Cognitive telephone group therapy with physically disabled elderly persons

Paraplegia from Spinal Cord Injury: Self-Esteem, Loneliness, and Life Satisfaction

With advances in health care sciences, people with spinal cord injuries can now live to old age. Rehabilitation of the disabled is a dynamic process and should include not only attaining maximum function, but also receiving satisfaction with life in one's environment. Life satisfaction is thought to be the subjective part of quality of life, i.e., the feelings of the persons concerned about their functioning and circumstances. However, these feelings are influenced by self-esteem, the positive or negative attitude toward oneself, as well as life satisfaction and the effect of loneliness on self-esteem. Forty community-living adults with paraplegia from spinal cord injury from the metropolitan area of Athens responded to the Rosenberg's Self-Esteem Scale, the Revised UCLA Loneliness Scale, and the Life Satisfaction Index. As expected, statistically significant correlations were obtained among self-esteem, life satisfaction, and loneliness. More specifically, the higher an individual's self-esteem: a) the higher the life satisfaction and b) the lower the feelings of loneliness experienced. Furthermore, there was a statistically negative relationship between loneliness and life satisfaction. Community mobility, architectural adaptations, and social support, as it is reflected through marital status and frequency of received visits, proved to be important factors in understanding loneliness, self-esteem, and life satisfaction. Implications for rehabilitation of individuals with spinal cord injuries are discussed.

Randomized trial of therapeutic group by teleconference: African American women with breast cancer

BACKGROUND

The effects of a therapeutic group by teleconference for African American women with breast cancer have not been documented, although the benefits of therapeutic groups for European women are well established. African American women with breast cancer may experience social disconnection, a sense of being cut off from partners, family, and friends because of side effects of treatment and fatalistic beliefs about cancer. A therapeutic group by teleconference may counteract these problems and improve social connection.

METHODS

A randomized trial design stratified by treatment type was used. Data were collected at baseline, at the end of the intervention, and 16 weeks from baseline. Repeated-measures, fixed-factor analyses of covariance were used for each outcome. The between-subject factors were group and replicate set, and the within-subject factor was time. Physical well being and educational level differed significantly between the 2 groups at baseline and were used as covariates.

RESULTS

The mixed-model analysis of the outcome variables revealed significant changes over time for knowledge (P ≤ .001), with higher scores on knowledge observed for the control group. Group-by-time interactions were observed for fatalism (P = .0276), fear (P = .0163), and social connection (P = .0174) as measured by the Social Well Being subscale from the Functional Assessment of Cancer Treatment-Breast Cancer Version. No group-by-time interaction was observed for social connection as measured by the Social Support Questionnaire. Social connection measured with the Social Well Being subscale improved significantly in the intervention group, whereas fatalism and fear significantly decreased.

CONCLUSIONS

In this study, the authors documented the benefits of a therapeutic group by teleconference, a novel way to provide support for African American women with breast cancer. Further research should include a behavioral outcome, such as treatment adherence.

A meta-analysis of interventions to reduce loneliness

Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.

Online self-management in rheumatoid arthritis: a patient-centered model application

OBJECTIVE

The aim of this study was to describe the online transformation of an empirically validated, clinic-based, self-management (SM) program for rheumatoid arthritis.

MATERIALS AND METHODS

A cognitive-behavioral framework served as the theoretical basis for the intervention. As with the clinic-based approach, the psychoeducational program included educational modules, weekly homework assignments, and self-evaluation. The dynamic online environment included secure communication tools to support a virtual community for the participants to garner peer support. In addition to peer support, weekly follow-up support was provided by a trained clinician via telephone. We describe the process and structure of the online self-management (OSM) intervention. Administrative issues including clinical monitoring and management, data collection, and security safeguards are considered. Utilization and management data are provided and explored for 33 initial subjects.

RESULTS

Individuals who volunteer to participate in an online modality are eager to receive this home-based programming. They readily engaged with all aspects of the OSM program and experienced few difficulties navigating the environment.

CONCLUSION

An OSM site provides a convenient, effective, and securely maintained health service, once restricted to clinic settings. The OSM application can be used to extend the benefits of SM programs to broad target audiences and serves as a model for the emerging generation of Internet-based clinical management/delivery systems.

