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Performance and Self-reported Functioning of People With Chronic Idiopathic Axonal Polyneuropathy: A 4-Year Follow-up Study. Arch Phys Med Rehabil 2020; 101:1946-1952. [DOI: 10.1016/j.apmr.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
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Stewart S, Thomas S, Van Doormaal PT, Höke A. Relation of exercise and pain in patients with idiopathic distal axonal polyneuropathies. J Peripher Nerv Syst 2020; 25:388-394. [PMID: 33025680 DOI: 10.1111/jns.12415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 12/24/2022]
Abstract
Although exercise is associated with better outcomes in patients with some peripheral neuropathies, data in idiopathic peripheral neuropathies is lacking. This study was completed to do a comprehensive data analysis about the benefits of regular exercise in a well-characterized cohort of patients with idiopathic distal, symmetrical, axonal polyneuropathy enrolled in the Peripheral Neuropathy Research Registry (PNRR) at Johns Hopkins University School of Medicine. From the patient-reported exercise habits, metabolic equivalents (METs) were calculated and the patient information was grouped into four categories. The PNRR data set, including patient reported pain, numbness, and weakness, was analyzed using the METs categories to evaluate for the benefits of exercise. We controlled for the components of metabolic syndrome including Hemoglobin A1c (HbA1c), systolic and diastolic blood pressure (BP), high density lipids (HDL) and triglyceride level, and body mass index (BMI) as defined by the Adult Treatment Panel III Guidelines. Lower METs were associated with neuropathic pain, but not with other peripheral neuropathy symptoms. Patients with IPN who exercised were less likely to have painful neuropathy independent of the average METs per week (P < .01). No significant differences were seen for patient reported numbness, weakness, or balance issues. The data suggests that patients with idiopathic neuropathy benefit from exercises even if performed on a low intensity level or less frequently, and patients are less likely to have severe pain symptoms when exercising on a regular basis.
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Affiliation(s)
- Sarah Stewart
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Simone Thomas
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Perry Tc Van Doormaal
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ahmet Höke
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Studer B, Geniole SN, Becker ML, Eisenegger C, Knecht S. Inducing illusory control ensures persistence when rewards fade and when others outperform us. Psychon Bull Rev 2020; 27:809-818. [PMID: 32424621 PMCID: PMC7399668 DOI: 10.3758/s13423-020-01745-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Persisting even when the rewards of continued effort are fading is essential for achieving long-term goals, skills, and good health, alike. Yet, we often quit when things get hard. Here, we tested whether augmenting the feeling of control through external measures increases persistence under such discouraging circumstances. In two laboratory experiments, we first induced illusory control by manipulating the base-rate of positive outcomes and then tested the effect of this elevation of participants' perceived control upon their persistence under diminishing returns and in a competition against a stronger opponent. Induced illusory control significantly enhanced people's persistence in both of these motivationally challenging situations. Our findings demonstrate that motivation is dependent upon perceived, rather than objective, control, and reveal that this can be leveraged to counteract quitting behavior when things get hard, for instance in rehabilitation, physical activity interventions, or other training settings.
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Affiliation(s)
- Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany.
| | - Shawn N Geniole
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
- Social-Neuroendocrinology Laboratory, Department of Psychology, Nipissing University, North Bay, Ontario, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
| | - Maike L Becker
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Christoph Eisenegger
- Neuropsychopharmacology and Biopsychology Unit, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Mauritius Hospital Meerbusch, Meerbusch, Germany
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Erdmann PG, Teunissen LL, van den Berg LH, Notermans NC, Schröder CD, Bongers BC, van Meeteren NL. Validity of the shuttle walk test as a functional assessment of walking ability in individuals with polyneuropathy. Disabil Rehabil 2016; 39:2112-2118. [DOI: 10.1080/09638288.2016.1217083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Peter G. Erdmann
- Department School of Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Laurien L. Teunissen
- Department of Neurology and Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Leonard H. van den Berg
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nicolette C. Notermans
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carin D. Schröder
- University Medical Center Utrecht and De Hoogstraat Rehabilitation, Center of Excellence for Rehabilitation Medicine, Utrecht, the Netherlands
| | - Bart C. Bongers
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Nico L.U. van Meeteren
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Topsector Life Sciences and Health, the Hague, the Netherlands
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Chronic idiopathic axonal polyneuropathy: a systematic review. J Neurol 2016; 263:1903-10. [DOI: 10.1007/s00415-016-8082-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 12/20/2022]
