Psychological Outcomes In Patients Research Articles

Nondisclosure of a cancer diagnosis and prognosis: Recommendations for future research and practice

Nondisclosure of a cancer diagnosis and prognosis is a common practice in many family-centric cultures wherein cancer is viewed negatively, resulting in family carers opposing truthful communication to patients. Oncologists comply with this request for diagnosis and/or prognosis nondisclosure owing to the cultural milieu, often choosing to describe the disease in less threatening terms such as "tumor" or "fever." This review provides a snapshot of existing research exploring diagnosis and prognosis disclosure and nondisclosure from the perspectives of the oncologists, family carers, and the patient with a particular focus on the psychological outcomes for patients who are aware versus not aware of their diagnosis and/or prognosis. Further, this review makes recommendations for future research and practice in cancer diagnosis and prognosis communication in India (e.g., communication skills training for family carers and healthcare providers).

Patients' perspective and usability of innovation technology in a new rehabilitation pathway: An exploratory study in patients with multiple sclerosis

Introduction: Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system, which causes sensori-motor and cognitive disabilities, as well as neuropsychiatric abnormalities. Technological innovations could offer a valuable way to improve neurorehabilitation outcomes. Aim of the study is to assess the feasibility and usability of new rehabilitation technologies as perceived by patients suffering from MS. Materials and Methods: MS inpatients attending the Robotic and Behavioral Neurorehabilitation Service of the IRCCS Centro Neurolesi Bonino Pulejo (Messina, Italy) from February 2017 to April 2019, were enrolled in this exploratory study. The patients were submitted to a personalized rehabilitation treatment using robotics (such as Lokomat, Geosystem, Ekso, Armeo) and virtual reality (i.e. BTS-Nirvana, CAREN, VRRS), following a dedicated innovative pathway. Results: All patients completed the study. Significant pre-post-treatment differences were found in the perception of patients' quality of life, regarding both physical and mental items (p<0,001), as well as in the achievement of the therapeutic goal. Finally, we observed that patients declared a high usability of the robotic devices, and that rehabilitation with the new devices was well tolerated. Conclusions: our results support the idea that neurorehabilitation using innovation technologies can be useful for the commitment and motivation during the rehabilitation process, with possible positive effects on the functional and psychological outcomes of patients with MS.

The Effectiveness of Peer Group-Based Training on the Outcomes of Patients Undergoing Transradial Coronary Angiography

Introduction Coronary artery angiography using radial artery is one of the methods used for diagnosis of coronary artery disease, which causes physical and psychological problems in patients despite its precise and definite diagnosis. The present study is aimed at investigating the effect of peer group-based education on physical and psychological outcomes of patients undergoing coronary artery angiography through the radial artery. Methodology. The present clinical study was conducted on 60 patients undergoing coronary angiography through the radial artery in Vali-e-Asr educational hospital of Fasa during 2018 to 2019. The participants were divided into peer training and control groups (n = 30 in each group) using permutated block randomization. In the peer training group, the patients received the necessary precare training through peer training during and after angiography care. In the control group, the patients received the routine care by the nurse of the related ward. The peer group's stress, anxiety, and depression levels were evaluated before and after the training. Indeed, their comfort, tolerance, satisfaction, and pain levels were measured by a nurse after angiography at the time of entering the ward. Findings. The results indicated no significant difference between the two groups regarding the mean scores of stress, anxiety, and depression before the intervention (p > 0.05). After the intervention, however, there was a significant difference between the two groups concerning the mean score of anxiety (p < 0.05). Nonetheless, no significant difference was found between the two groups in terms of tolerance, comfort, satisfaction, and pain levels (p > 0.05). Finally, the level of pain decreased in both groups over time (p < 0.001). Conclusion Peer group-based training was effective in decreasing the mean score of anxiety in the patients undergoing coronary angiography. Thus, this method is recommended to be utilized alongside other methods to train patients before coronary angiography due to its inexpensiveness and lack of side effects as well as not increasing the nurses' workload.

