Improvement In Overall Function Research Articles

Long-term functional outcomes of women receiving cognitive processing therapy and prolonged exposure.

The current study sought to determine whether trauma-focused treatments for posttraumatic stress disorder (PTSD) improve psychosocial functioning outcomes, and whether treatment gains are maintained over a long-term follow-up (LTFU) period (5–10 years). The relationship between symptoms of PTSD and depression and psychosocial functioning also were explored. A sample of 154 female rape victims who received cognitive processing therapy (CPT) or prolonged exposure therapy (PE) were assessed at pretreatment, posttreatment, 9 months, and 5–10 years following treatment. Hierarchical linear modeling demonstrated significant improvements in overall functioning, social/leisure adjustment, family unit adjustment, and economic adjustment in both treatment conditions, with gains maintained over the LTFU. Lower household income at baseline was associated significantly with poorer overall functioning, social/leisure adjustment, and economic adjustment over time. Structural equation modeling revealed that poorer overall functioning at posttreatment was associated significantly with higher levels of depressive symptoms at 9 months, whereas higher levels of depressive symptoms at 9 months were associated significantly with poorer levels of overall functioning at LTFU. Findings suggest that both cognitive and exposure-based treatments for PTSD have the potential to impact functioning outcomes over a long period of time.

Persistent diminished joint function following ankle fracture—A risk factor for posttraumatic osteoarthritis?

The optimal treatment of isolated medial malleolar fractures is widely debated. The aim of this study is to analyse the different treatment methods.The study included 137 patients with an isolated medial malleolar fracture treated at our hospital between 2000 and 2010. Functional outcome was assessed using Olerud–Molander score and health-related quality-of-life (HRQoL) was measured with RAND36 item health survey. Patients were sent follow-up questionnaires after an average of 9.5 years (4.3–15.2) from the date of treatment.The overall improvement in function was equivalent in both operative and non-operative treatment groups. However, the outcome scores declined in both groups as the primary displacement increased, regardless of the treatment method. HRQoL was similar in both groups.If maximal fracture displacement is ≤2 mm, isolated medial malleolar fractures can be treated non-operatively with good outcome, but the operative treatment may also be performed without serious complications. The degree of fracture displacement is an independent risk factor for inferior functional result, regardless of the treatment method.Therapeutic level of evidence: IV, retrospective cohort study.

The Mannerfelt wrist arthrodesis – A study of patient-reported outcomes in a rheumatoid population

BackgroundWrist arthrodesis has been established as a mainstay form of surgical intervention in the rheumatoid wrist. Despite this however, there is a distinct lack of patient-reported outcome measure (PROM) studies justifying the efficacy of this procedure in rheumatoid disease. The aim of this study was to report any change in function or pain following the tunnel Mannerfelt wrist arthrodesis in a single surgeon series of rheumatoid patients over a 6 year period. Methods14 consecutive patients (15 wrists) who had undergone the Mannerfelt wrist arthrodesis were followed prospectively with a mean follow up period of 45 months. No patients were lost to follow up. The primary outcome measures included the validated Patient Rated Wrist Evaluation (PRWE) questionnaire and a satisfaction questionnaire. ResultsThe mean total pain score improved from 41 points preoperatively to 14.2 points postoperatively correlating with a 65.4% improvement in overall pain outcomes. The mean total functional score improved from 83.7 points preoperatively to 45.5 points postoperatively demonstrating a 45.6% improvement in overall function at the time of follow up. ConclusionsAll patients reported an overall improvement in pain and functional capacity. The satisfaction results were excellent. All patients reported that they would elect to have the procedure again with the vast majority being ‘very pleased’ with the outcome of their surgery (93.7% very pleased and 6.3% fairly pleased). The procedure enjoyed favourable mid-term results and we recommend the tunnel Mannerfelt wrist arthrodesis for improving both pain and level of function in this group of patients.

