Higher Baseline Function Research Articles

Cognitive Impairment and Risk of Depressive Episodes from a Bipolar Spectrum Perspective: A Case-Control Study in Older Adults during the COVID-19 Lockdown

Background: A wide range of conditions, including mixed depressive symptoms, hyperactivity, cognitive impairment (CI) might be expressions of Bipolar Spectrum Disorder (BSD) according to the neo-Kraepelinian perspective, even in advanced age. CI, which has a high prevalence in the elderly population, when it occurs in comorbidity with depression further hinders therapy response and functional ability. The present study aims to explore risk factors associated with CI in elderly individuals experiencing a depressive episode during lockdown a period marked by significant stressors and rhythm disruption. Methods: A case-control study analyzed data from a previous RCT (secondary analyses) on elderly individuals living at home, assessing depressive symptoms, cognitive performance, hyperactivity, and hypertension before (T0) and during lockdown (T1). Results: Participants with lower pre-pandemic cognitive performance were more prone to lockdown depression compared to those with higher baseline function (F = 6.074; p = 0.016). Among those experiencing lockdown depression without prior depression, those with low cognitive performance were more prevalent than the control group without depression (OR = 11.8; p = 0.015). Conclusion: This study highlights a potentially vulnerable subgroup within the elderly population that requires targeted interventions and support during stressful events. Future research should explore the underlying mechanisms linking cognitive decline and depression in older adults, particularly those with a possible bipolar spectrum predisposition.

Palliative Rehabilitation in Patients with Cancer: Definitions, Structures, Processes and Outcomes.

This review examines the literature on palliative rehabilitation for patients with advanced cancer, focusing on definitions, structures, processes, and outcomes. Palliative cancer rehabilitation targets comfort and functional improvement for patients with limited rehabilitation potential across various settings. The palliative cancer rehabilitation team, typically led by a physician, coordinates symptom management and referrals to rehabilitation and other allied healthcare professionals as needed. The outcomes of palliative cancer rehabilitation varied widely by goals, settings, and interventions. Studies in hospice settings generally reported improved symptom control; inpatient rehabilitation had mixed functional outcomes; and outpatient palliative rehabilitation may contribute to enhanced functional and symptom outcomes, especially among patients with higher baseline function. Palliative cancer rehabilitation emphasizes a collaborative approach that integrates palliative care with rehabilitation interventions, aiming to enhance quality of life and address diverse patient needs. Further research and standardization are necessary to realize its full potential.

Feasibility of High Repetition Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy

Aims In pediatric upper extremity rehabilitation, feasible repetition rates are unknown. Our objectives were to examine repetition rates during rehabilitation and their impact on outcomes. Methods Children with unilateral cerebral palsy due to perinatal stroke (n = 55, median 10 y 7 mo, 30 males) received Constraint-Induced Movement Therapy (CIMT) followed by Bimanual Therapy, each for 5 days. Repetitions were documented during one-on-one therapy (1.5 h/day). Outcomes included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF), and Box and Block Test (BBT). Means and standard deviations for motor outcomes and frequencies for repetition rates were calculated. Factors associated with repetition rates and outcome change were explored using standard linear regression. Results Repetitions/hour averaged 365 ± 165 during CIMT and 285 ± 103 during Bimanual Therapy. Higher repetition rates were associated with higher baseline function by older age, a main effect of younger age, and improving motor skill (p < .05). Higher repetition rates corresponded with improvement of the AHA and BBT (p < .05, standardized ß = 0.392, 0.358). Conclusions Results suggest high repetition therapy is feasible in school-aged children with perinatal stroke, albeit with high individual variability. Multiple associations between repetition rates and baseline function and change point to the clinical importance of this measurable and potentially modifiable factor.

Do patient-reported outcome measures improve after aseptic revision total hip arthroplasty?