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O'Brien N, Philpott-Morgan S, Dixon D. Using impairment and cognitions to predict walking in osteoarthritis: A series of n-of-1 studies with an individually tailored, data-driven intervention. Br J Health Psychol 2015; 21:52-70. [PMID: 26227024 DOI: 10.1111/bjhp.12153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 06/26/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES First, this study compares the ability of an integrated model of activity and activity limitations, the International Classification of Functioning, Disability and Health (ICF), and the Theory of Planned Behaviour (TPB) to predict walking within individuals with osteoarthritis. Second, the effectiveness of a walking intervention in these individuals is determined. DESIGN A series of n-of-1 studies with an AB intervention design was used. METHODS Diary methods were used to study four community-dwelling individuals with lower-limb osteoarthritis. Data on impairment symptoms (pain, pain on movement, and joint stiffness), cognitions (intention, self-efficacy, and perceived controllability), and walking (step count) were collected twice daily for 12 weeks. At 6 weeks, an individually tailored, data-driven walking intervention using action planning or a control cognition manipulation was delivered. Simulation modelling analysis examined cross-correlations and differences in baseline and intervention phase means. Post-hoc mediation analyses examined theoretical relationships and multiple regression analyses compared theoretical models. RESULTS Cognitions, intention in particular, were better and more consistent within individual predictors of walking than impairment. The walking intervention did not increase walking in any of the three participants receiving it. The integrated model and the TPB, which recognize a predictive role for cognitions, were significant predictors of walking variance in all participants, whilst the biomedical ICF model was only predictive for one participant. CONCLUSION Despite the lack of evidence for an individually tailored walking intervention, predictive data suggest that interventions for people with osteoarthritis that address cognitions are likely to be more effective than those that address impairment only. Further within-individual investigation, including testing mediational relationships, is warranted. STATEMENT OF CONTRIBUTION What is already known on this subject? N-of-1 methods have been used to study within-individual predictors of walking in healthy and chronic pain populations An integrated biomedical and behavioural model of activity and activity limitations recognizes the roles of impairment and psychology (cognitions) Interventions modifying cognitions can increase physical activity in people with mobility limitations What does this study add? N-of-1 methods are suitable to study within-individual predictors of walking and interventions in osteoarthritis An integrated and a psychological model are better predictors of walking in osteoarthritis than a biomedical model There was no support for an individually tailored, data-driven walking intervention.
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Affiliation(s)
- Nicola O'Brien
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Siôn Philpott-Morgan
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Diane Dixon
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Schüz B, Wolff JK, Warner LM, Ziegelmann JP, Wurm S. Multiple illness perceptions in older adults: Effects on physical functioning and medication adherence. Psychol Health 2013; 29:442-57. [DOI: 10.1080/08870446.2013.863884] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Quinn F, Johnston M, Johnston DW. Testing an integrated behavioural and biomedical model of disability inN-of-1 studies with chronic pain. Psychol Health 2013; 28:1391-406. [DOI: 10.1080/08870446.2013.814773] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Johnston M, Dixon D. Developing an integrated biomedical and behavioural theory of functioning and disability: adding models of behaviour to the ICF framework. Health Psychol Rev 2013; 8:381-403. [DOI: 10.1080/17437199.2013.855592] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Okoro T, Morrison V, Maddison P, Lemmey AB, Andrew JG. An assessment of the impact of behavioural cognitions on function in patients partaking in a trial of early home-based progressive resistance training after total hip replacement surgery. Disabil Rehabil 2013; 35:2000-7. [DOI: 10.3109/09638288.2013.770082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE OF REVIEW This article reviews the clinical features, pathophysiology, and treatment of small fiber sensory neuropathy. RECENT FINDINGS Neuropathic pain is prevalent among patients with peripheral neuropathies of diverse etiologies. For example, in one recent study using the sensitive Neuropathic Pain Symptom Inventory as a screening tool, neuropathic pain was reported in 94% of patients with different peripheral nervous system diseases. Neuropathic pain is frequently underrecognized or inadequately treated. Furthermore, the paucity of clinical signs with small fiber neuropathy may delay recognition of an organic process. Pain, or uncomfortable symptoms, typically results from damage to small unmyelinated nerve fibers (C fibers) or thinly myelinated nerve fibers (A delta fibers). Recent research has helped discover the location of the "pain generators" within the injured peripheral nerves. Small fiber neuropathies are relatively common in clinical practice, but until recently most of the available neurodiagnostic tests focused on large caliber nerve fibers. In the past two decades, the widespread use of quantitative sensory testing and punch skin biopsies to evaluate small caliber nerve fibers has substantially changed the neurologist's ability to diagnose and manage small fiber sensory neuropathy. SUMMARY Neuropathic pain from small fiber neuropathy is prevalent and is caused by a wide variety of disorders, many of which are treatable, especially if recognized early in the process.
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Affiliation(s)
- Justin C McArthur
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-7613, USA.
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12
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Pollard B, Johnston M, Dieppe P. Exploring the relationships between International Classification of Functioning, Disability and Health (ICF) constructs of Impairment, Activity Limitation and Participation Restriction in people with osteoarthritis prior to joint replacement. BMC Musculoskelet Disord 2011; 12:97. [PMID: 21575238 PMCID: PMC3123258 DOI: 10.1186/1471-2474-12-97] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 05/16/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The International Classification of Functioning, Disability and Health (ICF) proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P). The ICF model allows for all paths between the constructs to be explored, with significant paths likely to vary for different conditions. The relationships between I, A and P have been explored in some conditions but not previously in people with osteoarthritis prior to joint replacement. The aim of this paper is to examine these relationships using separate measures of each construct and structural equation modelling. METHODS A geographical cohort of 413 patients with osteoarthritis about to undergo hip and knee joint replacement completed the Aberdeen measures of Impairment, Activity Limitation and Participation Restriction (Ab-IAP). Confirmatory factor analysis was used to test the three factor (I, A, P) measurement model. Structural equation modelling was used to explore the I, A and P pathways in the ICF model. RESULTS There was support from confirmatory factor analysis for the three factor I, A, P measurement model. The structural equation model had good fit [S-B Chi-square = 439.45, df = 149, CFI robust = 0.91, RMSEA robust = 0.07] and indicated significant pathways between I and A (standardised coefficient = 0.76 p < 0.0001) and between A and P (standardised coefficient = 0.75 p < 0.0001). However, the path between I and P was not significant (standardised coefficient = 0.01). CONCLUSION The significant pathways suggest that treatments and interventions aimed at reducing impairment, such as joint replacement, may only affect P indirectly, through A, however, longitudinal data would be needed to establish this.
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MESH Headings
- Activities of Daily Living
- Aged
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Chi-Square Distribution
- Disability Evaluation
- Female
- Hip Joint/physiopathology
- Hip Joint/surgery
- Humans
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Models, Statistical
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain Measurement
- Predictive Value of Tests
- Preoperative Period
- Scotland
- Severity of Illness Index
- Social Behavior
- Social Participation
- Surveys and Questionnaires
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Affiliation(s)
- Beth Pollard
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Paul Dieppe
- Peninsula Medical School, University of Plymouth, Plymouth, UK
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Pertl M, Hevey D, Thomas K, Craig A, Chuinneagáin SN, Maher L. Differential effects of self-efficacy and perceived control on intention to perform skin cancer-related health behaviours. HEALTH EDUCATION RESEARCH 2010; 25:769-779. [PMID: 20439349 DOI: 10.1093/her/cyq031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Previous research using the Theory of Planned Behaviour (TPB) for predicting skin cancer-related health behaviours has not adequately incorporated empirical advances in the conceptualization of the perceived behavioural control (PBC) component of the theory. This study examined the role of self-efficacy and controllability for predicting sunscreen and sunbed use intentions. Five hundred and ninety young adults completed a questionnaire on beliefs and intentions regarding sunscreen and sunbed use. Analysis using confirmatory factor analysis and multiple regression supported a conceptual distinction between two PBC subcomponents: controllability and self-efficacy. While self-efficacy--but not controllability--emerged as a significant predictor of intentions to use sunscreen, the opposite pattern was observed for the prediction of intentions to use sunbeds, whereby lower controllability beliefs were associated with higher intentions. Campaigns aimed at influencing health behaviours should consider the differential effects of the components of perceived control.
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Affiliation(s)
- M Pertl
- School of Psychology, Trinity College Dublin, Dublin 2, Ireland.
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Erdmann PG, Lindeman E, Cats EA, Van Den Berg LH. Functioning of patients with multifocal motor neuropathy. J Peripher Nerv Syst 2010; 15:113-9. [DOI: 10.1111/j.1529-8027.2010.00259.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kennedy P, Scott-Wilson U, Sandhu N. The psychometric analysis of a brief and sensitive measure of perceived manageability. PSYCHOL HEALTH MED 2010; 14:454-65. [PMID: 19697255 DOI: 10.1080/13548500903012848] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study was conducted to determine the psychometric properties of the newly developed Perceived Manageability Scale (PMnac). The study was retrospective in design. Two hundred sixty-one inpatients with a spinal cord injury were recruited from The National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, UK, as part of a convenience sample. The PMnac was developed to measure an individual's perceived manageability of their situation. The Mood Questionnaire is used to assess an individual's current mood. Both scales are part of the Needs Assessment Checklist; a psychometrically valid and reliable outcome tool and vital part of the rehabilitation pathway at the NSIC. Results indicated that out of the six items in the scale, five were found to load onto one factor. The remaining item (item number five) did not load onto this factor structure and was consequently removed from subsequent analyses. With the removal of this item, the PMnac was found to yield high internal validity correlations, internal consistency coefficients and significant sensitivity to change. The PMnac is a psychometrically reliable and valid clinical measure of an individual's perceived manageability of their situation.
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Affiliation(s)
- Paul Kennedy
- Department of Clinical Psychology, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire, United Kingdom.
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Dieppe P, Dixon D, Horwood J, Pollard B, Johnston M. MOBILE and the provision of total joint replacement. J Health Serv Res Policy 2008; 13 Suppl 3:47-56. [DOI: 10.1258/jhsrp.2008.008018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Modern joint replacements have been available for 45 years, but we still do not have clear indications for these interventions, and we do not know how to optimize the outcome for patients who agree to have them done. The MOBILE programme has been investigating these issues in relation to primary total hip and knee joint replacements, using mixed methods research. There have been five main strands: (1) Epidemiological investigations to find out who is receiving total hip and knee replacements in the National Health Service (NHS). This has shown that there are extensive variations in different regions of the UK, with inequalities and probable inequities in the provision of these operations; (2) Epidemiological work to ascertain the population-based needs for the operations, showing under-provision of knee joint replacements, and a relative reluctance of both patients and GPs to consider knee surgery; (3) Quantitative and qualitative research into the views of patients, health care professionals and the public on the indications for, and prioritization of, total hip and knee joint replacements. This has shown lack of agreement within or between professional groups, as well as a mismatch between the views of patients and the public, and those of professionals; (4) Theoretical and experimental work on patient-related outcome measures, and the development of new instruments to assess both pain and function in people with osteoarthritis, based on the International Classification of Function, as well as a new integrated model of function; (5) Cohort studies of patients undergoing hip or knee joint replacements to find out what the determinants of good and bad outcomes are. These studies have emphasized the huge variation in disease severity at the time of surgery. The challenge now is to use and implement our findings for maximum patient benefit.
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Affiliation(s)
- Paul Dieppe
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Diane Dixon
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Beth Pollard
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Marie Johnston
- Department of Social Medicine, University of Bristol, Bristol, UK
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Abstracts. Health Psychol Rev 2007. [DOI: 10.1080/17437190701472504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Erdmann PG, Teunissen LL, van Genderen FR, Notermans NC, Lindeman E, Helders PJM, van Meeteren NLU. Functioning of patients with chronic idiopathic axonal polyneuropathy (CIAP). J Neurol 2007; 254:1204-11. [PMID: 17385078 PMCID: PMC2794339 DOI: 10.1007/s00415-006-0501-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 11/23/2006] [Accepted: 11/24/2006] [Indexed: 11/29/2022]
Abstract
Although patients with Chronic Idiopathic Axonal Polyneuropathy (CIAP) report a slow deterioration of sensory and motor functions, the impact of this deterioration on daily functioning has not yet been investigated in detail. The first aim of this crosssectional study involving 56 patients with CIAP was, therefore, to assess patients’ functioning with use of the International Classification of Functioning, Disability and Health (ICF). The second aim was to find determinants of walking ability, dexterity, and autonomy. Fatigue and limited walking ability were present in most patients and differed considerably. In regression models, age, muscle strength, and fatigue together explained 63% of the variance in walking ability, which by itself explained almost 50% of the variance in patients’ autonomy indoors and outdoors (42% and 49%, respectively). Muscle strength and sensory function scores together explained 30% of the variance in dexterity scores, which in turn explained only 13% of the variance in autonomy indoors. The diminished autonomy of patients with CIAP might be improved by reducing fatigue, by means of training, and by improving walking ability.
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Affiliation(s)
- Peter G Erdmann
- Rudolf Magnus Institute of Neuroscience, Dept. of Neurology and Neurosurgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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