Multidisciplinary Treatment Program Research Articles

Integration of tobacco cessation services into multidisciplinary lung cancer care: rationale, state of the art, and future directions.

Tobacco use is the largest risk factor for lung cancer and many lung cancer patients still smoke at the time of diagnosis. Although clinical practice guidelines recommend that all patients receive evidence-based tobacco treatment, implementation of these services in oncology practices is inconsistent and inadequate. Multidisciplinary lung cancer treatment programs offer an ideal environment to optimally deliver effective smoking cessation services. This article reviews best practice recommendations and current status of tobacco treatment for oncology patients, and provides recommendations to optimize delivery of tobacco treatment in multidisciplinary practice.

Problems in Functioning in Patients with Chronic Musculoskeletal Pain Admitted for Multidisciplinary Rehabilitation.

Little is known about the extent to which improvements in various problem areas are attained after multidisciplinary rehabilitation program in patients with chronic musculoskeletal pain (CMP). To describe the pre- and postcontents of problems in functioning from the Canadian Occupational Performance Measure (COPM) in terms of the International Classification of Functioning, Disability and Health (ICF) in CMP patients following a 15-week rehabilitation program. In all patients admitted to a rehabilitation program, the COPM was administered at admission and discharge. The problems identified at admission were linked to ICF chapters using an established linking procedure. Changes of COPM Performance/Satisfaction scores (1-10; low-high) with 95% confidence intervals (CIs) were calculated, and effect sizes (ESs) were computed. In total, 165 patients were included with a mean age of 44.1 (SD 12.9)years; among them, 143 (87%) were women. At admission, totally 801 problems were identified and linked to 706 unique ICF categories: 83 (12%) were related to the ICF component "Body Functions" and 621 (88%) to "Activities and Participation". ICF chapters "d4 Mobility" (124, 18%) and "d9 Community social and civic life" (143, 20%) were most frequently identified. The median changes of the COPM total scores for Performance and Satisfaction were 2.1 (95% CI 1.9 to 2.3, ES: 1.75) and 3.2 (95% CI 2.9 to 3.4, ES: 2.38). A 15-week multidisciplinary treatment program showed that most problems were seen within chapters Mobility and Community life of the ICF. The program led to significant improvements of patient reported problems, the magnitude of which was similar for all different problem areas.

Evaluation of medication adherence in Lebanese hypertensive patients

Controlling hypertension is essential in cardiovascular diseases. Poor medication adherence is associated with poor disease outcomes, waste of healthcare resources, and contributes to reduced blood pressure control. This study evaluates treatment adherence to antihypertensive therapy in Lebanese hypertensive patients by estimating the proportion of adherent hypertensive patients using a validated tool and investigates what factors predict this behavior. A questionnaire-based cross-sectional study was conducted on a random sample of 210 hypertensive outpatients selected from clinics located in tertiary-care hospitals and from private cardiology clinics located in Beirut. Adherence level was measured using a validated 8-item Modified Morisky Medication Adherence Scale (MMMAS). Among 210 patients, 50.5% showed high adherence, 27.1% medium adherence, and 22.4% low adherence to medication. Mean MMMAS score was 6.59±2.0. In bivariate analyses, having controlled blood pressure (p=0.003) and taking a combination drug (p=0.023) were predictors of high adherence. Forgetfulness (p<0.01), complicated drug regimen (p=0.001), and side effects (p=0.006) were predictors of low adherence after multiple liner regression. Logistic regression results showed that calcium channel blockers (p=0.030) were associated with increased adherence levels. In conclusion, developing multidisciplinary intervention programs to address the factors identified, in addition to educational strategies targeting healthcare providers, are necessary to enhance patient adherence.

Day Hospital Treatment for Anorexia Nervosa: A 12-Month Follow-up Study.