The purpose of this study was to determine patient-reported outcome measures (PROMs) changes in: (1) pain, function and global health; and (2) predictors of PROMs in patients undergoing aseptic revision total hip arthroplasty (rTHA) using a multilevel model with patients nested within surgeon. A prospective cohort of 216 patients with baseline and 1-year PROMs who underwent aseptic rTHA between January 2016 and December 2017 were analysed. The most common indication for rTHA was aseptic loosening, instability, and implant failure. The PROMs included in this study were HOOS Pain and HOOS Physical Function Short-form (PS), Veterans RAND-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (MCS). Multivariable linear regression models were constructed for predicting 1-year PROMs. Mean 1-year PROMs improvement for aseptic revisions were 30.4 points for HOOS Pain and 22.1 points for HOOS PS. Predictors of better pain relief were patients with higher baseline pain scores. Predictors of better 1-year function were patients with higher baseline function and patients with a posterolateral hip surgical approach during revision. Although VR-12 PCS scores had an overall improvement, nearly 50% of patients saw no improvement or had worse physical component scores. Only 30.7% of patients reported improvements in VR-12 MCS. Overall, patients undergoing aseptic rTHA improved in pain and function PROMs at 1 year. Although global health assessment improved overall, nearly half of aseptic rTHA patients reported no change in physical/mental health status. The associations highlighted in this study can help guide the shared decision-making process by setting expectations before aseptic revision THA.

Who benefits from computerized cognitive training? Lower processing speed predicts greater cognitive improvement

• How does baseline cognition influence gains from computerized cognitive training? • Depressed young adults with lower processing speed show greater cognitive gains. • Gains were significantly greater in processing speed tasks. • Training type did not affect the relationship between baseline cognition and gains. Computerized cognitive training (CCT) is an intervention used to target cognitive deficits associated with depression, and has been found to improve mood, cognition, and everyday functioning. The aim of the present study is to determine if baseline cognitive presentation predicts improvement in cognition from CCT, and if this improvement varies based on the type of training received. Forty-six young adults with depressive symptoms were recruited as part of a randomized controlled trial studying the effects of CCT on mood, cognition, and everyday functioning. Participants completed training on their mobile devices for 15 min/day, 5 days/week, for 8 weeks. Clinical and neuropsychological assessments were completed at baseline and 8 weeks. Individuals with below average processing speed (PS) scores showed greater improvement in 2 out of 4 PS tasks (Cohen's d range > 1) compared to above average performers. The high and low performers did not differ in change in performance in non-PS tasks. Type of training had no effect. Small college-aged sample. CCT has differential effects on PS depending on baseline cognitive presentation. Individuals with an initial relative PS weakness improve more from CCT than those with higher baseline functioning. This study highlights the importance of identifying individual differences in cognition that may factor into CCT response.

Identifying Mechanisms of Normal Cognitive Aging Using a Novel Mouse Genetic Reference Panel.

Developing strategies to maintain cognitive health is critical to quality of life during aging. The basis of healthy cognitive aging is poorly understood; thus, it is difficult to predict who will have normal cognition later in life. Individuals may have higher baseline functioning (cognitive reserve) and others may maintain or even improve with age (cognitive resilience). Understanding the mechanisms underlying cognitive reserve and resilience may hold the key to new therapeutic strategies for maintaining cognitive health. However, reserve and resilience have been inconsistently defined in human studies. Additionally, our understanding of the molecular and cellular bases of these phenomena is poor, compounded by a lack of longitudinal molecular and cognitive data that fully capture the dynamic trajectories of cognitive aging. Here, we used a genetically diverse mouse population (B6-BXDs) to characterize individual differences in cognitive abilities in adulthood and investigate evidence of cognitive reserve and/or resilience in middle-aged mice. We tested cognitive function at two ages (6 months and 14 months) using y-maze and contextual fear conditioning. We observed heritable variation in performance on these traits (h2RIx̄ = 0.51–0.74), suggesting moderate to strong genetic control depending on the cognitive domain. Due to the polygenetic nature of cognitive function, we did not find QTLs significantly associated with y-maze, contextual fear acquisition (CFA) or memory, or decline in cognitive function at the genome-wide level. To more precisely interrogate the molecular regulation of variation in these traits, we employed RNA-seq and identified gene networks related to transcription/translation, cellular metabolism, and neuronal function that were associated with working memory, contextual fear memory, and cognitive decline. Using this method, we nominate the Trio gene as a modulator of working memory ability. Finally, we propose a conceptual framework for identifying strains exhibiting cognitive reserve and/or resilience to assess whether these traits can be observed in middle-aged B6-BXDs. Though we found that earlier cognitive reserve evident early in life protects against cognitive impairment later in life, cognitive performance and age-related decline fell along a continuum, with no clear genotypes emerging as exemplars of exceptional reserve or resilience – leading to recommendations for future use of aging mouse populations to understand the nature of cognitive reserve and resilience.

Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project)

BackgroundIschemia time during partial nephrectomy (PN) is among the greatest determinants of acute kidney injury (AKI). Whether this association is affected by the preoperative risk of AKI has never been investigated. ObjectiveTo assess the effect of the interaction between the preoperative risk of AKI and ischemia time on the probability of AKI during PN. Design, setting, and participantsData of 944 patients treated with on-clamp PN for cT1 renal tumors were extracted from the Registry of Conservative and Radical Surgery for Cortical Renal Tumor Disease (RECORD2) database, a prospective multicenter project. Outcome measurements and statistical analysisWe estimated the preoperative risk of AKI (defined according to the risk/injury/failure/loss/end-stage [RIFLE] criteria) according to age, baseline renal function, clinical stage, preoperative aspects and dimensions used for an anatomical (PADUA) score, and surgical approach. Classification and regression tree (CART) analysis identified patients at “high” and “low” risk of AKI. Finally, we plotted the probability of AKI over ischemia time stratified by the preoperative risk of AKI. Results and limitationsOverall, 235 (25%) patients experienced AKI after surgery. At multivariable analysis, older patients, those with more complex tumors, those with higher baseline function, and those treated with open surgery had an increased risk of AKI (all p ≤ 0.011). According to the first split at CART analysis, patients were categorized as those with “high” and “low” risk of AKI having a probability of >40% or <40%. For low-risk patients, the probability of AKI in case of <10 versus >20 min of ischemia was 13% versus 28% (absolute risk increase 15%). The risk of AKI for high-risk patients who had <10 versus >20 min of ischemia was 31% versus 77%. This corresponds to an absolute risk increase of 45%. Limitations include retrospective data analyses and lack of surgeons’ prior experience. ConclusionsIschemia time during PN has different implications for patients with different health status. Clamp time seems less clinically relevant for patients in good conditions who may endure prolonged ischemia with a mild increase in the risk of AKI, whereas frail patients seem to be more vulnerable to ischemic damage even for short clamp time. For individualized intra- and postoperative management, duration of ischemia needs to be questioned in the context of the individual health status. Patient summaryFunctional sequelae related to ischemia time during partial nephrectomy depend on baseline health status. The correlation between the duration of ischemia and baseline health status should be taken into account toward individualized intra- and postoperative management.

Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States.

With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers. National 2-day point prevalence study. Eighty-two PICUs in 65 hospitals across the United States. All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day. None. The primary outcome was prevalence of physical therapy- or occupational therapy-provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility-associated safety events, and barriers to mobility. The point prevalence of physical therapy- or occupational therapy-provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13-17 vs < 3 yr, 2.1; 95% CI, 1.5-3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61-0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1-0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1-0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1-6.6). Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.

Comparing Home Upper Extremity Activity With Clinical Evaluations of Arm Function in Chronic Stroke

ObjectiveTo determine if clinical evaluations of poststroke arm function correspond to everyday motor performance indexed by arm accelerometers. DesignCross-sectional study analyzing baseline data from a larger trial (NCT02665052). SettingOutpatient research center. ParticipantsCommunity-dwelling adults (N=20) with chronic arm motor deficits (stroke≥6mo). InterventionA total of 72 hours of home wrist-worn accelerometry during normal routine. Main Outcome MeasuresClinical evaluations included the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and 2 self-assessments: the Motor Activity Log (MAL) and hand motor subscale of the Stroke Impact Scale (SIS). Accelerometer-derived variables included quantifications of movement intensity (magnitude) and duration of arm use. ResultsParticipants had moderate arm impairment (FMA, 36.1±9.4). The accelerometer-derived mean magnitude ratio correlated significantly with the FMA (ρ=0.60, P<.01), WMFT functional score (ρ=0.59, P<.01), and ARAT (ρ=0.50, P<.05). The hours of use ratio correlated with the MAL amount of use (ρ=0.58, P<.01) and quality of movement (ρ=0.61, P<.01). Total paretic hours did not correlate with the FMA, WMFT, or ARAT, and intensity variables did not correlate with the MAL or SIS. ConclusionsParticipants with higher baseline function had greater intensity of paretic arm movement at home; similarly, those who perceived they had less disability used their paretic arm more relative to their nonparetic arm. However, some participants with higher clinical scores did not exhibit greater arm use in everyday life, possibly because of neglect and learned nonuse. Therefore, individualized home accelerometry profiles could provide valuable insight to better tailor poststroke rehabilitation.