Integrating Interventions after Traumatic Brain Injury: A Synergistic Approach to Neurorehabilitation

Deficits in attention, processing speed and executive functioning are among the most commonly reported and functionally limiting cognitive impairments among individuals with TBI. Changes in mood can exacerbate cognitive deficits and reduce life quality. Contemporary hierarchical models of cognitive functioning suggest that attention/arousal processes underlie and support higher-order functions. Building on decades of clinical research, a synergistic, integrative approach to neurorehabilitation is described, which combines bottom-up and top-town cognitive interventions in addition to psychotherapeutic interventions for mood. This approach is intended to address directly impairments in both foundational (i.e., attention) and higher-order (i.e., executive functions) processes. Executive dysfunction is addressed in a top-down fashion through the application of a series of problem-solving and emotional regulation modules that teach and integrate strategies that can be generalised across situations with practice. Attention, arousal and information processing are necessary prerequisites of successful higher-order thinking, attention skills, and are addressed in a bottom-up fashion through intensive individualised attention and processing training tasks. Combining top-down and bottom-up approaches within a comprehensive day-treatment programme can effect a synergistic improvement of overall functioning.

Work Adjustment and General Level of Functioning Pre- and Post-EAP Counseling

One hundred employee assistance clients completed self assessments during intake and again at the end of counseling. They rated their overall level of psychosocial functioning and their level of functioning at work. Counselors rated the clients on the Global Assessment of Functioning Scale at the beginning and at the end of counseling. In the termination summary, counselors also rated the amount of perceived improvement by each client on the major goals established at the beginning of counseling. The majority of clients showed improvement in overall functioning. Clients who had presented for counseling because of work-related problems reported improvement in their work adjustment, and so did clients who had presented with problems that were not related to work. Clients with work-related problems reported a somewhat-lower level of overall functioning before and at the end of counseling.

Bilateral Mini-Invasive Adductor Tenotomy for the Management of Chronic Unilateral Adductor Longus Tendinopathy in Athletes

Background: To date, the best management of chronic groin pain related to adductor longus tendinopathy has not been defined. Although there have been some studies investigating the effectiveness of adductor longus tenotomy, none have investigated bilateral adductor tenotomy for unilateral tendinopathy. Hypothesis: The use of bilateral percutaneous adductor tenotomy for the management of chronic unilateral groin pain as a result of adductor longus tendinopathy will result in improvement of overall function and facilitate a return to athletic activity. Study Design: Case series; Level of evidence, 4. Methods: During the period from 2004 to 2007, we prospectively enrolled 29 consecutive athletes (26 male and 3 female; median age, 28 years) with chronic groin pain from unilateral adductor longus tendinopathy who underwent bilateral adductor tenotomy. Functional outcome and health status were assessed with the Hip Disability and Osteoarthritis Outcome Score (HOOS), Short Form Health Survey (SF-36), and European Quality of Life–5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery and the time to return to training and return to sport were also recorded. The median follow-up after surgery was 36 months. Results: All questionnaires showed a statistically significant improvement (P < .0001) after surgery. At the time of latest follow-up, 20 of 29 patients (69%) returned to their preinjury level of sport and 2 of 29 patients (7%) to higher levels compared with preinjury status. However, 4 of 29 patients (14%) returned to sport at lower levels than those of preinjury status, and 3 of 29 patients (10%) ceased to participate in sport. The median time to return to training was 11 weeks and to return to sport was 18 weeks. Conclusion: Bilateral mini-invasive adductor tenotomy can be an effective treatment for athletes suffering from unilateral chronic groin pain associated with adductor longus tendinopathy refractory to nonoperative management.