Day hospitals (DHs) represent a treatment option for anorexia nervosa (AN), a mental disorder that is difficult to treat and has no evidence-based treatments available. We aimed to determine the effectiveness of a DH treatment that was specifically focused on the emotions of severe AN patients. Body mass index and eating psychopathology were the primary outcome measures. Fifty-six adult patients with AN were assessed upon admission, at the end of treatment (EOT) and at a 12-month follow-up evaluation (T18) using Eating Disorders Inventory-2, Beck Depression Inventory, Hamilton Rating Scale for Anxiety and Brief Social Phobia Scale. All participants received a multidisciplinary treatment programme that focused on psychodynamic psychotherapy. Seventy-eight per cent of participants reported positive outcomes at EOT and 68% at T18. Moreover, 82.1% and 65.4% of long-standing patients showed positive outcomes at EOT and T18, respectively. All measures of psychopathology were significantly improved at EOT and were maintained at follow-up. Our DH was effective at treating severe AN patients; however, further investigations of the processes of change are warranted.

Effects of a multidisciplinary program on morbid obese patients and patients with comorbility who are likely to be candidates for bariatric surgery

Morbid obesity is a disease that must be treated comprehensively (i.e. multi/interdisciplinary). Bariatric surgery is an effective and secure procedure for treating this health condition; however, the higher the weight is, the greater the risk of morbimortality might be. The aim of this study is to determine the effects of a multidisciplinary treatment program on metabolic and anthropometric parameters and the physical condition of bariatric surgery candidates. 1 man and 9 women of ~42.5 years old, with morbid obesity ( n = 3) or obesity and comorbilities (diabetes mellitus type II, hypertension, dyslipidemia and insulin resistance) (n = 7), all of them candidates for bariatric surgery, were submitted to physical exercise, psychological support and nutritional education, 3 times a week during 3 months. 72 hours before and after the last intervention session: body mass; fat mass index; BMI; waist circumference; physical condition; glycemia; HDL, LDL and total cholesterol; and triglycerides, were assessed (with a ≥12-hour fast). After intervention, body mass (p=0.004), BMI (p=0.002), fat mass index (p=0.047) and physical condition (p=0.000) showed significant changes. Despite their tendency to decrease, remaining variables did not show significant changes. A comprehensive reasonable-frequent, short intervention (i.e. 3 sessions per week, during 3 months) may lead to significant weight and body fat loss, apart from enhancing considerably the physical condition of candidates for bariatric surgery. Longer time and/ or higher frequency in interventions might be necessary in order to modify significantly plasmatic variables.

Proposal of a model for multidisciplinary treatment program of chronic migraine with medication overuse: preliminary study.

The treatment of patients with chronic migraine associated with medication overuse is challenging in clinical practice; different strategies of treatment have been recently developed, multidisciplinary treatment approaches have been developed in academic headache centers. Education and support of patients are necessary to improve patients' adherence to pharmacological treatments as well as to non-pharmacological therapies. This study reports a clinical experience conducted at our Headache center with a group of female patients, suffering from chronic migraine complicated by medication overuse, treated by a multidisciplinary approach and followed for a period of 1 year after withdrawal. Results confirm the efficacy of a multifaceted treatment to manage this problematic category of patients.

Sex differences in psychological response to pain in patients with fibromyalgia syndrome.

To examine whether men and women with fibromyalgia syndrome (FMS) differ with respect to pain severity and functioning, pain-related beliefs, or pain-related coping. We hypothesized no significant sex differences in measures of pain and functioning, but that we would observe differences between men and women in how they view and how they cope with FMS-related pain. A total of 747 women and 48 men with FMS who attended a multidisciplinary treatment program completed the study measures. Analyses of covariance were used to examine sex differences in the study measures, with a P-value of ≤0.01 and at least a moderate effect size (Cohen d≥0.5) required for a difference to be deemed statistically significant. Men and women did not differ on demographic measures except for their age, with the men in our sample being significantly younger than the women. Consistent with the study hypothesis, the results revealed no sex differences in the measures of pain and functioning. For pain-related beliefs, men were more likely to view pain as reflecting harm, and they were also more likely than women to use activity avoidance as a pain-coping strategy. The study findings suggest that women and men with FMS may think about and cope with pain somewhat differently, and may therefore benefit from different types of psychosocial pain intervention.

G282 The efficacy of a multidisciplinary intervention strategy for the treatment of benign joint hypermobility syndrome (bjhs) in childhood. a randomised, single centre parallel group trial (the bendy study)

Introduction Joint hypermobility is common in childhood and can be associated with musculoskeletal pain and dysfunction. Current management is delivered by a multidisciplinary team but evidence of efficacy is limited. This clinical trial aimed to determine whether a structured multidisciplinary intervention resulted in improved clinical outcomes compared with standard care. Method A prospective randomised, single centre parallel group trial comparing an 8-week individualised multidisciplinary intervention programme with current standard management (advice and a physiotherapy appointment). Children and young people (CYP) were assessed for pain, function, coordination and strength at baseline, 3 and 12 months. Results 119 children, aged 5 to 16 years, with symptomatic hypermobility were randomised to receive targeted multidisciplinary intervention (I) (n = 59) or standard management (S) (n = 60). Of these, 105 were followed to 12-months. There was a significant improvement in child and parent reported pain, coordination and strength. However, no added benefit could be shown from the intervention (Table 1). The number of CYP showing significant pain reduction (>=40%) was 27 (50.0%) (I) vs 21 (41.1%) (S). Those pain free at 12 months were 29 (56.9%) (I) vs 20 (45.5%) (S). The response was independent of the degree of hypermobility. Conclusions This is the first RCT to compare a structured multidisciplinary intervention with standard care in symptomatic childhood hypermobility. The study demonstrates significant improvement among subjects but no additional benefit from targeted intervention. The findings emphasise the benefit of informed diagnosis and management according to clinical need, but highlight the difficulty in demonstrating subtle benefit from specific interventions without better tools for case definition and outcomes assessment.

Longitudinal data from a school-based intervention - The ACORDA project (Datos longitudinales de un programa intervención en la escuela - proyecto ACORDA)

Abstract. The aim of this study was to analyse changes over 8-months of a multidisciplinary school-based intervention program (ACORDA-Project), in body fat, metabolic profile and physical activity (PA). 40 children [22 girls (55%), and 18 boys age=8.4±1.2] of 6 schools participated in a multidisciplinary program during a school year. Blood pressure (BP), physical activity (PA) by accelerometers, percentage of body fat (%BF) and of trunk fat (%TF) by DXA, and plasmatic total cholesterol (TC), triglycerides, HDL-cholesterol, LDL-cholesterol, insulin and glucose were taken at the baseline (Time point 1, TP1) and at the end of the intervention (Time point 2, TP2). General Linear Models (Repeated Measures Analysis of Covariance) was carried out comparing values at baseline vs. final evaluation, with adjustments for gender and age at baseline. Further adjustments were made to relative changes (increase%X) in height, weight, total PA through steps.day-1, sedentary (SEDPA), light (LIGPA) and moderate to vigorous (MVPA) intensities. Relative changes were calculated as: increase%X = (Xfinal – Xbaseline) / Xbaseline. Statistical significance was set at 5%. Eta squared (n2) was used as an indicator of effect size. There was a significant increase of LIGPA and MVPA, (P&lt;0.05), and significant reduction in systolic blood pressure (P&lt;0.05), but not in diastolic blood pressure. For TC and fasting glucose, significant reductions were also found P&lt;0.05). No changes were observed for other traditional cardiovascular risk factors. The present study found that 8-months of multidisciplinary intervention provided a significant increase in PA levels and reduced cardiovascular risk factors in school children, highlighting the importance of this type of intervention through promotion of PA and the positive impact on children health.Resumen. El objetivo de este estudio fue analizar los cambios en la grasa corporal, el perfil metabólico y la actividad física (AF) en jóvenes escolares que han participado en un programa de intervención multidisciplinario (ACORDA-Project). 40 niños [22 niñas (55%), y 18 niños de edad = 8,4 ± 1,2] de 6 escuelas participaron en un programa multidisciplinario durante un año escolar. La presión arterial (PA), AF por acelerómetros, la porcentaje de grasa corporal (% GC) y de la grasa del tronco (% TF) por DXA, y el colesterol total plasmático (CT), triglicéridos, HDL-colesterol, LDL-colesterol, insulina, la glucosa se tomaron a la línea de base (punto de tiempo 1, TP1) y al final de la intervención (punto de tiempo 2, TP2). Modelos lineales generales (medidas repetidas análisis de covarianza) se utilizaran para la comparación de los valores al inicio del estudio vs. evaluación final, con ajustes para el género y la edad al inicio del estudio. Se hicieron nuevos ajustes a los cambios relativos (incremento%X) de altura, el peso, actividad física total (PA) a través de pasos por día, sedentaria (SEDPA), leve (LIGPA) y de moderada a (MVPA) intensidades vigorosas. Se calcularon los cambios relativos como: incremento%X = (xfinal - Xbaseline) / Xbaseline. La significación estadística se fijó en 5%. Eta cuadrado (n2) se usó como un indicador del tamaño del efecto. Se observó un aumento significativo de LIGPA y MVPA, (P &lt;0.05) y una reducción significativa de la presión arterial sistólica (p &lt;0,05), pero no en la presión arterial diastólica. Para el CT y la glucosa en ayunas, también se encontraron reducciones significativas (P&lt;0.05). No se observaron cambios en otros factores de riesgo cardiovascular tradicionales. El presente estudio encontró que 8-meses de intervención multidisciplinaria proporcionaron un aumento significativo en los niveles de AF y reducción de factores de riesgo cardiovascular en niños en edad escolar. Se destaca la importancia de este tipo de intervención a través de la promoción de la AF y el impacto positivo en la salud de los niños.

The influence of familial predisposition to cardiovascular complications upon childhood obesity treatment

Introduction The aim was to investigate whether a familial predisposition to obesity related cardiovascular complications was associated with the degree of obesity at baseline and/or changes in the degree of obesity during a multidisciplinary childhood obesity treatment program.

Personal and environmental factors to consider when aiming to improve participation in physical activity in children with Spina Bifida: a qualitative study

BackgroundYouth with spina bifida (SB) are less fit and active than other groups with childhood disability. While recent studies have shown benefits of exercise training, the increased fitness levels do not sustain or lead to increased levels of physical activity (PA) in these children. Therefore, it seems important to explore which factors are associated with participation in PA (or lack of) in youth with SB. The objective of this study is to describe both personal and environmental factors that are important for participation in physical activity as experienced by these children and their parents, in order to better develop intervention strategies to improve participation in PA in youth with SB.MethodsEleven semi-structured interviews with parents of children with SB aged 4–7 years, nine focus groups with youth with SB (n = 33, age 8–18 years) and eight focus groups with their parents (n = 31) were conducted, recorded and transcribed verbatim. Two independent researchers analyzed the data. Central themes for physical activity were constructed, using the model for Physical Activity for Persons with a Disability (PAD model) as a background scheme.ResultsData showed that youth with SB encountered both personal and environmental factors associated with participation in PA on all levels of the PAD model. Bowel and bladder care, competence in skills, sufficient fitness, medical events and self-efficacy were important personal factors. Environmental factors that were associated with physical activity included the contact with and support from other people, the use of assistive devices for mobility and care, adequate information regarding possibilities for adapted sports and accessibility of playgrounds and sports facilities.ConclusionsOur findings suggest that a variety of both personal and environmental factors were either positively or negatively associated with participation in PA. An individual approach, assessing possibilities rather than overcoming barriers within and surrounding the child may be a good starting point when setting up intervention programs to improve participation in PA. Therefore, assessment of both personal and environmental factors associated with physical activity should be standard care within multidisciplinary intervention programs aimed to encourage healthy active lifestyles in youth with SB.

Multidisciplinary treatment for rheumatic pain.

Chronic pain experienced by patients with rheumatic conditions is recognized to contribute importantly to suffering. Multidisciplinary pain clinics that adhere to the biopsychosocial concept of pain management provide an effective treatment strategy for many with chronic pain. Other than for low back pain and fibromyalgia, little attention has been given to the specific experience of treating those with rheumatic diseases in such a setting. It is, however, reasonable to suggest that many patients with chronic rheumatic pain could benefit from exposure to a multidisciplinary pain treatment programme that incorporates components of education, exercise and activity, as well as psychological techniques and support. Although the specifics of such a treatment will require defining, rheumatologists can look forward to expanded care for their patients with chronic rheumatic pain, and they should be encouraged to become more involved in these clinics.

Multimodal therapy programs for chronic pain

Chronic pain is a common and disabling disorder with major consequences for patient quality of life and it is also a major economic burden to society. The management of chronic pain comprises a large range of different intervention strategies including pharmacological therapy, non-medicinal and invasive therapeutic options. While non-pharmacological and multimodal options are underused, monomodal options, especially pharmacotherapy and invasive therapies are overused. The effectiveness of multidisciplinary and multimodal treatment programs including physical and rehabilitation interventions and psychological treatment has been extensively studied in the last two decades. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy alone, there is some evidence for the effectiveness of behavioral therapy and there is at least moderate evidence for the effectiveness of multidisciplinary and multimodal treatment and other active treatment reducing pain and increasing functional capacity at short and intermediate term. Therefore, blanket coverage with provision of adequate treatment programs for chronic pain as well as studies evaluating the best composition of treatment elements are needed. The characteristics of chronic pain, the necessary assessment procedures and treatment types are described.

Factors associated with smoking cessation

OBJECTIVE To analyze the prevalence and factors associated with smoking abstinence among patients who were treated in a reference unit for smoking cessation.METHODS This cross-sectional study examined the medical records of 532 patients treated in a reference unit for smoking cessation in Belém, PA, Northern Brazil, between January 2010 and June 2012. Sociodemographic variables and those related to smoking history and treatment were analyzed. Statistical significance was set at p < 0.05.RESULTS The mean age of the participants was 50 years; 57.0% of the patients were women. The mean tobacco load was 30 packs/year, and the mean smoking duration was approximately 32 years. Most patients remained in treatment for four months. The rate of smoking abstinence was 75.0%. Regression analysis indicated that maintenance therapy, absence of relapse triggers, and lower chemical dependence were significantly associated with smoking cessation.CONCLUSIONS The smoking abstinence rate observed was 75.0%. The cessation process was associated with several aspects, including the degree of chemical dependence, symptoms of withdrawal, and period of patient follow-up in a multidisciplinary treatment program. Studies of this nature contribute to the collection of consistent epidemiological data and are essential for the implementation of effective smoking prevention and cessation strategies.

Effect of multidisciplinary interventions on quality of life in obese children: a systematic review and meta-analysis.

To assess the effect of multidisciplinary intervention (MI) programs for overweight and obese children on quality of life (QoL). Medline, EMBASE, Web of Science and Cochrane databases were searched for relevant studies without date restrictions up to July 2014. Included were randomized controlled trials and controlled clinical trials evaluating an MI aimed to reduce weight in overweight children and reporting QoL. The risk of bias of the included studies was assessed using the Cochrane guidelines. Data were pooled for short- (up to 6 months) and long-term (12-18 months) effects using a random effects model. In total, 11 studies were included, studying a total of 997 children aged 3-18 years. No significant differences were found between MI and control interventions on short-term QoL outcomes [mean difference (MD) 1.73, 95 % confidence interval (CI) -0.26 to 3.73 on a 0-100 scale]. Long-term results showed a nonsignificant trend toward a higher QoL in children following an MI program compared with control interventions (MD 4.40 95 % CI -0.12 to 8.92). There is insufficient evidence that MI programs, aimed to reduce weight in overweight and obese children, improve QoL.

Whanau Pakari: A multidisciplinary intervention programme for child and adolescent obesity in Taranaki – Results of the baseline assessments

Whanau Pakari: A multidisciplinary intervention programme for child and adolescent obesity in Taranaki – Results of the baseline assessments

Challenges and successes of a multidisciplinary pediatric obesity treatment program.

Despite the well-documented need for multidisciplinary pediatric obesity treatment programs, few programs exist and best practices are not clearly defined. We describe the design and initial quality-related outcomes of the Strong4Life multidisciplinary pediatric obesity treatment program along with some challenges and solutions implemented over the first 2 years. The purpose of this report is to inform others interested in designing similar programs. The Strong4Life Clinic obesity program was designed to provide children with the medical care, as well as the behavior change guidance and support needed to reverse their obesity and/or minimize the related health risks. This low-intensity program is designed to provide approximately 6 hours of care over 12 months from a medical provider, psychologist, registered dietitian nutritionist, exercise physiologist, and nurse. Between August 2011 and February 2014, the Strong4Life clinic served 781 high-risk (mean sex- and age-adjusted body mass index [BMI] percentile 98.8) and racially/ethnically diverse (45% non-Hispanic black and 24% Hispanic) patients. Of the 781 patients seen, 66% returned for at least 1 visit. Nearly all returning Strong4Life patients stabilized or improved their BMI (90% of those who participated <6 months, 97% of those who participated 6 to <12 months, and 92% of those who participated ≥12 months). This report describes a low-intensity multidisciplinary weight management program that is feasible. Initial assessment of the program suggests benefit in most patients who participate >6 months, but longer follow-up and assessment of comorbidities are needed.

Childhood Obesity and School Failure in Disadvantaged Contexts: Effect of a Multidisciplinary Intervention Program

In disadvantaged socio-economic backgrounds, inequalities of opportunities are translated into deficits in several domains of human development. In developed countries, many children are exposed to multiple risk factors (such as poverty, malnutrition, poor heath, and inadequate stimulation in the home environment) that will dramatically affect motor development, cognitive and socio-emotional child, particularly younger than 5 years. Children living in disadvantaged socio-economic backgrounds …

Translation, adaptation, validation and performance of the American Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) to a Norwegian version: a cross-sectional study.

Background. Researchers have emphasized a need to identify predictors that can explain the variability in weight management after bariatric surgery. Eating self-efficacy has demonstrated predictive impact on patients’ adherence to recommended eating habits following multidisciplinary treatment programs, but has to a limited extent been subject for research after bariatric surgery. Recently an American short form version (WEL-SF) of the commonly used Weight Efficacy Lifestyle Questionnaire (WEL) was available for research and clinical purposes.Objectives. We intended to translate and culturally adapt the WEL-SF to Norwegian conditions, and to evaluate the new versions’ psychometrical properties in a Norwegian population of morbidly obese patients eligible for bariatric surgery.Design. Cross-sectionalMethods. A total of 225 outpatients selected for Laparoscopic sleeve gastrectomy (LSG) were recruited; 114 non-operated and 111 operated patients, respectively. The questionnaire was translated through forward and backward procedures. Structural properties were assessed performing principal component analysis (PCA), correlation and regression analysis were conducted to evaluate convergent validity and sensitivity, respectively. Data was assessed by mean, median, item response, missing values, floor- and ceiling effect, Cronbach’s alpha and alpha if item deleted.Results. The PCA resulted in one factor with eigenvalue > 1, explaining 63.0% of the variability. The WEL-SF sum scores were positively correlated with the Self-efficacy and quality of life instruments (p < 0.001). The WEL-SF was associated with body mass index (BMI) (p < 0.001) and changes in BMI (p = 0.026). A very high item response was obtained with only one missing value (0.4%). The ceiling effect was in average 0.9 and 17.1% in the non-operated and operated sample, respectively. Strong internal consistency (r = 0.92) was obtained, and Cronbach’s alpha remained high (0.86–0.92) if single items were deleted.Conclusion. The Norwegian version of WEL-SF appears to be a valid questionnaire on eating self-efficacy, with acceptable psychometrical properties in a population of morbidly obese patients.

Acupuncture for Pediatric Pain.

Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed.