Measurement of psychophysiologic response variables in chronic bronchitis and emphysema

Guided imagery as a treatment option for fatigue: a literature review

PURPOSE

Fatigue is one of the most common complaints experienced among the general population. Because fatigue is recognized as a biobehavioral occurrence, a biobehavioral intervention such as guided imagery may be effective in reducing self-reported fatigue. Therefore, the purpose of this study was to explore the research literature related to the use of guided imagery as a nonpharmacological mind-body intervention for the symptom of fatigue.

METHOD

The electronic databases MEDLINE, CINAHL, PsychInfo, Psychology and Behavioral Sciences Collection and the Cochrane Library were searched from January 1980 to June 2010.

FINDINGS

Of 24 articles retrieved, eight met the inclusion criteria and were included in this systematic literature review. FINDINGS were inconsistent regarding the effectiveness of guided imagery on fatigue. Studies varied in study length, duration of the applied guided imagery intervention, dosage, and whether the images were targeted to the purpose of the intervention.

IMPLICATIONS

Guided imagery is a simple, economic intervention with the potential to effectively treat fatigue, thus further research is warranted using systematic, well-designed methodologies Standardizing guided imagery interventions according to total duration of exposure and targeted imagery in a variety of different populations adequately powered to detect changes will contribute to and strengthen nursing's symptom-management armamentarium.

Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients: a clinical trial

PURPOSE/OBJECTIVES

To test an intervention for hospice caregivers designed to help them better manage symptoms experienced by patients with cancer.

DESIGN

A three-group comparative design with repeated measures.

SETTING

A large nonprofit hospice that primarily provides home care.

SAMPLE

329 hospice homecare patients with cancer and their caregivers were randomized into three groups: a control group (n = 109) receiving standard care, a group (n = 109) receiving standard care plus friendly visits, and a group (n = 111) receiving standard care plus the COPE intervention.

METHODS

Caregivers received experimental training in the COPE intervention (creativity, optimism, planning, expert information) over nine days to assist with symptom management.

MAIN RESEARCH VARIABLES

Intensity of pain, dyspnea, and constipation, overall symptom distress, and quality of life (QOL). Data were collected on admission and days 16 and 30.

FINDINGS

Although symptom intensity for three target symptoms did not decrease, symptom distress was significantly improved (p = 0.009) in the COPE intervention group. QOL was not significantly different.

CONCLUSIONS

Symptom distress, a measure that encompasses patient suffering along with intensity, was significantly decreased in the group in which caregivers were trained to better manage patient symptoms.

IMPLICATIONS FOR NURSING

The COPE intervention is effective and immediately translatable to the bedside for hospice homecare patients with advanced cancer.

Clinically important changes in health-related quality of life for patients with chronic obstructive pulmonary disease: an expert consensus panel report

OBJECTIVE

Without clinical input on what constitutes a significant change, health-related quality of life (HRQoL) measures are less likely to be adopted by clinicians for use in daily practice. Although standards can be determined empirically by within-person change studies based on patient self-reports, these anchor-based methods incorporate only the patients' perspectives of important HRQoL change, and do not reflect an informed clinical evaluation. The objective of this study was to establish clinically important difference standards from the physician's perspective for use of 2 HRQoL measures among patients with chronic obstructive pulmonary disease (COPD).

DESIGN

We assembled a 9-person expert panel of North American physicians familiar with the use of the Chronic Respiratory Questionnaire (CRQ), a disease-specific HRQoL measure, or the generic Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, Version 2.0) among patients with COPD.

RESULTS

Using 2 rounds of the Delphi process, 1 in-person meeting, and an iterative improvement process for circulating and correcting the final report, the expert panel established small, moderate, and large clinically important change levels for the CRQ and SF-36.

CONCLUSIONS

For this expert physician panel, levels for detecting clinically important differences on the CRQ were equal to or slightly higher than previous studies based on patient-reported differences. Clinically important differences on the SF-36, Version 2.0, were noticeably larger than previous estimates based on cross-sectional differences between clinically defined patient groups.

Testing an uncertainty model for women with multiple sclerosis

This study sought to explain adaptation to the uncertainty of multiple sclerosis (MS) in women. A casual model, developed from the literature and from interviews with four women with MS, was tested on a sample of 90 women with MS. Successful adaptation was measured by self-esteem and mastery. The model accounted for 26% of the variance in mastery, with an empirical model accounting for a higher degree of variance (41%). Findings suggest that the negative impact of uncertainty in women with MS is significantly reduced by their spiritual and social relationships.

Effects of guided imagery in patients with chronic bronchitis and emphysema

Together, chronic bronchitis and emphysema (CBE) ranks as one of the top five leading health problems in the United States. Few nursing interventions have been tested that improve symptom management, functional status, and quality of life. This study tested the effects of guided imagery and maximal inspiratory muscle training (MITT) in a group of 10 males and 9 females, 56-75 years old, with moderate CBE. The research tested whether the independent variables, guided imagery and MITT, have significant independent and/or interaction effects on the dependent variables functional status, fatigue, dyspnea, depression, mastery, quality of life, perceived health status, and inspiratory muscle strength. Results showed that the psychologic intervention of guided imagery significantly improved subjects' perceived quality of life. The physiologic intervention of MITT could not be tolerated by subjects, which precluded testing the effects on the dependent variables. Application of study findings to clinical practice and the need for further research are discussed.