Pattern and time phase of shoulder function and power recovery after arthroscopic rotator cuff repair

It has been our observation that early during rehabilitation after rotator cuff repair, patients may take a step back before improving. The purpose of this study is to investigate the pattern and time phase of changes in Constant score and strength recovery after arthroscopic rotator cuff repair. Forty-five patients undergoing arthroscopic rotator cuff repair were prospectively enrolled in this study. Patients underwent scoring preoperatively with the Constant score. All were followed up at 3 months and 6 months after surgery. The Constant score and strength at 3 months were compared with those at the 6-month mark. The mean Constant score improved from 46.4 points (SD, 17.3) preoperatively to 51.8 points (SD, 13.5) 3 months postoperatively (P = .0777). At 6 months postoperatively, the mean Constant score was 69.0 points (SD, 11.1), a significant increase from both the preoperative (P < .0001) and 3-month (P < .0001) results. The mean preoperative strength result of 4.5 kg (SD, 3.2) decreased significantly to 3.3 kg (SD, 1.8) at 3 months postoperatively (P = .0154) before improving to 5.8 kg (SD, 2.6) at 6 months postoperatively. The improvement in strength at 6 months was significant compared with both the preoperative (P = .0070) and 3-month (P < .0001) results. Although there is highly significant improvement in overall function (Constant score) and strength 6 months postoperatively, patients appear to take a step back before improving, in fact with a drop in strength at 3 months. This may cause concern in patients and may require assurance that time and effort with physiotherapy will improve function and symptoms.

Intrathecal tripeptidyl-peptidase 1 reduces lysosomal storage in a canine model of late infantile neuronal ceroid lipofuscinosis

Late infantile neuronal ceroid lipofuscinosis (LINCL) is caused by mutations in the gene encoding tripeptidyl-peptidase 1 (TPP1). LINCL patients accumulate lysosomal storage materials in the CNS accompanied by neurodegeneration, blindness, and functional decline. Dachshunds homozygous for a null mutation in the TPP1 gene recapitulate many symptoms of the human disease. The objectives of this study were to determine whether intrathecal (IT) TPP1 treatment attenuates storage accumulation and functional decline in TPP1−/− Dachshunds and to characterize the CNS distribution of TPP1 activity. TPP1 was administered to one TPP1−/− and one homozygous wild-type (WT) dog. An additional TPP1−/− and WT dog received vehicle. Four IT administrations of 32mg TPP1 formulated in 2.3mL of artificial cerebrospinal fluid (aCSF) or vehicle were administered monthly via the cerebellomedullary cistern from four to seven months of age. Functional decline was assessed by physical and neurological examinations, electrophysiology, and T-maze performance. Neural tissues were collected 48h after the fourth administration and analyzed for TPP1 activity and autofluorescent storage material. TPP1 was distributed at greater than WT levels in many areas of the CNS of the TPP1−/− dog administered TPP1. The amount of autofluorescent storage was decreased in this dog relative to the vehicle-treated affected control. No improvement in overall function was observed in this dog compared to the vehicle-treated TPP1−/− littermate control. These results demonstrate for the first time in a large animal model of LINCL widespread delivery of biochemically active TPP1 to the brain after IT administration along with a decrease in lysosomal storage material. Further studies with this model will be necessary to optimize the dosing route and regimen to attenuate functional decline.

Goals of patients with rehabilitation needs in acute hospitals: goal achivement is an indicator for improved functioning

To identify goals of patients with rehabilitation needs in the acute hospital setting using the International Classification of Functioning, Disability and Health (ICF), to examine association of goal achievement with improvement in overall functioning, and to examine whether ICF Core Sets for the acute hospital cover patients goals. Multi-centre cohort study. A total of 397 patients (50% female, mean age 63 years) from 5 hospitals in Austria, Switzerland and Germany. A semi-structured questionnaire was used to assess patient goals and goal achievement. Overall functioning from the patients' and health professionals' perspective was assessed on a numerical rating scale. Improvement in functioning was calculated using a residualized gain score. Association between goal achievement and improvement in overall functioning was assessed with logistic regression. A total of 397 patients reported achievement of at least 1 goal. Eighty-eight percent of the goals were translated into categories of the ICF. Logistic regression analyses revealed significant association between goal achievement and overall functioning. The ICF might be useful to identify and structure patient's goals in acute hospital care. The association between goal achievement and improved functioning underlines that it is essential to involve the patient in the process of planning rehabilitation interventions in acute hospitals.

