL with the ability to perform physical functions in the same way they did before developing heart failure. They grieved for their former abilities and expressed lower self-esteem due to loss of independence from physical limitations. The Short Form-36 and the Minnesota Living With Heart Failure Questionnaire addressed the QOL issues important to our patients. It is important for health care providers to consider the patient's perception of QOL when using quantitative tools for QOL measurement in clinical practice.
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Affiliation(s)
- Sara Paul
- Medical University of South Carolina Heart Failure Clinic and College of Nursing, Charleston, SC 29425, USA.
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Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of smoking on the health status of spinal patients: the National Spine Network database. Spine (Phila Pa 1976) 2002; 27:313-9. [PMID: 11805698 DOI: 10.1097/00007632-200202010-00022] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, cross-sectional analysis of data from the National Spine Network. OBJECTIVES Investigate the association between the smoking status of spinal patients, duration and severity of symptoms, and their self-reported health status. BACKGROUND Although cigarette smoking was identified as a potential risk factor for lower back pain many years ago, more recent research is challenging this finding. METHODS The National Spine Network database contains information on the initial visit of spinal patients visiting physicians at 23 health care institutions in the United States. All patients for whom data were available regarding smoking status are included in this study (n = 25,455). RESULTS Data from a total of 25,455 patients (11,494 men and 13,961 women) were included in the study; 16.7% (n = 4249) were smokers. Smokers were younger than nonsmokers (44.2 vs. 48.7 years) and were more likely to report severe back symptoms (37 vs. 50%) and to report symptoms of depression (54 vs. 37%). Smokers of each gender scored 10-15 points lower than nonsmokers on each of the SF-36 subscales. These differences persisted when the absolute scores were compared with age- and sex-specific population norms and after adjustment for comorbid conditions, educational level, and depression. Similar results were obtained when the cohort was stratified by primary diagnosis or by surgical status. When postsurgical patients were grouped by time since surgery, those who were nonsmokers reported improved health status by time period; those who smoked did not. CONCLUSIONS Smokers and nonsmokers had had spinal symptoms for similar duration, but the smokers reported more severe symptoms, which were present for a greater proportion of time each day. Also, the smokers had lower physical and mental health status scores (based on the SF-36) than did nonsmokers.
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Affiliation(s)
- Molly T Vogt
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Abstract
PURPOSE The impact of low vision on self-reported quality of life and changes after low-vision intervention are investigated. METHODS Literature reports from 1990 to 2000 are reviewed. RESULTS Low vision is associated with increased risk for depression and decreased functional status and quality of life. Decreased visual acuity, visual field loss, and occasional blurred vision are also associated with decreased quality of life. Improvements in both functional status and quality of life occur after low-vision service delivery. CONCLUSIONS Self-reported quality of life is a significant outcome measure for low-vision rehabilitation. Questionnaires that are more sensitive to rehabilitation services provided as well as patient needs and goals are required to facilitate development of rehabilitation plans and to compare techniques, devices, and programs. Attention should be given to measurement properties, validity, and reliability of instruments used currently and in development of new instruments.
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Affiliation(s)
- J Stelmack
- Central Blind Rehabilitation Service, Edward Hines VA Hospital, Hines, Illinois 60141, USA.
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Abstract
OBJECTIVE: The measurement of health-related quality of life (HRQL) has become increasingly common in health services research. Whilst useful, its focus on behaviour, capacities and activities means that it remains relatively specific. This paper explores the possibility of extending the evaluation of health by considering the concept of patients' expectations. DESIGN: In-depth and semi-structured interviews were used to explore the concept of expectations from the patients' perspective. Patients' expectations were then used in the construction of a two-part questionnaire. SETTINGS AND PARTICIPANTS: Expectations were explored with a group of 33 cardiac patients. The resulting questionnaire was given to 400 cardiac patients in a large teaching hospital in London. RESULTS: Patients identified a range of expectations which related to their health and seemed to represent the desired results of their hospital stay. Comparison of the content of patient expectations with a commonly used generic measure of HRQL, the Short-Form 36 (SF-36), found some overlap but indicated that patients seemed to adopt a broader approach to their health. Expectations that patients identified were used to construct two scales to measure expectations and their evaluation. The internal consistency of these scales was 0.82 and 0.88, respectively. CONCLUSION: The study indicates the potential complexity of the concept of expectations and the need for further exploration. It also demonstrates the feasibility of constructing standardized scales to measure patient expectations. Whilst conceptually different from HRQL such standardized expectations scales could provide a useful adjunct to HRQL measurement and provide a meaningful context for the interpretation of HRQL data.
