Perceived Symptom Severity Research Articles

Predictors of Maternal Responses to Child Abdominal Pain

This study examined predictors of maternal responses to children's abdominal pain symptoms. Mothers (N = 450) provided data on psychological distress (self and child), responses to their children's symptoms, and perceived symptom severity. Several demographic factors predicted protectiveness and/or symptom monitoring: younger or male child, maternal non-Caucasian race or less education, and no father in the home. Psychosocial predictors included maternal somatization (related to greater monitoring and less minimization) and child distress (related to greater minimization). A child gender × condition severity interaction indicated greater protection of boys based on perceived severity, but no such discrimination for girls.

Illness perceptions in depersonalization disorder: Testing an illness attribution model

AbstractDepersonalization disorder (DPD) remains poorly understood and controversial in terms of diagnosis and treatment. Little is known about the cognitive representation of this disorder. In this study, 80 participants with DPD were assessed using the Revised Illness Perception Questionnaire to determine the nature of their perceptions, causal attributions and whether these correlate with levels of depersonalization and affect. Illness perceptions were generally negative; the nature of symptoms was described as mainly psychological but causal attributions were equally divided between psychological and physical. Over half of the sample believed that symptoms were due to ‘physical changes in the brain’. A strong illness identity, psychological illness attributions and high levels of depression were associated with greater depersonalization disorder severity. High levels of anxiety were also prevalent but the relationship between anxiety and depersonalization was unclear. The findings offer some support for a cognitive model of understanding depersonalization disorder, namely that attribution processes are linked to perceived symptom severity and a wide range of experiences come to be seen as part of the disorder. Copyright © 2007 John Wiley & Sons, Ltd.

Differences in physician and patient perceptions of uncomplicated UTI symptom severity: understanding the communication gap

Uncomplicated urinary tract infection (uUTI) is the most common bacterial infection encountered in clinical practice but evaluation and treatment of the illness vary considerably among physicians. The literature suggests that there is often a gap in the perception of symptom severity between physician and patient, a gap that may be a result of the different models they use to explain and manage disease, a result of misinformation or misconceptions about uUTIs, or a result of poor patient-physician communication. This gap in perceptions about uUTI may lead to poor patient care, decreased quality of life and increased antibiotic resistance. Good communication between patient and physician has been shown to result in improved health outcomes. Several approaches to improving communication during consultations have been described in the literature. Physician and patient education and their agreement about any disease, including uUTI can be expected to improve treatment compliance and reduce the incidence of recurrence of such infections. Future work should focus on improvement of communication during clinical consultations to encourage appropriate bidirectional sharing of clinical and patient information. Further research about behavioural risk factors for uUTI may allow evidence-based information to be used in educational programmes.

Evaluations of care by adults following a denial of an advertisement-related prescription drug request: The role of expectations, symptom severity, and physician communication style

As patients continue to take a more active role in their health care, an understanding of patient requests of health care providers, including what happens when requests are not fulfilled, is becoming more important. Although its merits have been debated, direct-to-consumer advertising of prescription drugs generates patient requests. The objective of this study was to assess the influence of physician communication style, respondents’ expectations of receiving a requested prescription, and perceived symptom severity on respondents’ evaluations of care following a physician denial of a prescription drug request stimulated by direct-to-consumer advertising. A 2×2×2, between-subjects experimental design was used. The respondents were made up of employees of the University of Mississippi. Physician communication style, respondents’ expectations, and respondents’ perceived symptom severity were manipulated using vignettes. Respondents’ post-visit evaluations of care were assessed by measuring trust in the physician, visit-based satisfaction with the physician, and commitment toward the physician. Factorial analysis of variance procedures for a three-way design were used to test the hypotheses and assess the research questions. Manipulation checks suggested that the independent variables were appropriately manipulated. No significant first-order or second-order interactions were noted in any of the analyses. Post-visit evaluations of care were significantly associated with physician communication style (a partnership response led to better evaluations of care). There were no significant effects of either prior expectation of request fulfillment or perceived symptom severity. However, non-significant trends in mean scores suggested a potential role of these variables in the evaluation process following request denial. The manner in which a physician communicates with an individual is an important determinant of the evaluation of care following the denial of a request. The results suggest that health care providers attempting to minimize the effect of request denials on patient evaluations should make an effort to involve the patient in the decision-making process.