The ICF forms a useful framework for classifying individual patient goals in post-acute rehabilitation

Timely goal setting in close collaboration with the patient is essential to successful rehabilitation. We therefore sought to identify goals of patients in early post-acute rehabilitation as predictors of improved functioning. We conducted a prospective multi-centre cohort study in 5 early post-acute rehabilitation facilities. Patients with musculoskeletal, cardiopulmonary and neurological conditions were recruited between May 2005 and August 2008. A semi-structured questionnaire was used to identify patient goals and to assess improvement in overall functioning. Patients' goals were coded according to the International Classification of Functioning, Disability and Health (ICF). By means of a mixed effects model we examined the association between goal attainment and improved functioning. A total of 116 patients gave 546 statements, of which 426 were linked to 74 ICF categories, which were assigned to the existing comprehensive post-acute ICF Core Sets. Improvements in walking, recreation and leisure, pain, and transfer were the most frequently reported goals. In multivariable analysis patients' goal attainment was not a predictor for improved overall functioning. The ICF can be used to identify and structure patients' goals. Patients' perspective should be considered in the rehabilitation process.

Staying in the here‐and‐now: A pilot study on the use of dialectical behaviour therapy group skills training for forensic clients with intellectual disability

Dialectic behaviour therapy (DBT) has been widely used with individuals diagnosed with borderline personality disorder who exhibit severe emotional and behavioural dysregulation. There is a paucity of research in assessing the effectiveness of DBT with forensic clients with intellectual disability (ID). This pilot study aims to evaluate the effectiveness of the DBT group skills training programme adapted particularly for offenders with ID. Six participants completed the 13-week adapted DBT group skills training programme. All participants exhibited challenging behaviours and have a history of prior charges or convictions for violent crimes. The study conducted pre- and post-tests using instruments that measured dynamic risks, relative strengths, coping skills and global functioning. The study result showed improvement across all measures. A decrease in the level of risks, increase in relative strengths and general improvement in overall functioning were found significant. The results were promising particularly as a stand-alone adapted DBT group skills training programme for this client group.

Preventing depression: a randomized trial of interpersonal psychotherapy-adolescent skills training

The study evaluated the efficacy of an indicated prevention program for adolescent depression. Fifty-seven adolescents with elevated depression symptoms were randomized to receive Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) or school counseling (SC). Hierarchical linear modeling examined differences in rates of change in depression symptoms and overall functioning and analysis of covariance examined mean differences between groups. Rates of depression diagnoses in the 18-month follow-up period were compared. Adolescents in IPT-AST reported significantly greater rates of change in depression symptoms and overall functioning than SC adolescents from baseline to post-intervention. At post-intervention, IPT-AST adolescents reported significantly fewer depression symptoms and better overall functioning. During the follow-up phase, rates of change slowed for the IPT-AST adolescents, whereas the SC adolescents continued to show improvements. By 12-month follow-up, there were no significant mean differences in depression symptoms or overall functioning between the two groups. IPT-AST adolescents reported significantly fewer depression diagnoses in the first 6 months following the intervention but by 12-month follow-up the difference in rates of diagnoses was no longer significant. IPT-AST leads to an immediate reduction in depression symptoms and improvement in overall functioning. However, the benefits of IPT-AST are not consistent beyond the 6-month follow-up, suggesting that the preventive effects of the program in its current format are limited. Future studies are needed to examine whether booster sessions lengthen the long-term effects of IPT-AST.