Telephone-delivered cognitive behavioural therapy: a systematic review and meta-analysis

Telephone-delivered cognitive behavioural therapy (CBT) is an increasingly popular mode of delivering care. We conducted a systematic review which focused on physical health outcomes. Literature searches were conducted to identify randomized controlled trials (RCTs) comparing telephone-delivered CBT for improving physical health with any other therapy or routine care in patients with chronic illness. Eight RCTs (1093 patients) met the eligibility criteria and were included in the review. Six of the eight RCTs compared the telephone intervention with routine care, one trial employed symptom monitoring as the control condition and the final trial compared telephone CBT to telephone supportive emotion-focused therapy. Meta-analysis found that telephone-delivered CBT significantly improved physical health in people with chronic illness (d = 0.225, 95% CI = 0.105, 0.344). Moderator analyses found that less therapist contact was associated with better outcomes, and telephone-delivered CBT was more effective for chronic illnesses that are not immediately life-threatening. The results of the meta-analysis support the use of telephone-delivered CBT as a tool for improving health in people with chronic illness. There is a need for future trials to evaluate cost-effectiveness.

Distance delivery of mindfulness-based cognitive therapy for depression: project UPLIFT

This study evaluated the efficacy of a newly developed, home-based depression intervention for people with epilepsy. Based on mindfulness-based cognitive therapy (MBCT), the eight-session, weekly intervention was designed for group delivery via the Internet or telephone. Forty participants were randomly assigned to intervention or waitlist. Depressive symptoms and other outcomes were measured at baseline, after intervening in the intervention group (~8 weeks), and after intervening in the waitlist group (~16 weeks). Depressive symptoms decreased significantly more in the intervention group than the waitlist group; Internet and telephone did not differ. This effect persisted over the 8 weeks when those waitlisted received the intervention. Knowledge/skills increased significantly more in the intervention than the waitlist group. All other changes, though not significant, were in the expected direction. Findings indicate that distance delivery of group MBCT can be effective in reducing symptoms of depression in people with epilepsy. Directions for future research are proposed.

Evaluation of a Teleconference-Delivered Energy Conservation Education Program for People with Multiple Sclerosis

Background. Little is known about the strengths and limitations of teleconference delivery for energy conservation education for people with multiple sclerosis (MS). This study evaluated such a program to address this gap. Methods. Data were collected from 28 individuals with MS who participated in a teleconference-delivered energy conservation education program. Participants shared their perspectives on the course and its delivery format. Session notes from the three occupational therapists who delivered the program were also reviewed. Findings. Participants found the format to be convenient and relaxed, and the content to be relevant to their everyday lives. Technical issues, lack of time for sharing, and lack of time to practice strategies were limitations. Although the format challenged the occupational therapists' group leadership skills, they were surprised at the extent of group cohesion that developed using this format. Implications. Feedback from both people with MS and occupational therapists suggests that providing energy conservation education by teleconference is acceptable, practical, and worth pursuing in the future.

Efficacy of Therapeutic Group by Telephone for Women With Breast Cancer

A pilot study was conducted to test the efficacy of a therapeutic group by telephone conference call for women with breast cancer. Sixty-six women with stage I or stage II breast cancer consented to participate in the study. Participants were randomly assigned to a usual psychosocial care or intervention group, using a permuted block method. Only 2 of 68 patients dropped out of the study, which included 27% African Americans. Assessments at 3 time periods (pretest, immediately after the intervention, and 3 months after the group ended) included evaluation of quality of life (QOL), mood, and immune function. ttests were performed to determine if differences on important variables existed at pretest. The intervention group had worse QOL and mood scores than did the control group on the pretests. A mixed-model repeated-measures procedure controlling for pretest differences was used to analyze data. A significant Group by Time interaction was found for spiritual well-being and mood. These differences were not in the expected direction. The intervention group showed improvement in QOL and mood during the intervention, but showed decompensation following the intervention. Conversely, the control group demonstrated stable or declining scores. This intervention is feasible and practical for women with breast cancer, especially African American participants. The puzzling results suggest several areas for future research, including a better conceptual fit with outcome measures, increasing dosage, and exploration of the value of emotional expression.

Telephone group intervention for older stroke caregivers

PURPOSE

This study evaluated the effectiveness of telephone groups for older, spousal caregivers of stroke survivors.

METHOD

The 88 caregivers were mostly white females who were 70 years old on average and who had been providing care for an average of 3 years. Participants were randomized to treatment or control conditions, followed for 6 months, and assessed for depression, burden, loneliness, stress, and competence. Treatment participants engaged in an eight-session psychoeducational telephone group.

RESULTS

Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress. Control participants showed a significant increase in burden during the study; treatment participants showed a significant increase in competence.

Psychotherapies and older adults

OBJECTIVE

To confirm clinical experience which suggests that older people are offered psychotherapies significantly less often than younger ones. For those who are able to access psychotherapeutic help the outcome is comparable, sometimes better, than for younger patients.