Psychological outcomes affect functional outcomes in patients with severe pelvic ring fractures

To evaluate the correlation between post-traumatic functional and psychological outcomes in patients with severe pelvic ring injuries. Forty-four patients who sustained a completely unstable pelvic ring injury (Tile C, AO/OTA 61C) treated in our institution from 2012 to 2017 were included. A telephone interview was performed in 16 of 44 patients to evaluate pelvic functionality, using the Majeed pelvic score, and psychological evaluation, using Hamilton anxiety and depression rating scales. The mean Injury Severity Score (ISS) was 27±12, and mean GCS at presentation was 13±4. Average time from trauma to interview was 3 years (range, 1-5 years). Mean Majeed pelvic score was 67±22. Majeed sub-scores were pain 19±9, work 10±7, sitting 8±2, sexual intercourse 3±2, walking aids 11±2, gait unaided 9±2, walking distance 8±3. Mean depression and anxiety scores were 16±12 and 17±14, respectively. Significant correlations were observed between functional and psychological outcomes (P<0.005). Majeed score was negatively correlated with depressive symptoms (r=-0.721, P=0.002) and anxiety symptoms (r=-0.756, P=0.001). Depression and anxiety scores were positively correlated (r=0.945, P<0.001). Lower functional outcomes in patients with Tile C pelvic injuries were correlated with more severe symptoms of depression and anxiety. We recommend that providers consider and treat patients' mental health condition during posttraumatic recovery.

Psychological Analysis of Non-surgical Rhinoplasty.

The aim of this study is to analyze the psychological outcomes for patients undergoing non-surgical correction of nasal defects using injections of cross-linked hyaluronic acid. We assessed changes in the subjective perception of nasal appearance after non-surgical rhinoplasty using the Rhinoplasty Outcomes Evaluation (ROE) questionnaire, which is validated and widely used in the literature. One hundred adult subjects without prior history of surgical or non-surgical rhinoplasty underwent non-surgical recontouring using the hyaluronic acid filler from December 2016 to December 2018. The points of inoculation have been standardized by the authors and are divided according to the aesthetic subunits of the nose. A final 74 patients (65 females and 9 males) completed a one-year follow-up and were included in the present study. The ROE questionnaire consists of six questions and assesses the way patients perceive the appearance of their nose and the way they think the people around them view the appearance of their nose. The results of each question were analyzed for each patient, comparing the preoperative results over a 12-month time-frame. Candidates for rhinoplasty, either medical or surgical, are among the most difficult to treat and, interestingly, there is substantial literature showing that among these patients, there is a higher rate of psychiatric disorders. Many of these patients seek aesthetic surgery and are often dissatisfied with the outcome of their surgery. The authors suggest that the use of ROE is not only a valid method of assessing patient satisfaction, but it could also be used as a tool to highlight some of the psychological characteristics of patients long before performing any treatment and could help identify potentially problematic patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Effect of Psychological Intervention on Quality of Life and Psychological Outcomes of Colorectal Cancer Patients

Objective: This study was undertaken to evaluate the effect of psychological interventions on quality of life (QOL) and psychological outcomes in colorectal cancer patients. Methods: Three components—the Hospital Anxiety and Depression Scale (HADS), cancer-related distress, and QOL—were assessed at admission (T0/baseline), three-month follow-up (T1), and six-month follow-up (T2). Results: The general characteristics of participants were well balanced between the psychological intervention group and control group. Psychological intervention significantly improved the anxiety measured by HADS in the psychological intervention group at T1 and T2 compared with the control group (T1 = −2.83 versus 0.33, p = .002; T2 = −2.64 versus 0.13, p = .045). Both total and avoidance scores of cancer-related distress decreased significantly in the psychological intervention group at T1, and the amelioration maintained until T2. However, the psychological intervention group and the control group did not show any significant differences between global QOL and cognitive function. While the psychological intervention greatly improved physical function at T1 (4.30 versus −4.28, p = .012), the difference was not significant at T2 (3.36 versus −3.41, p = .116). However, the fatigue score in the psychological intervention group was reduced significantly compared with that in control group at T2 (−4.94 versus 3.61, p = .027). Conclusion: Our results suggest that psychological intervention benefits QOL and psychological outcomes of patients with colorectal cancer.

Effects of high-quality nursing care on psychological outcomes in patients with chronic heart failure.

Background:This study will assess the effects of high quality nursing care (HQNC) on psychological outcomes (PCO) in patients with chronic heart failure (CHF).Methods:We will carry out a through search in 7 databases: PUBMED, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, WANGFANG, and China National Knowledge Infrastructure. Eligibility criteria will be randomized controlled trials on assessing effects of HQNC on PCO in patients with CHF. Cochrane risk of bias evaluation will be utilized for methodological quality.Results:This proposed study will summarize a rational synthesis of current evidence for HQNC on PCO in patients with CHF.Conclusion:The results of this study will provide convinced evidence for judging the effects of HQNC on PCO in patients with CHF.

Superior knee self-efficacy and quality of life throughout the first year in patients who recover symmetrical muscle function after ACL reconstruction

PurposeThe aim of this study was to (1) describe psychological outcomes during the first year after an anterior cruciate ligament (ACL) reconstruction and (2) compare psychological outcomes in patients who recover symmetrical muscle function with patients who do not.MethodsThe included patients had undergone a unilateral ACL reconstruction. Patients with a re-rupture and contralateral ACL injury were excluded. Three groups, based on the results from 5 tests of muscle function 12 months after reconstruction, were created. Three validated questionnaires (the Knee Self-Efficacy Scale; the Knee injury and Osteoarthritis Outcome Score subscale “Quality of Life”; the ACL Return to Sport after Injury scale) and a single question “Have you achieved your goal with rehabilitation?” were analysed in 4 different follow-ups after ACL reconstruction (10 weeks, 4, 8 and 12 months). Means and standard deviations were analysed with standard t tests and reported with 95% confidence intervals.ResultsA total of 328 patients (120 men, 37%), mean age 27.8 ± 10 years, were included. Patients who did not recover symmetrical muscle function (n = 56; 17%) at the 12-month follow-up reported inferior knee-related self-efficacy and quality of life than patients who recovered symmetrical muscle function (n = 96; 29%) at all follow-ups, except quality of life at 4 months. The proportion of patients who stated they achieved their rehabilitation goal at 12 months was 17% for the entire cohort, 24% for patients who recovered muscle function and 5% for patients who did not recover muscle function.ConclusionPatients who recovered strength and hop symmetry 12 months after ACL reconstruction had superior knee-related self-efficacy and greater quality of life during the whole first year after ACL reconstruction. These results can aid clinicians in the decision-making process by providing knowledge of patients who might need further attention during rehabilitation.Level of evidenceIII.

Association of Alterations in Intestinal Microbiota With Impaired Psychological Function in Patients With Inflammatory Bowel Diseases in Remission

Depression and anxiety are frequent comorbidities with inflammatory bowel diseases (IBD). Alterations to the intestinal microbiome promote not only intestinal inflammation but also psychologic function. We studied the interactions between the composition ofthe intestinal microbiota and psychological outcomes in patients with IBD in Switzerland. We performed a prospective study of psychological comorbidities and quality of life (QoL) in 171 participants in the Swiss IBD Cohort Study with IBD in remission. Participants complete the Hospital Anxiety and Depression Scale, Perceived Stress Questionnaire, the 36-Item Short Form Survey, and the IBD QoL Questionnaire. Microbes were collected from intestinal biopsies and analyzed by 16S rRNA high-throughput sequencing. Microbiomes of patients with higher perceived stress had significantly lower alpha diversity. Anxiety and depressive symptoms were significantly associated with beta diversity. We found a negative correlation between psychological distress and abundance of Clostridia, Bacilli, Bacteroidia, and Beta- and Gamma-proteobacteria. Psychological distress was also associated with decreases in operational taxonomic units from the lineages of Lachnospiraceae, Fusobacteriaceae, Ruminococcaceae, Veillonellaceae, Alcaligenaceae, Desulfovibrionaceae, and Bacteroidaceae families. The relative abundance of Bifidobacterium in patients with Crohn's disease and Desulfovibrio in patients with ulcerative colitis correlated with depression, whereas abundance of Sutterella, RF 32, and Lactococcus correlated with quality of life in patients with Crohn's disease. We identified correlations between the composition of the intestinal microbiota in patients with IBD and remission, psychological well-being, and QoL. Further studies should investigate how intestinal inflammation, the microbiome, and microbial metabolites affect psychological well-being and whether these components are mono- or bi-directionally linked.

Reproducibility, responsiveness and validation of the Tampa Scale for Kinesiophobia in patients with ACL injuries

Background and purposePsychological factors including fear of pain, re-injury during movement (kinesiophbia) affect return-to-sport rates after anterior cruciate ligament (ACL) reconstructive surgery. Clinicians often encounter in the daily practice that athletes explain lack of self-confidence or psychological readiness during the sports activity. The Tampa Scale for Kinesiophobia (TSK) has been used to evaluate psychological outcomes in patients with ACL injuries in many countries and translated into Japanese version in 2013. However, no researchers validated its reliability, validity, and responsiveness of TSK for patients with ACL injury up to now. The purpose of this study was to evaluate the measurement properties of the Japanese version of the TSK (TSK-J) in patients with ACL injuries.Study designCohort study (Diagnostic); Level of evidence, 2.MethodsThis prospective study was performed in the department of orthopaedic surgery at the university hospital of Juntendo from Sep 2016 and Apr 2017. Patients who diagnosed with ACL injury with or without reconstruction surgery completed several patient-reported outcome measures (PROMs) were included in this study. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines were used to evaluate reliability, validity, responsiveness, and interpretability of the TSK-J.Results222 patients were included in this study. The TSK-J for ACL injured patients showed good internal consistency (Cronbach’s alpha = 0.79) and excellent test-retest reliability (intra-class correlation coefficient, ICC2,1 = 0.90, 95% CI = 0.81 to 0.95). In addtion, the TSK-J was significantly but moderately correlated with the IKDC-SKF (r = − 0.49, P <0.001), VAS-Sports (r = − 0.48, P <0.001), and JACL-25 (r = 0.48, P <0.001). The effect size (ES) was small with the Cohen’s d = − 0.2. The minimal important difference (MID) was − 1.3 points. No significant TSK-J score change was observed over 1-year after ACL reconstruction (r = − 0.12, P <0.001). There were no floor or ceiling effects.ConclusionsOur study demonstrated that the Japanese version of TSK has good reliability. However, its low validity and responsiveness indicate that it may not the best way to assess psychological factors for patients with ACL injury.

Effects of online care on functional and psychological outcomes in patients with psoriasis: A randomized controlled trial

Theimpact of online care on patients' functional and psychological outcomes is critical to determine yet still unknown. To evaluate how a novel online health model that facilitates physician-patient collaboration compares with in-person care for improving functional status and mental health of patients with psoriasis. This 12-month randomized controlled equivalency trial randomly assigned patients with psoriasis 1:1 to receive online or in-person care. Functional impairment and depression were assessed at baseline and at 3-month intervals using the 5-level EuroQol-5 Dimensions index and Patient Health Questionnare-9. Overall, 296 patients were randomly assigned to the online or in-person groups. The between-group difference in overall improvement in the EuroQol Visual Analogue Scale was -0.002 (95% confidence interval, -2.749 to 2.745), falling within an equivalence margin of ±8. The between-group difference in overall improvement in the 5-level EuroQol-5 Dimensions index was 0 (95% confidence interval, -0.003 to 0.003), falling within an equivalence margin of ±0.1. The between-group difference in overall improvement in Patient Health Questionnare-9 score was -0.33 (95% CI, -1.20 to 0.55), falling within an equivalence margin of ±3. Slightly different attrition rates between online and in-person arms (11% vs 9%), but no impact on outcomes. The online health model was equivalent to in-person care for reducing functional impairment and depressive symptoms in patients with psoriasis.

The modifying effects of social support on psychological outcomes in patients with heart failure.

We examined the modifying effects of social support on depressive symptoms and health-related quality of life (QoL) in patients receiving coping skills training (CST). We considered the modifying effects of social support in the Coping Effectively with Heart Failure clinical trial, which randomized 179 heart failure (HF) patients to either 4 months of CST or usual care enhanced by HF education (HFE). CST involved training in specific coping techniques, whereas HFE involved education about HF self-management. Social support was assessed by the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory, QoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and depression was assessed with the Beck Depression Inventory-II (BDI-II). Linear regression models revealed a significant Intervention Group × Baseline Social Support interaction for change in KCCQ total scores (p = .006) and BDI-II scores (p < .001). Participants with low social support assigned to the CST intervention showed large improvements in KCCQ scores (M = 11.2, 95% CI [5.7, 16.8]), whereas low-social-support patients assigned to the HFE controls showed no significant change (M = -0.8, 95% CI [-7.2, 5.6]). Similarly, BDI-II scores in participants with low social support in the CST group showed large reductions (M = -8.7, 95% CI [-11.3, -6.1]) compared with low-social-support HFE participants (M = -3.0, 95% CI [-6.0, -0.1]). HF patients with low social support benefit substantially from telephone-based CST interventions. Targeting HF patients with low social support for behavioral interventions could prove to be a cost-effective strategy for improving QoL and reducing depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

EFFICACY OF COGNITIVE BEHAVIORAL THERAPY AND POSITIVE PSYCHOLOGY ON PSYCHOLOGICAL OUTCOMES IN PATIENTS WITH CORONARY ARTERY DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS

Cognitive behavioral therapy (CBT) and positive psychology (PP) are two psychological interventions (PIs) that may have a positive impact in patients with cardiovascular disease. We systematically evaluated the efficacy of these PIs on psychological outcomes in patients with coronary artery disease

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders.

Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Long-term follow-up for Psychological stRess in Intensive CarE (PRICE) survivors: study protocol for a multicentre, prospective observational cohort study in Australian intensive care units

IntroductionThere are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating...

Patient goals, motivations, and attitudes in a patient-driven variant reclassification study.

Family studies to reclassify clinically ascertained variants of uncertain significance (VUS) can impact risk assessment, medical management, and psychological outcomes for patients and their families. There are limited avenues for patients and their families to actively participate in VUS reclassification, and access to family studies at most commercial laboratories is restricted by multiple factors. To explore patient attitudes about participation in family studies for VUS reclassification, we conducted semistructured pre- and post-participation telephone interviews with 38 participants in a family-based VUS reclassification study that utilized a patient-driven approach for family ascertainment and recruitment. Participants had VUS from multigene panel testing performed at multiple clinical laboratories for cancer or other disease risk. Inductive thematic analysis of transcribed interviews highlighted four major themes: (a) Participants' study goals were driven by the desire to resolve uncertainty related to the VUS, (b) Participants had mixed reactions to the VUS reclassification outcomes of the study, (c) Personal, public, and familial knowledge increased through study participation and (d) Participants used study participation to actively cope with the uncertainty of a VUS. As personalized genomic medicine becomes more prevalent, clinicians, clinical laboratories, and researchers could consider creating more opportunities for active partnership with patients and families, who are motivated to contribute data to familial VUS studies.

Recover your smile: Effects of a beauty care intervention on depressive symptoms, quality of life, and self-esteem in patients with early breast cancer.

ObjectiveMedical cancer treatment is often accompanied by appearance‐related side effects such as hair loss, skin irritation, and paleness, which can subsequently lead to psychosocial distress. Initial evidence suggests that beauty care interventions may reduce distress and improve quality of life (QoL), body image, and self‐esteem immediately.MethodsWe investigated the effects of a brief beauty care intervention on self‐reported symptoms of depression, quality of life, body image, and self‐esteem in 39 female primary breast cancer patients with appearance‐related treatment side effects. Patients were randomly assigned either to an immediate intervention group (IG) or to a wait‐list control (WL). The intervention consisted of a single‐session group makeup workshop, a photo shooting, and of receiving professionally edited portrait and upper‐body photos.ResultsWhile groups did not differ regarding any measure at the pretreatment baseline assessment, IG patients reported less symptoms of depression, higher QoL, and higher self‐esteem compared with baseline and compared with WL. Follow‐up at 8 weeks indicated moderate stability of these improvements.ConclusionsIn contrast to previous research, results indicate beneficial short‐term and midterm effects of beauty care on psychological outcomes in patients with early breast cancer. These results emphasize the utility of this type of brief, low‐cost intervention in women undergoing medical cancer treatment in order to improve their well‐being.

Time course of changes in motor-cognitive exergame performances during task-specific training in patients with dementia: identification and predictors of early training response

BackgroundSome studies have already suggested that exergame interventions can be effective to improve physical, cognitive, motor-cognitive, and psychological outcomes in patients with dementia (PwD). However, little is known about the training volume required to induce such positive effects and the inter-individual differences in training response among PwD. The aim of the study was to analyze the time course of changes in motor-cognitive exergame performances during a task-specific training program and to identify predictors of early training response in PwD.MethodsSecondary analyses of data from the intervention group (IG) of a randomized, placebo-controlled trial to improve motor-cognitive performances in PwD. Fifty-six geriatric patients with mild-to-moderate dementia randomized to the IG underwent a 10-week, task-specific training program (2×/week) on an exergame-based balance training system (Physiomat®), combining postural control tasks with cognitive tasks of an established neuropsychological test (Trail Making Test). Main outcome was the time required to complete different Physiomat®-Tasks (PTs) assessed at baseline (T1), training session 7 (TS7) and 14 (TS14), and post-intervention after 20 training sessions (T2). Reliable change indices were used to identify early responders from T1 to TS7. A multivariate logistic regression analysis was performed to determine independent predictors of early training response.ResultsCompletion time significantly improved already from T1 to TS7 in all PTs (p ≤ .001–.006), with moderate to very large effect sizes (r = .38–.52; Cohen’s d = .85–1.45). For most PTs, significant progressive improvements from TS7 to TS14 and TS14 to T2 were not observed. Thirty-one (59.6%) participants were classified as early responders and 21 (40.4%) as non-early responders. Lower baseline exergame performance and lower visuospatial and divided attention abilities were independently associated with early training response.ConclusionsSubstantial task-specific improvements in complex motor-cognitive exergame performances can be obtained within a surprisingly short intervention period in PwD. Our results confirm that not only an excellent training response can be achieved in this patient population, but also that more vulnerable patients with greater deficits in domain-specific cognitive functions associated with fall risk may even reap the most and fastest benefit from motor-cognitive exergame interventions.Trial registrationISRCTN registry, ISRCTN37232817 (retrospectively registered on 04/02/2012).

A Systematic Review and Meta-Analysis of the Effectiveness of Psychological Interventions Delivered by Physiotherapists on Pain, Disability and Psychological Outcomes in Musculoskeletal Pain Conditions.

This systematic review and meta-analysis examined the effectiveness of physiotherapist delivered psychological interventions combined with physiotherapy on pain, disability, and psychological outcomes for patients with musculoskeletal pain conditions. The review was conducted in accordance with the (PRISMA) guidelines. Five databases were systematically searched for randomized controlled trials from inception to May 2016. Studies were required to compare a psychological intervention delivered by physiotherapists combined with physiotherapy to physiotherapy alone or usual care. Physiotherapists delivering the interventions must have undergone training by a psychologist or a health professional trained in the delivery of psychological interventions. A total of 34 articles met the eligibility criteria, of those, 30 were suitable for meta-analysis. There was low to high quality evidence that physiotherapist delivered psychological intervention combined with physiotherapy decreased pain in the short (26 studies, mean difference=-0.37; 95% confidence interval [CI], -0.65 to -0.09) and long term (22 studies, mean difference=-0.38; 95% CI, -0.67 to -0.10) and decreased disability in the short term (29 studies, standardized mean difference =-0.14; 95% CI, -0.26 to -0.01). Effect sizes were small. Low to high quality evidence demonstrated small to medium effects for some psychological outcomes at short-term and long-term follow-ups. The results indicate that psychological interventions delivered by physiotherapist show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions.

Nurses' Knowledge and Practices about Management of Acute Pain among Injured Persons at Kafr El Sheikh General Hospital

Background: Pain is the most common reason due to which patients come to the emergency department and painful traumatic injuries account for a large portion of emergency department visits. Inadequately managed pain can lead to adverse physical and psychological patient outcomes. Because of the capricious nature of trauma pain, recognition and alleviation of pain, regular assessment and frequent adjustments in medications, dosages, and techniques should be a priority when treating the ill and injured patients. Aim of the study: to assess nurses' knowledge and practices regarding management of acute pain among injured persons at Kafr El Sheikh General Hospital. Research Design: A Descriptive exploratory research design was utilized in the current study. Research questions: a) What do emergency nurses know about management of acute pain among injured persons at Kafr El Skeikh general hospital? b) What are the emergency nurses’ practices toward acute pain among injured persons at Kafr El Skeikh general hospital?Setting: The study was carried out at the emergency department in Kafr El sheikh general hospital. Sample: A purposive sample including nursing staff who were working in the emergency department at Kafr El Sheikh general Hospital and were willing to participate in this study(70 nurses).Tools of data collection; Tool 1:Knowledge assessment questionnaire sheet which consist of two parts(a)personal characteristics& background data.(b)Emergency nurses' knowledge regarding management of acute pain Tool 2: An observational checklist Results: (91.4%) of the study sample were females .As Well, (85.7%) of them were married .While (47.1%) of them were having technical nursing institute degree and (45.7%) of them got training courses in emergency courses, the highest mean scores related to causes of acute pain(0.4333 out of 1),all the study subjects had unsatisfactory general knowledge about acute pain and hundred percent of the studied sample were having an unsatisfactory practice level in relation to nursing management for acute pain Conclusion: considering the result of the present study and the available evidence it can be concluded that, hundred percent of the studied sample were having an unsatisfactory Knowledge practice level in relation to nursing management for acute pain. Recommendations: based on results of the present study can recommended Hospital decision makers create strategies to decrease work load on nurses and encourage inservices training programs for nurses included knowledge and skills for how to apply assessment and management of patients with acute pain.