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Affiliation(s)
- Sophie Staniszewska
- Research Fellow in Patient Evaluation and Involvement, Royal College of Nursing Institute, Oxford, UK
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Abstract
STATEMENT OF PROBLEM From the dental professional's standpoint, implant rehabilitation offers dramatically improved treatment alternatives to orally disabled patients. However, what a patient perceives as important to their function and satisfaction with their prostheses may be quite different from what the dentist believes are significant health-related improvements. PURPOSE To resolve this problem, a series of investigations were designed to measure satisfaction and performance in groups of patients who wore various types of prostheses supported by endosseous titanium implants. MATERIAL AND METHODS Methods are described for assessing treatment efficacy and population needs, including measures of perceived levels of disability, health-related quality of life, and functional capacity. RESULTS The findings highlight patient factors that have not been considered before and appear to contribute to the success of prosthetic rehabilitation for the edentulous patient. CONCLUSION Patient-centered approaches to the assessment of treatment efficacy are highly relevant to today's prosthodontists, whose goals are the improvement of function and quality of life for their patients.
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Affiliation(s)
- J S Feine
- McGill University, Montreal, Quebec, Canada
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Feine JS, Awad MA, Lund JP. The impact of patient preference on the design and interpretation of clinical trials. Community Dent Oral Epidemiol 1998. [DOI: 10.1111/j.1600-0528.1998.tb02086.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Feine JS, Awad MA, Lund JP. The impact of patient preference on the design and interpretation of clinical trials. Community Dent Oral Epidemiol 1998; 26:70-4. [PMID: 9511845 DOI: 10.1111/j.1600-0528.1998.tb01927.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Research on several health problems shows that patients and health care providers do not use the same criteria to evaluate the effectiveness of treatment and often disagree on the severity of symptoms. When the disease is chronic and the main aim of treatment is to improve quality of life, we argue that variables rated as important by patients should be used as outcomes in clinical trials, and that in most cases these need to be measured from subjects' self-reports. In many non-pharmacological randomized clinical trials, the subjects cannot be blinded to treatment. Furthermore, many of them will probably have a preference for a particular treatment option. It has been proposed that emotional responses following assignment of treatments, which may or may not be preferred, will strongly influence the outcome, especially when it is based on self-reports of treatment satisfaction. Because of this concern, some investigators have suggested alternative study designs that incorporate preference. Brewin & Bradley (Br Med J 1989; 299 [6694]:313-5) have proposed allocating subjects to treatment methods according to their preferences, and randomizing those individuals with no preference. To determine the influence of preference on treatment outcome, they recommend comparing results from the preference group with those of the randomized group. However, we have found that there are clear differences in level of education and in the pre-treatment state between individuals with preferences and those with no strong preferences. Therefore, we believe that the design proposed by Wennberg et al. (Ann N Y Acad Sci 1993;703:52-62) is more appropriate. In it, subjects are randomly allocated to a preference trial (subjects choose their treatment) or to a randomized trial (random allocation to treatment). Between-trial comparisons can then be used to determine the influence of preference on outcome. This will lead to better evaluation of treatment efficacy and allow better estimates of the true effectiveness to be made.
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Affiliation(s)
- J S Feine
- McGill University Faculty of Dentistry, Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada.
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Abstract
It has been apparent for some time that utilisation of health services is more influenced by how people feel than by their 'objective' symptoms. Research has also shown that compliance with treatment regimens is dependent on the impact of that treatment on the patient's well-being. Such findings highlight the need to assess the patient's view of his or her progress through the health care system. This has led to a growing interest in quality of life assessment and, in particular, to the impact of illness and its treatment on the quality of life of the patient. Perhaps surprisingly, interest in quality of life measures for outcome assessment in Psychiatry has been slower to develop than in other specialties. While a number of clinician- and patient-completed measures of the severity of depressive symptoms exist, no measure of the quality of life of depressed patients is available. This paper describes the development and testing of the Quality of Life in Depression Scale (QLDS), a new measure designed to fill this gap. The theoretical basis for the instrument is that life gains its quality from the ability and capacity of the individual to satisfy his or her needs. The items included in the QLDS were derived from 30 qualitative interviews with depressed or recently recovered patients. Further interviews were held with depressed patients to establish the face and content validity of the instrument. Respondents had little trouble completing the questionnaire and found the content to be relevant to their experience of depression. The QLDS represents an important advance in our ability to understand the impact of depression on quality of life.
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Abstract
The opening section of this paper is concerned with certain questions concerning the concept 'quality of life'. Is it possible for one person to make judgements about the quality of life of another? If it is possible, then is it morally acceptable? Given that quality of life is a concept and therefore not amenable to direct observation, which visible phenomena will be chosen as its indicators, and how can their choice be justified? Do the components of a life of quality vary from person to person, or can features be identified which are common to all? Next, it is argued that instruments which have been developed to measure quality of life give clues to the ontological beliefs of their authors; those which address fragments of the human experience, or accept the artificial limits of the subjective/objective dichotomy, are expressive of a fractured and reductionist view of what it means to be a human being. Finally, it is suggested that the adoption of insights drawn from Heidegger's work would enable us to develop a rather more unified view of quality of life as quality of being, and that this theoretical principle might constitute a common link between nurses of varying professional backgrounds.