METHOD

Contemporary and older seminal literature was reviewed for psychodynamic, cognitive-behavioural, reminiscence and systemic family therapies treating older patients.

RESULTS

The main findings supported the experience of staff in old age psychiatry that if the reluctance of referrers and sometimes of older patients themselves can be overcome this type of work is valuable and effective.

CONCLUSIONS

Each patient is unique. Generalizations are not always appropriate, however, with advancing years some common themes emerge in therapeutic work. It may be necessary to make modifications to the therapeutic technique to accommodate the difficulties experienced by people in later life but also to use their strengths. Staff working in this field need to have the capacity to be aware of and to understand their own feelings and prejudices about the second half of life. For patients not offered formal therapy a psychotherapeutic approach will nevertheless enhance their psychiatric care. Although the body of research is growing, more work needs to be done in evaluating all of the psychotherapies offered to older people.

Patterns of telephone use among nursing home residents

There is convincing evidence that nursing home residents who have more visitors fare better than those who have fewer visitors. However, as many as one third of all individuals living in nursing homes have virtually no visitors. The purpose of this study was to address this concern by examining telephone use in older adults living in nursing homes, and evaluating the potential of telephone communications as a means of social support for this at-risk group. Using a recording device activated each time the receiver was picked up, the research team "listened in" on the telephone conversations of three nursing home residents (aged 76, 79, and 92) for a period of 1 week. The transcripts revealed 56 minutes of actual conversation during the week (10, 21, and 25 minutes, respectively), most often with family or longtime friends living out of town. Each resident laughed aloud more than once per minute. The telephone conversations provided the residents with vivid glimpses of life outside the walls of their facility and appeared to help them stay connected with their family and friends. The findings support further study of the telephone as a way to sustain authentic social support in long-term care populations.

Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis

This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy (CBT) for the treatment of depressive symptomatology in multiple sclerosis (MS) patients. The treatment, Coping with MS (CMS), included a patient workbook designed to structure the treatment, provide visual aids, and help with homework assignments. Thirty-two patients with MS, who scored at least 15 on the Profile of Mood States Depression-Dejection scale, were randomly assigned to either the telephone CMS or to a usual-care control (UCC) condition. Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition. Furthermore, adherence to interferon beta-1a, a disease-modifying medication for the treatment of MS, was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition.

A telephone intervention to reduce fatigue and symptom distress in mothers with difficult infants in the community

The purpose of this study was to test the effectiveness of a telephone intervention to reduce fatigue and the resulting symptom distress of mothers in Iceland who reported having a behaviourally difficult infant of 2-3 months of age. A sample of 78 mothers who reached distress criteria of depressive symptoms and parental stress was selected and randomly allocated in a controlled experimental study. In a brief intervention both maternal distress and infant difficulty were discussed. Results indicate a significant (P < 0.001) intervention effect on fatigue and its side-effects. It is concluded that intervention by telephone can be effective with fatigued mothers caring for a difficult infant.

Participation in teleconference support groups: application to drug-using pregnant patients

This paper describes our experience using telephone conference calls to conduct support groups for chemically-dependent women. Forty-seven women agreed to participate in regular, weekly support groups that were conducted by two chemical dependency counselors. Counselors attempted to conduct 59 support groups via a telephone conferencing system. Our data indicated that attendance at these sessions was poor. Seventeen sessions had no participants. No group sessions were attended by 4 or more women, and only 3 sessions (7.1%) included 3 participants. Very few clients made regular use of the support groups. Only 4 clients (8.5%) participated in more than 3 group sessions. Our findings suggest that teleconferencing may not be the most effective method for providing support services to chemically-dependent women.