Exploration of nurse practitioner practice with clients who are grieving

Nurse practitioners (NPs) have provided care to clients in primary care settings for more than 40 years. Although NP practice standards have identified grief as a health concern that needs to be addressed, little is known about the practice of NPs with this population. The purpose of this study was to describe the clinical practice of NPs in primary care with clients who were grieving the death of a significant person. This descriptive exploratory qualitative study explored NPs' assessment, plan of care, and evaluation of healthcare outcomes for their clients who were grieving. Semi-structured audiotaped interviews with nine NPs providing primary care to clients were completed. The data were analyzed using qualitative content analysis. The NPs' descriptions of their clinical practice yielded important information about their assessment, intervention, and evaluation of grieving clients. Descriptions of assessments by NPs provided important data that were categorized as physical complaints, overall functioning, and emotional well-being or coping. Descriptions of interventions included validation of clients' grief, prescriptions, and teaching or referral. Descriptions of outcomes included relief of physical complaints and stabilized chronic illness, improvements in overall functioning, and improvements in clients' emotional well-being and coping. For NPs to be able to provide effective care to clients grieving the death of a loved one, they need a better understanding of theoretical models and current research related to grief. Further studies are needed to provide insight into the practice of NPs with this population.

Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial

BackgroundSeveral uncontrolled studies of hyperbaric treatment in children with autism have reported clinical improvements; however, this treatment has not been evaluated to date with a controlled study. We performed a multicenter, randomized, double-blind, controlled trial to assess the efficacy of hyperbaric treatment in children with autism.Methods62 children with autism recruited from 6 centers, ages 2–7 years (mean 4.92 ± 1.21), were randomly assigned to 40 hourly treatments of either hyperbaric treatment at 1.3 atmosphere (atm) and 24% oxygen ("treatment group", n = 33) or slightly pressurized room air at 1.03 atm and 21% oxygen ("control group", n = 29). Outcome measures included Clinical Global Impression (CGI) scale, Aberrant Behavior Checklist (ABC), and Autism Treatment Evaluation Checklist (ATEC).ResultsAfter 40 sessions, mean physician CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0008), receptive language (p < 0.0001), social interaction (p = 0.0473), and eye contact (p = 0.0102); 9/30 children (30%) in the treatment group were rated as "very much improved" or "much improved" compared to 2/26 (8%) of controls (p = 0.0471); 24/30 (80%) in the treatment group improved compared to 10/26 (38%) of controls (p = 0.0024). Mean parental CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0336), receptive language (p = 0.0168), and eye contact (p = 0.0322). On the ABC, significant improvements were observed in the treatment group in total score, irritability, stereotypy, hyperactivity, and speech (p < 0.03 for each), but not in the control group. In the treatment group compared to the control group, mean changes on the ABC total score and subscales were similar except a greater number of children improved in irritability (p = 0.0311). On the ATEC, sensory/cognitive awareness significantly improved (p = 0.0367) in the treatment group compared to the control group. Post-hoc analysis indicated that children over age 5 and children with lower initial autism severity had the most robust improvements. Hyperbaric treatment was safe and well-tolerated.ConclusionChildren with autism who received hyperbaric treatment at 1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air.Trial Registrationclinicaltrials.gov NCT00335790

Effectiveness of Cognitive Behavioural Therapy Administered by Videoconference for Posttraumatic Stress Disorder

Telehealth, or health care via videoconferencing, constitutes a clinical option that makes it possible to treat patients remotely. A growing number of studies have demonstrated that telehealth is a feasible and effective method for diagnostic interviews and psychiatric consultations. However, few studies have assessed the effectiveness of psychotherapy given by videoconference. This study examines the effectiveness of cognitive behavioural therapy (CBT) administered by videoconference for posttraumatic stress disorder (PTSD). Forty‐eight participants with PTSD were recruited for the study: 16 in the videoconferencing condition and 32 in a control face‐to‐face condition. Each participant received CBT for 16 to 25 weeks and completed various questionnaires before and after treatment. The results show a significant decline in the frequency and severity of posttraumatic symptoms after treatment in both conditions. A clinical improvement in overall functioning was also observed. No significant difference was observed in the effectiveness of the two therapeutic conditions. The examination of effect sizes supports these results. A number of clinical implications and certain avenues for future research are discussed.

An Adult with Childhood Medical Trauma Treated with Psychoanalytic Psychotherapy and EMDR: A Case Study

Adverse childhood experiences have been found to be a strong predictor of emotional and physical problems in adulthood. However, the long-term sequelae for children who have suffered critical illness and exposure to invasive medical procedures are less well documented. This is a case study of an adult client who sought treatment for depression and attention deficit disorder. The psychotherapy treatment is discussed and the use of eye movement desensitization and reprocessing (EMDR) is described targeting a memory of a medical trauma resulting from a tonsillectomy when the client was 8 years old. Significant healing outcomes were attained as a result of the therapy, i.e., decreased depression, less hypervigilance, and increased ability to concentrate, which resulted in the discontinuation of medication for depression and ADHD as well as significant improvement in overall functioning.

Innovative Treatment for Children With Serious Emotional Disturbance: Preliminary Outcomes for a School-Based Intensive Mental Health Program

This article describes the development, implementation, and preliminary evaluation of a school-based Intensive Mental Health Program (IMHP) for 50 children (42 boys, 8 girls) with severe, early-onset, serious emotional disturbances (SED). Eighty-four percent of the children showed clinically significant improvement in overall functioning as measured by the Child and Adolescent Functional Assessment Scale (CAFAS). Child functioning at home and school, behavior toward others, regulation of moods and emotions, self-harm, and problems in thinking improved significantly. Results provide initial support for the IMHP as a promising approach to serving the needs of children with SED.

Psychotherapy Draws Upon Trauma Survivors’ Testimonies

Psychotherapy Draws Upon Trauma Survivors’ Testimonies

A double-blind, placebo-controlled study of antidepressant augementation with mirtazapine

Background: A previous pilot study of open-label mirtazapine augmentation conducted by the authors in 20 depressed patients yielded a 55% response rate at week 4. A double-blind controlled trial was undertaken to further elucidate the efficacy of this intervention. Methods: 26 adult outpatients with persistent major depression despite adequate antidepressant monotherapy were randomized to receive 4 weeks of mirtazapine or placebo augmentation. Mirtazapine was begun at 15 mg at bedtime, with possible titration to 30 mg at bedtime per physician’s discretion after week 1. Results: Categorical positive response rate at end point was 64% for active drug and 20% for placebo. Remission rates were 45.4% and 13.3% for active drug and placebo groups, respectively, Mirtazapine demonstrated statistically significant superiority to placebo on most major outcome measures, and was associated with improvement in overall functioning and quality of life. There were no significant group differences with regard to emergent side effects, weight change, or serum concentrations of primary antidepressants. Conclusions: Mirtazapine appears safe and effective for short-term antidepressant augmentation.

Functional outcome in knee osteoarthritis after treatment with Hylan G-F 20: A prospective study

Goorman SD, Watanabe TK, Miller EH, Perry C. Functional outcome in knee osteoarthritis after treatment with Hylan G-F 20: a prospective study. Arch Phys Med Rehabil 2000;81:479-83. Objective: To assess functional change in patients with knee osteoarthritis (OA) after treatment with intra-articular hyaluronic acid (Hylan G-F 20; Synvisc®). Design: Prospective case series with 6-month follow-up. Setting: Outpatient community orthopedic practice. Participants: Eighty-four consecutive patients referred to private orthopedic group with symptoms and radiographic evidence of unilateral or bilateral knee OA who had either failed or could not tolerate the side effects of conservative treatment. Sixty-one patients completed the study. Nineteen patients were lost to follow-up. Four patients withdrew from study due to subsequent knee arthroplasty. Intervention: Three weekly injections of Hylan G-F 20 into one or both (if bilaterally symptomatic) knees (110 knees total). Outcome Measure: SF-36 Health Survey was completed before treatment and 6 months after treatment. Results: Statistically significant improvement (p <.001) in Physical Functioning, Role–Physical, Bodily Pain, Social Functioning, and Role–Emotional categories on 6-month follow-up survey. Age and percent above ideal body weight were not significant predictors of functional change. Conclusion: Efficacy of intra-articular injection of Hylan G-F 20 for knee OA 6 months after injection is demonstrated in several categories of the SF-36, indicating a measurable improvement in overall functioning in these patients. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation