Multidisciplinary Treatment Program Research Articles

Intensive Multidisciplinary Intervention for Young Children with Feeding Tube Dependence and Chronic Food Refusal: An Electronic Health Record Review

To assess characteristics and outcomes of young children receiving intensive multidisciplinary intervention for chronic food refusal and feeding tube dependence. We conducted a retrospective study of consecutive patients (birth to age 21years) admitted to an intensive multidisciplinary intervention program over a 5-year period (June 2014-June 2019). Inclusion criteria required dependence on enteral feeding, inadequate oral intake, and medical stability to permit tube weaning. Treatment combined behavioral intervention and parent training with nutrition therapy, oral-motor therapy, and medical oversight. Data extraction followed a systematic protocol; outcomes included anthropometric measures, changes in oral intake, and percentage of patients fully weaned from tube feeding. Of 229 patients admitted during the 5-year period, 83 met the entry criteria; 81 completed intervention (98%) and provided outcome data (46 males, 35 females; age range, 10-230months). All patients had complex medical, behavioral, and/or developmental histories with longstanding feeding problems (median duration, 33months). At discharge, oral intake improved by 70.5%, and 27 patients (33%) completely weaned from tube feeding. Weight gain (mean, 0.39±1kg) was observed. Treatment gains continued following discharge, with 58 patients (72%) weaned from tube feeding at follow-up. Our findings support the effectiveness of our intensive multidisciplinary intervention model in promoting oral intake and reducing dependence on tube feeding in young children with chronic food refusal. Further research on the generalizability of this intensive multidisciplinary intervention approach to other specialized treatment settings and/or feeding/eating disorder subtypes is warranted.

SiTe iC: A telemonitoring system for heart failure patients

In the last years, multidisciplinary post-discharge treatment programs, such as telemonitoring, have been promoted as a strategy for Heart Failure (HF) management. However, the distinctive requirements that a telemonitoring system should have, have not been clearly identified. To this aim, the most relevant requirements for telemonitoring of HF patients are derived from evidence-based Clinical Practice Guidelines (CPGs) for HF management. The main objective of this work is to present a prototype of a telemonitoring system for HF patients, named SiTe iC, that has been developed based on the identified requirements, highlighting its design and evaluation.A first prototype of the system was designed and programmed. It consists of an mHealth app for HF patients, a website for physicians who monitor patients, and a server which runs an Application Programming Interface to allow communication between the app and the website.The system was thoroughly assessed through a clinical trial that demonstrates that telemonitoring using SiTe iC actually improves patients self-care when compared to usual care and it has the potential to avoid patient re-hospitalizations.This study demonstrated that the identified functional requirements for telemonitoring systems are relevant. In addition, thanks to SiTe iC, HF patients would take a more active role in their disease management by improving self-care.

The influence of a multidisciplinary intervention program on Achilles tendon structure in children with overweight and obesity.

The effects of childhood obesity on tendon structure and its relation to physical activity are barely known. We aimed to investigate the influence of a 6-month multidisciplinary childhood obesity management program (which included dietary intervention and an exercise program) on Achilles tendon structure in overweight/obese children. Twenty-five overweight/obese children (overweight group) who participated in a 6-month multidisciplinary childhood obesity program, and 27 normal-weight controls were examined for anthropometric measurements and for Achilles tendon structure (using ultrasound tissue characterization to capture a three-dimensional structure of four echo type fibers and the cross-sectional area) at baseline, 3, and 6months. The BMI of the overweight group significantly decreased from the pre- to the post-intervention period, (p = .002, η2 = .229), yet among the control group, the BMI significantly increased (p = .002, η2 = .222). Interactions (pre-post × group) showed a significant decrease in the prevalence of echo type I and in echo type III fibers and a significant increase in the prevalence of echo type II fibers and in the cross-sectional area along the intervention. No significant changes in echo type fibers were found in the control group along the 6months.Conclusion: At pre-intervention, the overweight group had significantly "worse" tendon structure, with a lower prevalence of echo type II fiber and a higher prevalence of echo type III fibers compared with the control group. Following the 6-month intervention, the tendon structure of the overweight group was "positively" changed, with reduced echo type III fibers and increased echo type II fibers. What is Known: • Physical activity and weight reduction programs are efficient for obese children. • Obese children tend to suffer orthopedic problems and pain during physical activity. What is New: • Pre-intervention, obese children had 'worse' tendon structure compared to controls. • Following 6-month program, tendon structure of obese children 'positively' changed.

Outcome Measures for Evaluating the Effect of a Multidisciplinary Intervention on Axial Symptoms of Parkinson's Disease.

Introduction: The satisfactory symptomatic control of the axial symptoms of Parkinson's disease (PD) remains challenging. As these symptoms are an important cause of disability, new therapeutic strategies should be developed and evaluated. To do this, it is necessary to select the outcomes to be measured and reported in a clinical trial. In this study, we sought to identify the most responsive outcome measures for assessing the efficacy of a multidisciplinary intervention on the axial symptoms of PD.Methods: An exploratory prospective clinical study was conducted. PD patients engaged in a pre-defined multidisciplinary intervention program for parkinsonian patients were assessed at admission and discharge by a multidisciplinary team. The responsiveness to intervention was evaluated and the smallest sample size needed to enable statistically significant results for an expected 30% change from baseline for each outcome was calculated.Results: Twenty-two patients were included in the study. The effect size detected varied between 0.04 and 0.83. The Movement Disorder Society—Unified Parkinson's Disease Rating Scale (MDS-UPDRS) total score and each subsection, the N-FOG questionnaire, the 10-m walk test, and Frenchay Dysarthria Assessment-2 Edition (FDA-2) showed a medium to large effect size. Sample size calculations for 90% power and assuming 30% change from baseline ranged from eight to 180 participants. The outcome measures that require a small number of participants to enable statistically significant results were the FDA-2 rating scale (n = 4 participants), the MDS-UPDRS total score (n = 9), the 10-m walk test (n = 9), and the MDS-UPDRS motor examination (n = 10).Conclusions: The MDS-UPDRS part III and total score and the 10-m walk test were the outcomes with the best responsiveness to a multidisciplinary intervention and required a small number of participants to enable statistically significant results. Further studies are needed to clarify the suitability of the Timed Up and Go test.

The OPTIMIZE study: protocol of a pragmatic sequential multiple assessment randomized trial of nonpharmacologic treatment for chronic, nonspecific low back pain

BackgroundLow back pain is a prevalent condition that causes a substantial health burden. Despite intensive and expensive clinical efforts, its prevalence is growing. Nonpharmacologic treatments are effective at improving pain-related outcomes; however, treatment effect sizes are often modest. Physical therapy (PT) and cognitive behavioral therapy (CBT) have the most consistent evidence of effectiveness. Growing evidence also supports mindfulness-based approaches. Discussions with providers and patients highlight the importance of discussing and trying options to find the treatment that works for them and determining what to do when initial treatment is not successful. Herein, we present the protocol for a study that will evaluate evidence-based, protocol-driven treatments using PT, CBT, or mindfulness to examine comparative effectiveness and optimal sequencing for patients with chronic low back pain.MethodsThe Optimized Multidisciplinary Treatment Programs for Nonspecific Chronic Low Back Pain (OPTIMIZE) Study will be a multisite, comparative effectiveness trial using a sequential multiple assessment randomized trial design enrolling 945 individuals with chronic low back pain. The co-primary outcomes will be disability (measured using the Oswestry Disability Index) and pain intensity (measured using the Numerical Pain Rating Scale). After baseline assessment, participants will be randomly assigned to PT or CBT. At week 10, participants who have not experienced at least 50% improvement in disability will be randomized to cross-over phase-1 treatments (e.g., PT to CBT) or to Mindfulness-Oriented Recovery Enhancement (MORE). Treatment will consist of 8 weekly sessions. Long-term outcome assessments will be performed at weeks 26 and 52.DiscussionResults of this study may inform referring providers and patients about the most effective nonoperative treatment and/or sequence of nonoperative treatments to treat chronic low back pain.Trial registrationThis study was prospectively registered on March 1, 2019, with Clinicaltrials.gov under the registration number NCT03859713 (https://clinicaltrials.gov/ct2/show/NCT03859713).

