A new perspective on family involvement in chronic pain management programmes

OBJECTIVES

The aim of this study was to investigate how those with pain, and their significant others, perceive the involvement of significant others in a multidisciplinary chronic pain management programme.

METHODS

Semi-structured telephone interviews were conducted with eight people who had attended a Family Day as part of a three-week multidisciplinary chronic pain management programme in Auckland, New Zealand. Four of the participants had pain and four were significant others. Follow-up interviews were conducted with seven of the participants up to one year after their initial interview. Conventional content analysis was used to analyse collected data.

RESULTS

Participants viewed the involvement of significant others to be important because managing pain necessitates 'being on the same page' and significant others also needed an opportunity to access support and information.

CONCLUSION

The involvement of significant others in programmes is perceived to be important but must be a balance between what is feasible for significant others and beneficial for all. Further research into when and how significant others are included within programmes is urgently required.

Evaluation of cognitive performance in the heat by functional brain imaging and psychometric testing

Military operations in tropical environments have imposed a significant challenge to the Australian Defence Forces (ADF). The hot and humid conditions are known to cause debilitating effects on soldiers deployed to northern regions of Australia, with the consequence that the effectiveness and efficiency of operations are severely compromised. While the adverse effects of thermal stress on soldiers' physiological capability are well established, this has not been confirmed for cognitive performance. A select range of psychometric tests were administered and functional brain electrical activity imaging was performed to investigate the impact of thermal stress on cognitive performance. The brain electrical activity of subjects was measured while undertaking a range of cognitive tasks. Steady State Probe Topography (SSPT), a novel brain imaging technology, was employed to monitor the changes in regional brain activity and neural processing speed of subjects under thermal stress. The psychometric test batteries included the following tasks; Rey Auditory Verbal Learning Test; Inspection Time; Digit Span test; a spatial working memory task; and the AX-continuous performance task. These tasks measure a range of cognitive processes including attention, memory, verbal learning, information processing and concentration. The functional brain imaging provided topographical information, which showed changes in electrical activity in response to thermal stress during cognitive performance. These changes in brain electrical activity and neural speed induced by thermal stress may help to identify the type of cognitive functions that are likely to be impaired under operational conditions. Results indicated that subjects experienced increasing cardiovascular strain through thermally neutral to thermally straining conditions. The results from the psychometric test battery showed some promising effects given the small sample size including deficits in working memory, in information retention and in information processing. There was also marked differences in the electrical responses of the brain when subjects were thermally strained. The Steady-State Visual Evoked Potential recordings showed an increase in amplitude and a decrease in latency, suggesting an increase in the utilisation of neural resources or effort by subjects to maintain the same level of performance as under thermally neutral conditions. The data are suggestive of the high sensitivity of brain imaging techniques with high temporal resolution to identify important decrements in cognitive performance in hostile environments.

Reflections on a renaissance of occupation

At the close of the 20th century, there is a renaissance of occupation in occupational therapy and occupational science. Kielhofner (1992) offers an intraprofessional explanation that the growing interest in occupation recaptures occupational therapy's lost identity. An extraprofessional explanation is that postmodern ideas and social practices have helped to create a societal context in which a renaissance of occupation is welcome. Postmodernism raises questions and awareness of power, diversity, temporality, and situatedness in which normative ideas of occupation as paid work can be challenged. Since occupation is of primary concern to occupational therapy and occupational science, the authors reflect on postmodernism and its influence on a renaissance of occupation in these two fields. These reflections consider what such a renaissance means for occupational therapists and occupational scientists in the 21st century.

Sensitivity of Shah, Vanclay and Cooper's modified Barthel Index

OBJECTIVE

To investigate whether Shah, Vanclay and Cooper's modification of the Barthel Index improved its sensitivity to change.

DESIGN

Correlational study.

SETTING

School of Occupational Therapy at Auckland Institute of Technology, Auckland, New Zealand.

SUBJECTS

One hundred subjects requiring rehabilitation following a stroke.

MAIN OUTCOME MEASURES

Change in function which was measured using Shah, Vanclay and Cooper's (1989) modified Barthel Index and walking speed over 10 metres.

RESULTS

Five statistical analyses were undertaken, none of which demonstrated clear superiority of one measure over the other.

CONCLUSIONS

The study did not indicate the modified Barthel Index to be more sensitive to change than the 20-point Barthel Index for this population. The statistical analysis strategies utilized are recommended for similar studies.

Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke

OBJECTIVE

To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists.

DESIGN

A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital.

SETTING

A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand.

MAIN OUTCOME MEASURES

(1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit.

RESULTS

No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p = 0.003).

CONCLUSIONS

A supervised home-based programme is as effective as outpatient or day hospital therapy.