Hyaluronic Acid for the Treatment of Knee Osteoarthritis

Intraarticular hyaluronic acid is indicated for patients with osteoarthritis of the knee. However, clinical experience, especially efficacy and adverse events, with repeated injection series in the long term are limited. Patients were referred to a large primary care center for management of osteoarthritis of the knee. All were naive to intraarticular hyaluronic acid therapy and met our entry criteria, including resting visual analog scale pain of > 45 mm, radiographic confirmation of unilateral knee grade 1-3 osteoarthritis, and willingness to receive intraarticular therapy. Patients received a three-intraarticular injection series with Suplasyn (10 mg/ml, 2-ml injection) over 3 wks. Patients were instructed to return for consideration of repeat injection series based on their perception of pain restricting daily activity and a resumption of severity similar to their initial presentation. This prospective naturalistic cohort was followed for 6.7 yrs. Patients completed baseline assessment of rest and walking visual analog scale pain (primary efficacy variable), completed a 5-point categorical global satisfaction score, and recorded adverse events and concomitant therapeutic modality use at each study visit. Patients returned for consideration of a repeat injection series based on their perception of symptom severity and were eligible if their resting visual analog scale pain was > 45 mm. The three-injection series and data collection were repeated, and again, patients were given similar instructions regarding consideration of a third injection series. Of 897 referral patients, 537 (mean age, 68 +/- 8 yrs; mean duration of symptoms, 7.4 +/- 4.1 yrs) met our criteria, and only 21 patients did not return for a second injection series. The mean time between first and second series was 27 +/- 7 wks. The change in walking visual analog scale pain was significantly improved from baseline after the first series (81.3%, P < 0.001) and second series (86.7%, P < 0.0001). Similarly, resting visual analog scale pain was significantly decreased from baseline after the first (P < 0.001) and second (P < 0.001) series, and patient satisfaction was significantly improved with each injection series (P < 0.03 and P < 0.01). Very few adverse events were recorded and were limited to local pain and swelling. Use of concomitant therapeutic modalities at presentation for a second injection series included: nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 medications (37%), acetaminophen (31%), oral nutraceuticals (12%), and physical therapy and bracing (12%). Intraarticular hyaluronic acid injections were highly effective in improving resting and walking pain in patients with osteoarthritis of the knee on a first and a second treatment series. Duration of symptom control was about 6 mos, and the therapy was highly satisfactory to patients and was associated with very few local adverse events and limited use of concomitant therapeutic modalities. These data support the potential role of intraarticular hyaluronic acid as an effective long-term therapeutic option for patients with osteoarthritis of the knee.

Psychosocial factors and perceived severity of functional dyspeptic symptoms: a psychosocial interactionist model.

A psychosocial interactionist model was presented to provide a systematic account of individual differences in perceived functional dyspeptic symptom severity. In a population-based survey, 4038 Hong Kong subjects (age 18-80 years) were interviewed. Five hundred ninety interviewees (14.6%) met the diagnostic criteria for functional dyspepsia (FD), and 396 of them participated in this study. Results from multiple regression analyses revealed significant main effects of monitoring, emotional support, and coping flexibility on perceived FD symptom severity. A significant emotional support by coping flexibility interaction effect was also found. The present findings provided support for the psychosocial interactionist model in showing that (1) monitoring is a risk factor related to greater perceived symptom severity, (2) emotional support and coping flexibility are resource factors related to lower perceived symptom severity, and (3) the beneficial role of emotional support is present only among those higher in coping flexibility but not among those lower in coping flexibility.

Patient's perceptions of biofeedback therapy for obstructive defaecation.

OBJECTIVE: The aim of this study is to assess the long-term outcomes of a biofeedback treatment programme for obstructive defaecation up to five years after completion of treatment, reporting from the patients' perspective the subsequent progression of defaecation difficulties and the perceived usefulness of the biofeedback training and its components. METHODS: A biofeedback program for obstructive defaecation at a major hospital in Sydney provided 37 patients with reading material, taught defaecation techniques, and prescribed simulated defaecation and anal relaxation exercises to practice between their monthly biofeedback sessions. Twenty-nine of these patients were contacted by telephone an average of 23 months after last attending and asked to rate the present severity of their condition, changes since last attending biofeedback, and which aspects of the program they found most helpful. RESULTS: Of patients who completed the program, 70% achieved at least a 15% improvement in perceived symptom severity. Those who completed the program and achieved benefit were more likely to name the exercises as the most helpful program component. At the time of follow-up, however, there was no difference in perceived symptom severity between program completers and noncompleters. Program completers, and those followed up more than two years after last attending biofeedback, were more likely to report a worsening in symptom severity subsequent to their final treatment session. CONCLUSIONS: This study confirms the favourable short-term outcomes achieved by some patients completing biofeedback treatment for obstructive defaecation. The findings suggest that biofeedback equipment may be economically used in an educative and corrective role, and that other factors such as education, exercises and counselling alone play an important role. Finally, the benefits of biofeedback may not be maintained through long-term follow-up, raising questions as to the natural history of the disorder and the long-term effectiveness of biofeedback treatment.

A Test of the Wicks Family Health Model in Families Coping with Chronic Obstructive Pulmonary Disease

This study used the Wicksfamily health model to test relationships among family health and time since diagnosis, perception of symptom severity, caregiver stress, and family stressors in 140families coping with chronic obstructive pulmonary disease. Hypotheses were tested using Pearson's correlation coefficients and hierarchical multiple regression analysis. Family health was influenced by time since diagnosis, patient perceptions of symptom severity, caregiver stress, and family stressors as predicted. Cognitive impairment (patient-reported poor memory) was the only symptom significantly influencing family health. Even when physicalfrailty is the hallmark of a disease, it may be the cognitive aspects of the disease that strain family relationships.