Functional Recovery in Critically Ill Children, the "WeeCover" Multicenter Study.

To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness. Prospective observational longitudinal cohort study. Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences. Children 12 months to 17 years old, admitted to PICU for at least 48 hours with one or more organ dysfunction, were eligible. Patients not expected to survive, direct transfers from neonatal ICU and patients in whom long-term follow-up would not be able to be conducted, were excluded. None. The primary endpoint was functional outcome up to 6 months post PICU discharge, measured using the Pediatric Evaluation of Disabilities Inventory Computer Adaptive Test. Secondary outcomes included predictors of unfavorable functional outcome, caregiver stress, health-related quality-of-life, and clinical outcomes such as mortality, length of stay, and PICU-acquired complications. One hundred eighty-two patients were enrolled; 78 children (43.6%) had functional limitations at baseline and 143 (81.5%) experienced functional deterioration following critical illness. Ninety-two (67.1%) demonstrated some functional recovery by 6 months. Higher baseline function and a neurologic insult at PICU admission were the most significant predictors of functional deterioration. Higher baseline function and increasing age were associated with slower functional recovery. Different factors affect the domains of functioning differently. Preexisting comorbidities and iatrogenic PICU-acquired morbidities were associated with persistent requirement for caregiver support (responsibility function) at 6 months. The degree of functional deterioration after critical illness was a significant predictor of increased hospital length of stay. This study provides new information regarding functional outcomes and the factors that influence meaningful aspects of functioning in critically ill children. Identifying patients at greatest risk and modifiable targets for improvement in PICU care guides us in developing strategies to improve functional outcomes and tailor to the rehabilitation needs of these patients and their families.

A longitudinal ICF-CY-based evaluation of functioning and disability of children born with very low birth weight

This paper aims to describe the longitudinal changes in disability, defined by the International Classification of Functioning, Disability, and Health - Children and Youth version (ICF-CY) biopsychosocial model, and developmental outcomes in a cohort of 56 very low birth weight children over 14-20 months. We used a neurofunctional assessment, the Griffiths Mental Development Scales-Revised: 2-8 years (Griffiths 2-8) to evaluate psychomotor development and the ICF-CY questionnaire for ages 0-3 and 3-6 to address children's disability. Extension indexes on the basis of ICF-CY categories were computed, and longitudinal change was tested. Complete follow-up was available for 55 children (mean age 36.7 months, SD 6.7). Considering the sample as a whole, neurofunctional assessment, Griffiths score and disability were basically stable. When the subsample of children with the higher baseline functioning was taken into account, some degree of worsening, in terms of an increase in the number of impairments and limitations, was found. Our results show that disability profiles, neurofunctional assessment and global development were basically stable, except for the subgroup of children who were in the intermediate/high-functioning cluster at baseline. The increased disability among these children might be because of the possibility to observe a wider set of age-specific problems, such as emotional, regulation and social abilities that are not detectable at an early stage of development and that might lead to reduced participation in social activities.

Age and Baseline Quality of Life at Radical Prostatectomy—Who Has the Most to Lose?

Although younger men have better health related quality of life scores after radical prostatectomy, many have higher baseline function with more to lose than older men. We examined the impact of age on sexual and urinary function and bother during the first 2 years after radical prostatectomy. Participants enrolled in CaPSURE™ reported sexual and urinary scores before and after radical prostatectomy using UCLA-PCI. Repeated measures mixed models were used to compare the change in health related quality of life with time between men who were younger (age 60 years or less) and older (age greater than 60 years). Logistic regression models were used to assess associations between age and clinically meaningful health related quality of life decreases (worsening). Models were adjusted for clinical characteristics. Of 1,806 patients younger men reported higher sexual and urinary function scores at each time point and higher sexual function decrease rates at 1 year than older men (81% vs 75%, p<0.01). Younger men also had higher sexual bother decrease rates 1 year (74% vs 61%, p<0.01) and 2 years (62% vs 56%, p=0.02) after radical prostatectomy. On multivariate analysis age was associated with changes in sexual function and bother from baseline through 2 years (each p<0.01). Younger men had higher adjusted odds of sexual function decreases at 1 year (OR 1.15/5 years, 95% CI 1.01-1.30, p=0.03) but not at 2 years. Younger age was associated with lower odds of worsening sexual bother at 2 years (OR 0.79/5 years, 95% CI 0.67-0.94, p<0.01). Urinary function and bother decrease rates were similar by age. Secondary analyses of the age/health related quality of life interaction showed that men were at greater risk for health related quality of life decreases if baseline scores were above average regardless of age. Younger men reported higher sexual and urinary function overall, and experienced greater decreases in sexual function immediately after radical prostatectomy than older men. While the 2 groups experienced similar relative sexual function decreases at 2 years, younger men had worse interim decreases at 1 year. Providers should consider these findings when discussing treatment timing, particularly with younger men diagnosed with early stage, low grade disease.

Heart Failure–Related Mortality and Hospitalization in the Year Following Admission to a Long-Term Care Facility: The Geriatric Outcomes and Longitudinal Decline in Heart Failure (GOLD-HF) Study

BackgroundHeart failure (HF) is common in long-term care facilities (LTCs). This study compared mortality and hospitalization rates and examined predictors of these outcomes among new LTC residents with and without HF. Methods and ResultsThis prospective cohort study followed 546 newly admitted residents from 42 LTCs for up to 1 year. Health information was collected from participant and caregiver interviews, physicians’ records, diagnostic procedures, and hospitalization records. Multivariate logistic regression modeling determined predictors of hospitalization among residents, and Cox proportional hazards regression determined predictors for time to mortality. HF prevalence was 21.4%. The sample was predominantly (>70%) female, and individuals with HF were significantly older with higher prevalence of reduced left ventricular ejection fraction. Overall annual mortality and hospitalization rates were 24% and 27%, respectively. Among residents with HF, 42% died and 31% were hospitalized within 1 year. Among residents with HF, use of major tranquilizers was the strongest predictor of sooner mortality; use of anticoagulants and major tranquilizers also increased mortality risk, whereas higher baseline function was associated with longer time to mortality. History of peripheral vascular disease was the strongest predictor of hospitalizations among residents with HF, and use of antiplatelet agents and history of any smoking exposure increased this risk. ConclusionsAmong LTC residents, HF is associated with high mortality and hospitalization rates. Many factors contribute to mortality and hospitalizations among residents with HF, and comprehensive HF management programs are needed to improve outcomes.

Patient predictors of symptom and functional outcome following cognitive behaviour therapy or befriending in first-episode psychosis

BackgroundCognitive behaviour therapy (CBT) is an effective treatment for many, but not all, individuals with psychosis. An important goal is identifying individuals more likely to benefit from CBT to ensure appropriate delivery. The current study aimed to examine patient-related predictors of symptom and functional outcome following CBT and Befriending in first-episode psychosis (FEP). MethodOur original randomized controlled trial compared 14weeks of CBT (n=31) and Befriending (n=31) in FEP (Jackson et al. 2008). A series of regressions were conducted separately for each group to examine demographic, cognitive, symptoms/illness and functioning variables in predicting positive symptoms (BPRS Psychotic), negative symptoms (SANS Total) and functioning (SOFAS) at 1-year follow-up. ResultsIn the CBT group, higher baseline functioning (SOFAS) predicted lower levels of positive symptoms (R2=0.19; p=0.023), higher educational achievement and lower levels of avolition symptoms (SANS Avolition) predicted lower levels of total negative symptoms (R2=0.38; p=0.003), and working/studying at baseline predicted higher functional outcome (R2=0.35; p=0.004) at 1year. In the Befriending group, premorbid adjustment (PAS Average) was the only variable that predicted 1-year positive symptom (R2=0.26; p=0.010), negative symptom (R2=0.35; p=0.016) and functional (R2=0.48; p=0.002) outcome. ConclusionsFEP individuals with higher baseline functioning may benefit more from CBT than those with poorer functioning. Individuals with functional difficulties may benefit from alternative treatments initially, such as supported education or employment.

Pain Medicine

Opioid use has increased in Canada as have reports of opioid abuse and opioid-related mortality. This retrospective study examined the potential association between increased opioid prescribing in Canada with opioid-related mortality.Data from IMS Health Canada were collected from 1991 to 2007 for all opioid-containing analgesics and cough suppressants prescribed on an outpatient basis. Opioid-related deaths were determined by the coroner and based on high opioid concentrations or drug combination including one opioid.Between 1991 and 2007, the prescribing of opioid analgesics increased by 29%, from 458 to 591 prescriptions per 1,000 individuals annually, and oxycodone prescriptions increased by more than 850%. The amount of drug dispensed also increased by 24%. Of 7,099 drug or alcohol-related deaths, 3,406 involved opioids. Morphine or heroin administration was the most common cause of single opioid-related deaths (36%), compared with codeine (20%), methadone (14%), and oxycodone (11%). The majority of deaths involved one nonopioid central nervous system depressant (91.6%). The addition of long-acting oxycodone to the drug formulary was associated with a fivefold increase in oxycodone-related mortality and a 41% increase in overall opioid-related mortality. The majority of deaths were deemed unintentional.Most patients (66.4%) had visited a physician in the month before death and of the 1,095 patients for whom individual-level prescribing data were available, 56.1% had filled a prescription for an opioid in the month before death.This Canadian study demonstrated an association between increases in opioid prescribing and opioid-related mortality through a 10-yr period. Most deaths were associated with the use of other central nervous depressant drugs and were not ruled intentional. Importantly, visits to physicians within the month before death indicates that there may be an opportunity for interventions to prevent mortality related to opioid use in these patients.Failed back surgery syndrome, including chronic back and leg pain that failed to improve after spine surgery, is often treated using spinal cord stimulation (SCS). Although previous trials of SCS demonstrated favorable results compared with lumbar spine reoperation and conventional medical management, they did not always include comparisons with treatments other than reoperation or patients receiving worker's compensation, which may have worse outcomes with any pain therapy.This prospective controlled cohort study compared pain, function, medication use, and work outcomes of patients in the Washington State Workers' Compensation Program who received SCS (n = 51) with patients who did not receive SCS (“Pain Clinic” group; n = 39) and with patients who did not receive SCS or pain clinic evaluation (“Usual Care” group; n = 68).The average age of patients was 44 yr and most patients were men. At baseline, the SCS group had significantly longer work time loss compensation, leg pain, and claim duration compared with the other two groups. No difference was observed between groups for the primary composite endpoint of pain, function, and opioid medication use. Few (&lt;10%) patients in any group achieved success at any follow-up. At 6 months, the SCS group showed slightly more improvement in leg pain and function, but with higher rates of daily opioid use at 6 months compared with the other two groups. However, differences were not sustained over longer periods of time.The lack of long-term effectiveness of SCS in this population does not necessarily imply ineffectiveness in other patient populations. The issues associated with workers' compensation may have significant effect on pain therapy and patient outcomes. It is possible that subgroups in this population such as those with unilateral radicular pain, higher baseline functioning, and greater mental health status may have better results.

Factors associated with symptomatic improvement and recovery from major depression in primary care patients

This article describes a post-hoc analysis of clinical and psychosocial factors and beliefs about health associated with treatment outcome in a sample of depressed primary care patients ( N=181) randomly assigned to a standardized treatment or physician’s usual care (UC). Different factors were found to predict clinical outcomes for treatment modality [UC vs. interpersonal psychotherapy (IPT) or nortriptyline (NT)] and the type of outcome evaluated (i.e., depressive symptoms at 8 months or symptomatic and functional recovery at 8 months). Factors associated with treatment-specific outcomes are also described. Consistent with prior studies, lower depressive symptom severity at 8 months was associated with higher baseline functioning, minimal medical co-morbidity, race, and standardized pharmacologic or psychotherapeutic treatment. Additionally, an interaction between treatment modality and health locus of control indicated that individuals perceiving more self-control of their health and who received a standardized treatment experienced greater depressive symptom reduction at 8 months. Factors associated with symptomatic and functional recovery from the depressive episode were also examined. Patients who received a standardized treatment (IPT or NT) perceived greater control of their health and lacked a lifetime generalized anxiety disorder or panic disorder were more likely to recover by month 8 than those who received usual care. While clinical severity and treatment adequacy play an important role in both symptomatic improvement and full recovery from a depressive episode, other key factors such as health beliefs and non-depressive psychopathology also influence recovery.