Evaluating rehabilitation medicine: effects on survival, function, and home care

The goal of this study was to measure the clinical impact of rehabilitation on adults diagnosed with a disabling disorder in four major diagnostic groups (nervous, circulatory, musculoskeletal, and injury). To summarize the current knowledge in this area, a meta-analysis of rehabilitation studies was also completed. Specific objectives of the clinical trial were to determine the effects of inpatient rehabilitation on: (1) survival, (2) function, (3) home care, and related variables such as family function and use of health care resources. Patients hospitalized for the first time with a disabling condition (n = 85) were randomly assigned to inpatient rehabilitation (n = 43) or to outpatient follow-up (n = 42) in which the usual medical services were provided but no scheduled rehabilitative therapies were offered. To compare the two groups, analyses of covariance were conducted for functional ability, health care use, survival, health status, personal adjustment and family function. The between subjects factor was inpatient rehabilitation versus the control group. The within subjects factor was time of assessment (index, six months, and 1 year). No significant treatment effect was found at six months or one year for any of the variables under study using analyses of covariance. There were also no differences between groups in their use of nursing homes, length of hospital stay, survival, or in the number of hospital readmissions or clinic visits during the first year after hospital discharge. Rehabilitation did cost significantly more than medical care, primarily due to the cost of inpatient services. Some clinical trials have noted a treatment effect on functional ability but not on mortality, need for skilled care, or mental health status. The current study is consistent with these previous findings except for the lack of impact on physical function. This exception may be due to the fact that prior studies looked only at homogeneous groups, whereas the current study utilized heterogeneous grouping across four major diagnostic categories. Any apparent benefit may not be detectable across disability groups and may require more specialized scrutiny, or even tailored rehabilitative care, to detect a difference. It is recommended that health care systems evaluate the benefits of subacute rehabilitative care and consider outpatient programs that can be provided at home for implementation.

Characterizing the use of health care services delivered via computer networks

OBJECTIVE

Evaluators must develop methods to characterize the use of the rapidly proliferating electronic networks that link patients with health services. In this article the 4-S framework is proposed for characterizing the use of health services delivered via computer networks. The utility of the 4-S framework is illustrated using data derived from a completed, randomized field experiment in which 47 caregivers of persons who had Alzheimer's disease accessed ComputerLink, a special computer network providing information, communication, and decision support to homebound caregivers of persons who have Alzheimer's disease.

DESIGN

Human-computer interaction theories characterize the use of health services delivered via computer networks in behavioral terms. The 4-S framework incorporates perspectives based on user (subject) behavior: access to and use of the total system, use of specific services, behavior within single sessions, and enduring behavioral characteristics. The 4-S framework was tested in a secondary analysis of data from over 3,800 uses of ComputerLink.

MEASUREMENT

The 4-S framework was instantiated using data obtained from the ComputerLink evaluation. Three types of secondary data were obtained. A passive monitor of access to the computer network provided quantitative information, such as time of day when access occurred, duration of access, and sequence of services used. Full-text messages were available from the public message postings. Subjective appraisal of use was obtained from self-reporting by users at the end of the experiment.

RESULTS

The components of the 4-S framework were suitable to characterize operational aspects of ComputerLink use by Alzheimer's disease caregivers. Through application of the 4-S framework, an understanding of both quantitative use and qualitative use emerged (e.g., insight was gained into the differential use of specific services).

CONCLUSIONS

The 4-S framework provided a mechanism for combining various measures of use into a coherent whole. The framework promotes a precise characterization of use and thereby facilitates evaluation of health services delivered via computer networks. It is suitable for evaluation of user satisfaction, measurement of needs resolution, and ascertainment of selected clinical outcomes.

Assessment of quality of life in the elderly assisted at home through a Tele-Check service

This study evaluates the effects of a Tele-check/Tele-emergency service on the quality of life in the elderly. Through telephone interviews a questionnaire has been repeatedly administered to explore various psychological, somatic, and social aspects in a random sample of 574 subjects aged 65 years and over (mean = 76.8 years). The findings suggest that the elderly helped by the service (in its 'control' functioning) make less demands on health facilities (GPs visits, number of days in hospital) as compared to controls. Implications are presented and discussed.

Using personal and family variates to predict patients' adjustment after stroke

Forty patients diagnosed with strokes were evaluated to examine the contribution of typical stroke-outcome correlates toward personal adjustment. Multiple regression analyses indicated that significant variance in personal adjustment was accounted for by caregivers' anxiety. Compared to community norms, stroke patients were significantly more confused and depressed, but they were no different on interpersonal adjustment. Results may help in developing methods to identify stroke patients at risk for poor adjustment.

A telephone support service to reduce medical care use among the elderly

A randomized controlled trial was performed to determine whether a telephone support system could reduce the frequency of ambulatory physician encounters. A total of 182 elderly persons were enrolled in the study. The experimental group was regularly called by a public health nurse and could call the nurse every weekday during normal working hours. The control group received no intervention. A year later, the experimental group reported 7.40 ambulatory encounters with a physician (SD = 4.94) and the control group reported 8.61 encounters (SD = 6.85). The difference between the groups, after adjusting for various prognostic factors, was 1.20 (95% confidence interval, -0.84 to 3.24). Although the difference did not achieve statistical significance, the results suggest that telephone support may bring about a substantial decrease in medical care utilization. Further research assessing the cost-advantage ratio for this type of intervention is recommended.