Utilization of emergency medical services for symptoms of acute myocardial infarction

To examine patient characteristics and situational and clinical factors that affect utilization of Emergency Medical Services (EMS) for symptoms of acute myocardial infarction (AMI). Telephone interview of patients hospitalized with suspected AMI. Nine hospitals in King County, Washington. Patients admitted to a coronary or intensive care unit between October 1, 1986, and December 31, 1987, with suspected AMI occurring out of hospital. Spouses of patients who met criteria but died during the hospitalization also participated. Patient demographics, coping strategies, situational factors, prior cardiac history, perceived symptom severity, belief about the nature of condition, and method of transportation. Descriptive statistics showed that although few patients called EMS as a "first thing" in response to symptoms, almost half of all patients called EMS before being hospitalized. Stepwise logistic regression analyses revealed that being older, the belief that one was experiencing a heart attack, the presence of other people (including the spouse), and the lack of physical activity at time of symptom onset, were related to both greater and quicker utilization of EMS. Additionally, education, medical history of angina, and severity of symptoms also were related to utilization of EMS. The findings are discussed in a theoretical context, using Leventhal's self-regulatory model to suggest avenues for future research and interventions.

The Adolescent Menstrual Attitude Questionnaire, Part II: Normative scores.

Results obtained from administering the Adolescent Menstrual Attitude Questionnaire to 860 pre- and 1,013 postmenarcheal girls from 49 randomly selected schools in a large western Canadian city are reported. Scores obtained for both the pre- and the postmenarcheal versions of the total scale and the subscales are presented by age and by grade. In addition, for postmenarcheal girls, the self-report of menstrual symptoms gives insight into the prevalence of symptoms and the perception of symptom severity. Correlations between self-reported symptoms with the Menstrual Symptoms subscale score and the total scale score add validity to the scale. These data may be used by clinicians for comparison when administering the scale to individuals or to groups.

Pain-specific beliefs, perceived symptom severity, and adjustment to chronic pain.

Cognitive theories of appraisal argue for the importance of beliefs as determinants of adjustment to stress. The current investigation sought to examine the relation between beliefs about chronic pain and adjustment in a group of chronic pain patients. Patients' belief in themselves as disabled was found to be inversely related to activity level for patients reporting low and medium levels of pain severity. This same belief correlated with professional services utilization and was negatively related to psychological functioning. Believing in a medical cure for pain was also positively related to professional services utilization. Finally, an expressed belief in the appropriateness of solicitous responses from family members was negatively related to psychological functioning for patients reporting relatively low levels of pain. Although these findings support the broad-based hypothesis that the illness-relevant beliefs of chronic pain patients are associated with their multidimensional pain adjustment, they emphasize the importance of beliefs concerning whether or not one is disabled by pain. The findings also highlight the fact that the belief/functioning relation is not always direct and can be moderated by perceived pain severity.

Job Retention Among People with Multiple Sclerosis

This article reports the results of a survey using a self-report instrument to assess how job retention among multiple sclerosis (MS) patients is affected by functional impairment, symptom severity, demographic characteristics, and the potential disincentives of savings and investments, income from a spouse, social security disability insurance (SSDI), and supplemental security income (SSI). A mail survey of New York City MS Chapter members resulted in the collection of questionnaires from 439 individuals who had been employed at diagnosis and were not currently retired. Perceived symptom severity, functional impairment, and demographic characteristics together accounted for 31% of the variance in job retention. When all other variables were controlled for, SSDI and SSI acted as disincentives, accounting for 12% of the variation in work status. When SSDI was removed from the equation, the amount of variance accounted for was reduced to 37%, with income from a spouse accounting for 5% of the variation among disincentives. While symptom severity and functional impairment played an important role in predicting job retention, other factors such as government benefits and demographic status must be considered in order to more fully understand what makes the difference between those MS patients who are employed and those who are not.

Prediction of Functional Impairment from Patient Evaluations of Multiple Sclerosis Symptoms and Symptom Change

This paper reports the results of a survey using an inexpensive self-report instrument to assess patient evaluations of severity of symptoms among those with multiple sclerosis (MS). A mail survey of New York City MS chapter members resulted in collection of 747 questionnaires to gather information on self-assessed symptom severity, functional impairment, and demographic characteristics of the respondents. Data focusing on patients' perceptions of variation in symptom severity over time and the relationship between patient-assessed symptom severity and functional impairment are presented. Patient perceptions mirrored the clinical picture: MS symptoms were reported to increase in severity over time for the majority of patients. Perceived symptom severity accounted for about one-half of the variation in functional impairment, an indication that other factors in addition to the physical impairment itself are related to how disabled the MS patient becomes.