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Affiliation(s)
- P Draper
- Institute of Nursing Studies, University of Hull, England
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Fitzpatrick RM, Bury M, Frank AO, Donnelly T. Problems in the assessment of outcome in a back pain clinic. INTERNATIONAL DISABILITY STUDIES 1987; 9:161-5. [PMID: 2964431 DOI: 10.3109/03790798709166354] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A sample of 72 patients attending the rheumatological back pain clinic of a district general hospital were interviewed at home, before their visit, about their expectations of the clinic. They also completed a Back Pain Disability Questionnaire. Fifty of the patients were recontacted by mail 3 months after their first clinic attendance and asked to complete the Back Pain Disability Questionnaire together with satisfaction questionnaires. Patients' reports, both with regard to expectations and satisfaction, particularly emphasized the importance of communication. One-third of the follow-up sample rated their clinic attendance as unhelpful, and although such views correlated with lack of improvement in pain and disability, other factors are involved in patients' evaluations. Significant correlations were obtained between subjective outcomes and health locus of control, social class and previous hospital treatment. Patient satisfaction may be a valuable measure of outcome in assessing the efficacy of back pain treatment.
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Feuerstein M, Labbé EE, Kuczmierczyk AR. Pain. Health Psychol 1986. [DOI: 10.1007/978-1-4899-0562-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Radley A, Green R, Radley M. Impending surgery: the expectations of male coronary patients and their wives. INTERNATIONAL REHABILITATION MEDICINE 1986; 8:154-61. [PMID: 3497130 DOI: 10.3109/03790798709166206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Waiting to receive coronary graft surgery presents patients and their spouses with a stressful episode which nevertheless holds out the possibilities of symptom relief and improved quality of life. This study examines differences between couples in their experience of waiting, approach to surgery and expectations of treatment benefit. These differences, conceptualized in terms of a theory of adjustment to illness, are discussed in relation to their practical implications for helping patients and spouses to prepare for surgery and its possible outcomes.
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Abstract
This descriptive study focused on self-esteem and types of attributional style, and their relationship to sensation and distress pain ratings. Negative correlations were hypothesized between self-esteem and each pain rating, between positive internal type of attributional style and each pain rating, and between negative external type of attributional style and each pain rating. One hundred and nine healthy, non-institutionalized males, aged 21-50 years, participated in this study. The Tennessee Self-Concept Scale and revised Attributional Style Questionnaire were administered prior to the cold pressor test, a safe, short duration cold water hand immersion procedure for pain induction. Sensation and distress pain ratings were measured using visual analogue scales, and a pain history was obtained. The predicted relationship between self-esteem and distress pain ratings was supported. All other correlations were not statistically significant. A pain history question, asking subjects to rate their pain tolerance as compared with other people, was significantly related to both pain ratings, the correlations being negative.
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Bury MR. Dilemmas facing patients and providers in disablement. INTERNATIONAL REHABILITATION MEDICINE 1985; 7:162-6. [PMID: 2936695 DOI: 10.3109/03790798509165988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
When the relationships between patients and their providers are poor, rehabilitation will suffer. This paper explores four areas of such relationships: the factors influencing the decision to seek help, information and its communication, patient and provider expectation, and changing experience of disablement over time. On the basis of these areas it is possible to improve both the clinical and research approach to disability and to enlist more help from the social scientist.
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McKenna SP, McEwen J, Hunt SM, Papp E. Changes in the perceived health of patients recovering from fractures. Public Health 1984; 98:97-102. [PMID: 6718676 DOI: 10.1016/s0033-3506(84)80103-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Hunt SM, McEwen J, McKenna SP, Backett EM, Pope C. Subjective health assessments and the perceived outcome of minor surgery. J Psychosom Res 1984; 28:105-14. [PMID: 6737323 DOI: 10.1016/0022-3999(84)90002-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A simple and standardised measure of perceived health status, the Nottingham Health Profile, was used to assess the effect on perceived health status of surgical intervention in a variety of non-acute medical disorders. Patients were assessed a few days before their operation and again two months later and were compared with a control group who had not undergone surgery. Results showed very little change in subjective health from before to after surgical intervention. The experimental group had similar perceived health scores to the control group on the pre- and post-tests. It is suggested that the period allowed to elapse after surgical intervention was too short, or that the level of problems experienced by patients prior to surgery was too low to show significant change. It is also possible that the particular presenting disorders were only one possible somatic representation of general feelings of minor ill-health in the group. The findings of this study point to the need to look at the differences between doctors and patients expectations of the outcome of surgery, the decision to seek care and the factors that govern wellbeing.
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Reading AE. A critical analysis of psychological factors in the management and treatment of chronic pelvic pain. Int J Psychiatry Med 1982; 12:129-39. [PMID: 7118442 DOI: 10.2190/v543-d58q-wj3e-g2x5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic pelvic pain is a common presenting complaint in gynecology clinics. In a proportion of cases no pathology or sufficient pathology can be found to account for the level of complaint. This paper reviews the evidence on the psychological characteristics of patients presenting with chronic pelvic pain without obvious pathology. Methodological considerations are identified in order to guide future research. There is a need for prospective studies, in which women with pelvic pain of whatever etiology are evaluated, in order to provide contextual data and to identify predictors of treatment response.
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