Effects of recreational therapy and speech therapy among participants with Parkinson disease and Parkinson plus conditions: Findings from a 16-week multidisciplinary program

Idiopathic Parkinson disease (IPD) affects multiple aspects of a person’s daily functioning. The current study examined the effects of a multidisciplinary intervention program, including recreational therapy (RT) and speech therapy, among individuals with IPD or PD plus conditions over 16 weeks. The study included six participants with IPD and a participant with progressive supranuclear palsy (PD plus condition). Participants with IPD attended a weekly LOUD Crowd® program consisting of different speech and cognitive activities. In addition, all seven participants attended an RT intervention focusing on fall prevention education and implementing balance, strength, and endurance routines. Results indicated improvements in dynamic balance, reduced fall risk, cognition, swallowing, and voice-related outcomes. In conclusion, a multidisciplinary intervention program is beneficial for individuals with PD or PD plus conditions.

A Multidisciplinary Intervention in Childhood Obesity Acutely Improves Insulin Resistance and Inflammatory Markers Independent From Body Composition.

Childhood obesity is an increasing health care problem associated with insulin resistance and low-level systemic inflammation, which can ultimately lead to diabetes. Evidence for efficacy of therapeutic intervention programs on the early development of obesity associated sequelae is moderate. This paper investigates the effect of a multidisciplinary short-term intervention program on insulin resistance and metaflammation in childhood obesity. Two hundred and 36 overweight or obese children and adolescents between the ages of 10 and 14 were included in a prospective 5 months intervention study, which included sports, psychotherapy, and nutritional counseling. Primary endpoints were the effects on body mass index standard deviation score (BMI-SDS) and homeostatic model assessment of insulin resistance (HOMA-IR), key secondary endpoints were the levels of C-reactive protein (CRP), leptin, and adiponectin. At baseline, a substantial proportion of participants showed signs of insulin resistance (mean HOMA-IR 5.5 ± 3.4) despite not meeting the diagnostic criteria for diabetes, and low-level inflammation (mean CRP 3.9 mg/l ± 3.8 mg/l). One hundred and 95 participants (83%) completed the program resulting in a significant reduction in BMI-SDS, HOMA-IR, CRP, and leptin and a significant increase in adiponectin (mean change compared to baseline −0.14, −0.85, −1.0 mg/l, −2.8 ng/ml, and 0.5 μg/ml, respectively; p < 0.001 each). Effects on BMI-SDS, HOMA-IR, CRP, and adiponectin were largely independent whereas leptin was positively correlated with BMI-SDS and total fat mass before and after intervention (r = 0.56 and 0.61, p < 0.001 each). Short-term multidisciplinary intervention successfully improved body composition, insulin sensitivity, low-level systemic inflammation, and the adipokine profile in childhood obesity. Our findings highlight the immediate connection between obesity and the pathophysiology of its sequelae, and emphasize the importance of early intervention. Continued lifestyle modification is likely necessary to consolidate and augment the long-term effects.

Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial

BackgroundThe prevalence rates of childhood obesity are increasing. The current multidisciplinary treatments for (childhood) obesity are effective but only moderately and in the short term. A possible explanation for the onset and maintenance of childhood obesity is that it reflects a maladaptive mechanism for regulating high levels of stress and emotions. Therefore, the current RCT study aims to test the effectiveness of adding an emotion regulation training to care as usual (multidisciplinary obesity treatment) in young inpatients (10–14) involved in an obesity treatment program compared to care as usual alone.The research model for this RCT study states that when high levels of stress are regulated in a maladaptive way, this can contribute to the development of obesity.MethodsThe current study will recruit 140 youngsters (10–14 years) who are involved in an inpatient multidisciplinary obesity treatment (MOT) program. After giving consent to participate in the study, youngsters will be randomly assigned, during consecutive waves, to one of two conditions: care as usual (receiving MOT) or intervention (receiving MOT in addition to emotion regulation training). The training itself consists of 12 weekly sessions, followed by a booster session after 3 and 5 months. The participants will be tested pretraining, post-training, and at 6 months’ follow-up. We hypothesize that, compared to the control condition, youngsters in the intervention condition will (1) use more adaptive emotion regulation strategies and (2) report less emotional eating, both primary outcome measures. Moreover, on the level of secondary outcome measures, we hypothesize that youngsters in the intervention condition, compared with the control condition, will (3) report better sleep quality, (4) undergo improved weight loss and weight loss maintenance, and (5) experience better long-term (6-months) psychological well-being.DiscussionThis study will add to both the scientific and clinical literature on the role of emotion regulation in the development and maintenance of different psychopathologies, as emotion regulation is a transdiagnostic factor.Trial registrationThe RCT study protocol is registered at ISRCTN Registry, with study ID “ISRCTN 83822934.” Registered on 13 December 2017.

Effects of an Inpatient Multidisciplinary Intervention on Physical Ability and Self Perceived Health Status in Multiple Sclerosis and Parkinson?s Disease Patients

Objective: The current study’s objectives were to investigate the effects of a multidisciplinary intervention (MDI) for multiple sclerosis (MS) and Parkinson's disease (PD) patients on physical ability and self-perceived health status, and to examine the relationship between physical ability and health status in these patient groups. Methods: 110 patients (44 with PD, 66 with MS) were enrolled in a 4-week inpatient MDI program. Measures of health status (SF-12) and physical ability (6 min walking, timed up-and-go test, and sit-to-stand test) were administered before and after intervention. Results: The results showed significant improvements on physical performance and increased physical and mental health status in both patient groups. Physical health status (PCS) correlated significantly with all three physical tests. Physical test scores showed a significant predictive value on PCS. Few previous studies have explored the effects of short, intensive, inpatient treatment programs on quality of life measures in these patient groups. Results of the current study suggest that the short intensive inpatient rehabilitation is effective in producing short term improvements. Conclusion: The conclusion is multiple sclerosis and Parkinson’s disease patients seem to benefit from a multidisciplinary intervention, improving both objective and subjective perceptions of health. As expected, physical ability was closely related to perceived physical health, but not mental health, highlighting the importance of addressing psychological symptoms separately in treatment. Knowing the heterogeneity of among the two groups of patients regarding symptoms and disability, finding an ‘ideal’ intervention across patients is nearly impossible. This variation within the patient groups makes studying mechanisms of change, or pathways leading to improvements in quality of life, difficult. Two plausible mechanisms are proposed: First, improvements on the level of physical function may influence health status positively. Secondly, the holistic, multidisciplinary approach to treatment may target nonmotor factors important to patient-perceived health status. The results of the current study also supported a holistic multidisciplinary approach to treatments for Parkinson’s disease and multiple sclerosis patients.

Problematic Internet Use, Non-Medical Use of Prescription Drugs, and Depressive Symptoms among Adolescents: A Large-Scale Study in China.

This large-scale study aimed to test, among Chinese adolescents, the association between problematic Internet use (PIU), non-medical use of prescription drugs (NMUPD), and depressive symptoms, as well as the mediating effects of NMUPD on the associations above. This study used the data from the 2017 National School-based Chinese Adolescents Health Survey, and 24,345 students’ questionnaires qualified for the analyses. Generalized linear mixed models and path models were performed. In the models without mediation, PIU was associated with depressive symptoms (unstandardized β estimate = 0.26, 95% CI = 0.25–0.27); frequent use of opioid or sedative was also related to depressive symptoms (unstandardized β estimate for opioid = 2.77, 95% CI = 1.90–3.63; unstandardized β estimate for sedative = 4.45, 95% CI = 3.02–5.88). Additionally, the results of the path models indicated that opioid misuse partially mediated the association between PIU and depressive symptoms. PIU and opioid/sedative misuse were related to the increased risk of depressive symptoms, respectively. The association above might be complicated, and PIU may elevate the risk of opioid or sedative misuse and depressive symptoms, which in turn could worsen the situation of PIU and vice versa. Multidisciplinary health intervention programs to prevent adolescents involving in PIU, as well as NMPUD, are recommended to be provided.

Prognostic Factors for Disability and Pain Outcomes in Patients with Axial Low Back Pain Undergoing a Multidisciplinary Spine Treatment Program

Prognostic Factors for Disability and Pain Outcomes in Patients with Axial Low Back Pain Undergoing a Multidisciplinary Spine Treatment Program

The placebo effect on aerobic fitness test results is preserved following a multidisciplinary intervention program for treating childhood obesity.

The aim of the study was to examine the placebo effect on fitness test results in trained and untrained overweight and obese children. Twenty pre-pubertal overweight children performed two pairs of progressive treadmill exercise tests before and 12weeks into a multidisciplinary program for the treatment of childhood obesity. In each test pair, at random order, participants received different types of information regarding a water drink consumed prior to testing-standard information (water) vs deliberate positive information (presumed energy drink, placebo). The intervention led to a significant change (P<.05) in BMI%ile (95.6±4.4 vs 93.6±6.9), % fat (35.4±6.0 vs 31.6±5.8), baseline heart rate (104.2±11.6 vs 94.0±7.0bpm), total leisure activity score-Godin (9.3±8.8 vs 41.5±15.2), total screen time (6.9±5.8 vs 3.1±1.4h/d), and a significant improvement in fitness. Following the placebo drink, both groups achieved a significantly higher peak heart rate (untrained: 176.1±13.7 vs 167.5±16.8; trained: 170.7±11.6 vs 166.2±11.4bpm) and longer running time (untrained: 559.9±151.0 vs 434.4±140.3seconds; trained: 728.3±177.3 vs 667.1±176.1seconds). Despite longer exercise duration and higher peak exercise heart rate, average, and peak RPE were lower after the placebo drink (untrained: 12.1±2.3 vs 13.6±2.1; trained:10.0±1.8 vs 11.6±2.1), recovery time was shorter (untrained: 119.2±25.3 vs 133.2±23.7seconds; trained: 92.6±18.9 vs 102.7±18.3seconds). The placebo-induced change in running time and peak RPE were significantly greater prior to training. The significant information placebo effect is preserved in trained overweight children. Information, as well as other motivating aidsand fatigue distractors may be useful in enhancing physical performancein obese children.

Demography and Treatment of Complex Regional Pain Syndrome Among Children

Introduction: Complex Regional Pain syndrome (CRPS) is a rare chronic pain syndrome characterized by amplified pain and autonomic dysfunction. A systematic multidisciplinary treatment program for affected children exists at our department. This study aims to estimate the incidence of CRPS and describe the demography, symptoms and psychosocial characteristics of the patients and evaluate the treatment results. Method: A retrospective medical chart review of all patients under the age of 16 years treated for CRPS between 2004 and 2014 at Hans Christian Andersen Children Hospital. Results: A total of 29 children fulfilled the diagnostic criteria for CRPS. The mean incidence was 2,4/100.000 children per year. Most patients were girls (90%) with a median age of 11 years. A lower extremity was most often involved (86%). Time to diagnosis had a mean of 174 days. All patients reported complete disappearance or significant reduction of pain at discharge without any medication. Walking was normalized in 75% and almost 1/3 could run normally. School attendance and social life was restored. Conclusion: The typical child with CRPS is a girl of normal stature, around 11 years old, who is affected by intolerable pain in a lower extremity and has severe limitation in walking. The condition is rare with a mean incidence of 2,4/100.000 children. Attention is important in order to reduce the diagnostic delay. Our treatment program was successful as the children were in reduced pain, gaining normal physical function and out of social isolation at completion of the program.

Are Processes in Acceptance & Commitment Therapy (ACT) Related to Chronic Pain Outcomes Within Individuals Over Time? An Exploratory Study Using n-of-1 Designs.

IntroductionAcceptance & Commitment Therapy (ACT) explicitly postulates experiential avoidance (EA) and values-based living (VBL) as essential treatment processes. As outcomes from between-subject studies cannot readily be generalized to within-subject processes in individuals, we explored the unfolding of, and relationship between, EA and VBL and levels of pain interference in daily life and emotional well-being within individuals experiencing chronic pain.MethodsUsing n-of-1 designs, three participants following a multidisciplinary treatment program filled out a 12-item daily questionnaire (87–110 days). After multiple imputation of missing data, McKnight Time-series analysis procedures were performed for each participant separately. The interrelationships of EA, VBL and pain intensity, and the relationship of EA and VBL beyond pain intensity with both chronic pain outcomes were assessed both concurrently (same day) and prospectively (consecutive days).ResultsBoth EA and VBL were associated with at least one of five outcome variables (four domains of pain interference and emotional well-being) beyond pain intensity in two participants, but not in the third participant. These associations primarily existed for concurrent, but not consecutive, days. In contrast to VBL, EA was not associated with emotional well-being for any of the three participants.ConclusionsAlthough the finding that ACT-processes were associated with pain outcomes on concurrent days is consistent with ACT theory, the absence of such associations on consecutive days means that alternative explanations cannot be rule out. One possibility is that pain interference fluctuates within days at a higher variability rate than was currently assessed. Future research should consider using a higher measurement frequency to be able to grasp time-lagged effects.

Educación multidisciplinaria en la prevención de obesidad en educandos de la Ciudad de México

La obesidad es un problema de salud pública, que afecta recientemente a la población de menor edad, impactando en la salud y desarrollo psico-social del infante, por lo que la educación temprana orientada a fomentar los hábitos saludables representa un eje central en su prevención y control. El presente trabajo es un ejercicio de análisis y reflexión sobre la eficiencia de los programas multidisciplinarios y preventivos para controlar la obesidad, basados en la educación como eje central. Se realizó una revisión y análisis de estudios que abordan el problema de la obesidad como fenómeno social, y de estudios que evalúan la aplicación de programas multidisciplinarios basados en la educación para incidir en acciones integrales de prevención de la obesidad. La prevalencia de obesidad no ha disminuido pese a las estrategias implementadas por las instancias de salud. Los programas multidisciplinarios de intervención cuyo tema central es la concientización de los educandos sobre cómo contribuye la nutrición y la actividad física en el cuidado de su salud, pueden ser un medio eficiente para prevenir y disminuir la obesidad infantil, cuando se integra la educación en el ámbito escolar y familiar. “La salud es un derecho y bien tutelar del infante”, que puede asegurarse a través de la implementación de programas de intervención multidisciplinar, sustentados en los cuidados primarios con participación de la familia y la escuela.

A family-oriented intervention programme to curtail obesity from five years of age had no effect over no intervention.

To examine the effect of a family-oriented multidisciplinary intervention programme to curtail weight increase in young children with obesity. Children who weighed more than one kilogram above the 97th percentile for height at the preschool assessment in Oppland County, Norway, were identified. Parents residing in one part of the county were invited to participate in a group-based three-year intervention programme while the rest had no interventions. Body mass index (BMI) and family characteristics at entry and measurements at birth were explanatory variables, and change in BMI standard deviation score (SDS) the outcome measure. For the intervention group, outcome was also related to skinfold thicknesses, waist-to-height ratio and physical ability. The programme was completed by 31 families in the intervention and 33 in the control group. At entry, the respective median (interquartile) age was 5.83 (0.36) and 5.74 (0.66) years, and the BMI SDS 2.35 (1.06) and 1.95 (0.49), P=.012. The median decrease in BMI SDS was 0.19 in both groups. The decline increased with increasing BMI SDS at entry, but irrespective of group. Social or behavioural factor or other anthropometric measures were not associated with outcome. The intervention programme had no effect on BMI SDS.

Survey of Barriers and Facilitators to Engagement in a Multidisciplinary Healthy Lifestyles Program for Children

ObjectiveTo understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Māori, the Indigenous people of New Zealand. MethodsWhānau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance. ResultsSelf-reported attendance levels were higher when respondents reported sessions to be conveniently located (P = .03) and lower when respondents considered other priorities as more important for their family (P = .02). Māori more frequently reported that past experiences of health care influenced their decision to attend (P = .03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program. Conclusions and ImplicationsProgram convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services.

Comparative Effectiveness of Embedded Mental Health Services in Pain Management Clinics vs Standard Care.

Embedded behavioral medicine services are a common component of multidisciplinary chronic pain treatment programs. However, few studies have studied whether these services are associated with improved treatment outcomes. Using a retrospective, matched, two-cohort study design, we examined patient-reported outcomes (PROs), including Patient-Reported Outcomes Measurement Information System pain, mental health, and physical function measures, collected at every clinic visit in every patient. Changes from baseline through 12 months were compared in those receiving embedded Behavioral Medicine in addition to usual care to a Standard Care group seen in the same pain practice and weighted via propensity scoring. At baseline, Behavioral Medicine patients had worse scores on most pain, mental health, and physical health measures and were more likely to be female, a member of a racial minority, and have lower socioeconomic status. Regardless of having a worse clinical pain syndrome at baseline, at follow-up both Behavioral Medicine (N = 451) and Standard Care patients (N = 8,383) showed significant and comparable improvements in pain intensity, physical function, depression, and sleep disturbance. Behavioral Medicine patients showed significantly greater improvements in their global impressions of change than the Standard Care patients. Despite worse pain and physical and psychological functioning at baseline, Behavioral Medicine patients showed improvements comparable to patients not receiving these services. Further, Behavioral Medicine patients report higher global impressions of change, indicating that embedded mental health services appear to have the additive value of amplifying the benefits of multimodal pain care.

Disturbed eating behaviours do not impact treatment response in a paediatric obesity chronic care treatment programme.

This study investigates the prevalence of disturbed eating behaviours in children and adolescents initiating obesity treatment, and how the prevalence varies with age, sex and body mass index (BMI) standard deviation score (SDS). Secondly, it examines whether the presence of disturbed eating behaviours at enrolment is associated with the degree of weight loss after 12 months of treatment. A total of 3621 patients aged 3-18 years enrolled in a multidisciplinary obesity treatment programme were studied. Follow-up data after a median of 12.4 months were available for 2055 patients. Upon entry, patients were assessed for the following disturbed eating behaviours: meal skipping, emotional eating, overeating and rapid eating. Height and weight were measured at baseline and follow-up. At enrolment, median age was 11.4 years, median BMI SDS was 2.87, and 82.2% of patients exhibited one or more disturbed eating behaviours. The prevalence of meal skipping, emotional eating and rapid eating increased with age (P < 0.01). Patients who reported overeating or rapid eating exhibited a 0.06-0.11 higher BMI SDS at enrolment than patients without these disturbed eating behaviours (P < 0.02). After 1 year of treatment, BMI SDS was reduced in 75.7% of patients, and the median reduction was 0.24 (95% confidence interval: 0.22-0.27). Overeating was associated with a higher degree of weight loss, while meal skipping, emotional eating and rapid eating did not associate with the degree of weight loss at follow-up. Disturbed eating behaviours were highly prevalent in children and adolescents with overweight or obesity, and varied with age and sex. After 1 year of treatment, the degree of obesity improved, regardless of the presence of disturbed eating behaviours at treatment initiation.

Regional multidisciplinary team intervention programme to improve colorectal cancer outcomes: study protocol for the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCR BCIP)

IntroductionAlthough colorectal cancer outcomes in England are improving, they remain poorer than many comparable countries. Yorkshire Cancer Research has, therefore, established a Bowel Cancer Improvement Programme (YCR BCIP) to improve...