Self-reported Recovery Research Articles

Health-related quality of life, clinical outcomes, and subjective experiences of parent donors of pediatric liver transplant recipients.

The understanding of the HRQOL issues for parent donors of children who underwent LDLT is lacking. We evaluated the HRQOL of donor and non-donor parents, described their subjective experiences and identified factors associated with lower HRQOL post-donation. This is a cross-sectional study of parent donors whose children underwent LDLT, using SF-36v2 Health Survey to measure HRQOL, and a self-developed questionnaire to evaluate their subjective experiences. Of 32 pairs of donor and non-donor parents, 27 donor and 19 non-donor parents responded. The data of respondents were analyzed. Both donor and non-donor parents' SF-36v2 norm-based scores were average or above average as compared to the Singapore population. Donors who made lifestyle changes post-donation (adopting a healthy balanced diet, regular physical activity, quitting smoking, and moderate alcohol intake) were associated with lower GH (P=0.009) and PF (P=0.002) scores. Donors who took more than 3months for full recovery had lower RP (P=0.022) and BP scores (P=0.038). On multivariate analysis, recipient complication of Clavien grade 3 or 4 was associated with increased RP score by 8.71 points (95% CI: 1.74-15.68), after adjusting for time taken for full recovery. Majority (88.8%) had self-reported recovery time under 6months and returned to work within 3months (74.0%). Donors with factors potentially associated with lower HRQOL may need more support to ensure better HRQOL outcomes post-donation.

Housing Transitions and Recovery of Older Adults Following Hurricane Sandy.

This study explores the effects of social and environmental disruption on emergency housing transitions among older adults following Hurricane Sandy. It is based upon the Sandy Child and Family Health (S-CAFH) Study, an observational cohort of 1,000 randomly sampled New Jersey residents living in the nine counties most affected by Sandy. This analysis examines the post-Sandy housing transitions and recovery of the young-old (55-64), mid-old (65-74), and old-old (75+) compared with younger adults (19-54). We consider length of displacement, number of places stayed after Sandy, the housing host (i.e., family only, friends only, or multi-host), and self-reported recovery. Among all age groups, the old-old (75+) reported the highest rates of housing damage and were more likely to stay in one place besides their home, as well as stay with family rather than by themselves after the storm. Despite this disruption, the old-old were most likely to have recovered from Hurricane Sandy. Findings suggest that the old-old were more resilient to Hurricane Sandy than younger age groups. Understanding the unique post-disaster housing needs of older adults can help identify critical points of intervention for their post-disaster recovery.

Recovery, symptoms, and well-being one to five years after lung transplantation - A multi-centre study.

In recent years, survival after lung transplantation has remained largely unchanged despite improvements in short-and intermediate-term survival, indicating the need to identify factors associated with recovery and long-term survival. Very little is known about how lung recipients recover after lung transplantation and whether such factors are related to symptom distress and well-being. This constitutes the rationale of the study. The aim was to explore symptom prevalence and distress as well as the degree of self-reported perceived recovery and well-being 1-5 years after adult lung transplantation. This multicentre, cross-sectional nationwide study includes 117 lung recipients due for follow-up at 1 year (n = 35), 2 years (n = 28), 3 years (n = 23), 4 years (n = 20) and 5 years (n = 11). Three different self-assessment instruments were utilised; The Postoperative Recovery Profile, the Organ Transplant Symptom and Well-Being Instrument, and the Psychological General Well-Being Instrument. Ethical approval of the study was obtained. Few (5.7%) lung recipients were recovered 1-5 years after lung transplantation and 27.6% were not recovered at all. No relationship was identified between present lung function and self-reported recovery or well-being. There was a strong relationship between recovery and well-being. It is possible to be partly recovered and experience good health. The most prevalent symptoms were tremor 66%, breathlessness 62%, and decreased libido 60%, while the symptoms perceived as most distressing were embarrassment about appearance, decreased libido, and poor appetite. The cross-sectional design prevents identification of any causal relationships. Patient loss due to transplant mortality and inclusion difficulties resulted in a fairly small sample. Our findings suggest the need for changes in follow-up care such as systematic measurement of the degree of self-reported recovery and symptoms. This entails self-management support tailored to the recipients' symptom-management and health-management requirements.

Quantitative Susceptibility Mapping after Sports-Related Concussion.

Quantitative susceptibility mapping using MR imaging can assess changes in brain tissue structure and composition. This report presents preliminary results demonstrating changes in tissue magnetic susceptibility after sports-related concussion. Longitudinal quantitative susceptibility mapping metrics were produced from imaging data acquired from cohorts of concussed and control football athletes. One hundred thirty-six quantitative susceptibility mapping datasets were analyzed across 3 separate visits (24 hours after injury, 8 days postinjury, and 6 months postinjury). Longitudinal quantitative susceptibility mapping group analyses were performed on stability-thresholded brain tissue compartments and selected subregions. Clinical concussion metrics were also measured longitudinally in both cohorts and compared with the measured quantitative susceptibility mapping. Statistically significant increases in white matter susceptibility were identified in the concussed athlete group during the acute (24 hour) and subacute (day 8) period. These effects were most prominent at the 8-day visit but recovered and showed no significant difference from controls at the 6-month visit. The subcortical gray matter showed no statistically significant group differences. Observed susceptibility changes after concussion appeared to outlast self-reported clinical recovery metrics at a group level. At an individual subject level, susceptibility increases within the white matter showed statistically significant correlations with return-to-play durations. The results of this preliminary investigation suggest that sports-related concussion can induce physiologic changes to brain tissue that can be detected using MR imaging-based magnetic susceptibility estimates. In group analyses, the observed tissue changes appear to persist beyond those detected on clinical outcome assessments and were associated with return-to-play duration after sports-related concussion.

Self-reported functional recovery after reconstruction versus repair in acute anterior cruciate ligament rupture (ROTOR): a randomized controlled clinical trial

BackgroundAnterior cruciate ligament (ACL) reconstruction is today’s surgical gold standard for ACL rupture. Although it provides satisfactory results, not all patients return to their previous activity level and moreover, early posttraumatic osteoarthritis is not prevented. As such, a renewed interest has emerged in ACL suture repair combined with dynamic augmentation. Compared to ACL reconstruction, the hypothesized advantages of ACL suture repair are earlier return to sports, reduction of early posttraumatic osteoarthritis and preservation of the patient’s native ACL tissue and proprioceptive envelope of the knee. In recent literature, ACL suture repair combined with dynamic augmentation tends to be at least equally effective compared to ACL reconstruction, but no randomized comparative study has yet been conducted.Methods/designThis study is a prospective, stratified, block randomized controlled trial. Forty-eight patients with an ACL rupture will be assigned to either a suture repair group with dynamic augmentation and microfracture of the femoral notch, or an ACL reconstruction group with autologous semitendinosis graft and all-inside technique. The primary objective is to investigate the hypothesis that suture repair of a ruptured ACL results in at least equal effectiveness compared with an ACL reconstruction in terms of patient self-reported outcomes (IKDC 2000 subjective scale) 1 year postoperatively. Secondary objectives are to evaluate patient self-reported outcomes (IKDC 2000, KOOS, Tegner, VAS), re-rupture rate, rehabilitation time required for return to daily and sports activities, achieved levels of sports activity, clinimetrics (Rolimeter, LSI, Isoforce) and development of osteoarthritis, at short term (6 weeks, 3, 6 and 9 months and 1 year), midterm (2 and 5 years) and long term (10 years) postoperatively.DiscussionA renewed interest has emerged in ACL suture repair combined with dynamic augmentation in the treatment of ACL rupture. Recent cohort studies show good short- and midterm results for this technique. This randomized controlled trial has been designed to compare the outcome of suture repair of a ruptured ACL, combined with DIS as well as microfracture of the femoral notch, with ACL reconstruction using autologous semitendinosus.Trial registrationClinical Trials Register NCT02310854 (retrospectively registered on December 1st, 2014).

Nutritional supplements for patients being treated for active visceral leishmaniasis.

Visceral leishmaniasis (VL) is a disease caused by a parasite, which can lead to death if untreated. Poor nutritional status hastens the progression of VL infection, and VL worsens malnutrition status. Malnutrition is one of the poor prognostic factors identified for leishmaniasis. However, the effects of nutritional supplementation in people treated for VL are not known. To assess the effects of oral nutritional supplements in people being treated with anti-leishmanial drug therapy for VL. We searched the Cochrane Infectious Diseases Group (CIDG) Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and two trial registers up to 12 September 2017. We checked conference proceedings and WHO consultative meeting reports, the reference lists of key documents and existing reviews, and contacted experts and nutritional supplement companies. Randomized controlled trials (RCTs), quasi-randomized controlled trials (quasi-RCTs), and non-randomized controlled trials (NRCTs) of any oral nutritional supplement, compared to no nutritional intervention, placebo, or dietary advice alone, in people being treated for VL. Two review authors independently screened the literature search results for studies that met the inclusion criteria. We had planned for two review authors to independently extract data and assess the risk of bias of the included studies. We planned to follow the Cochrane standard methodological procedures for assessing risk of bias and analysing the data. We identified no eligible studies for this review, either completed or ongoing. We found no studies, either completed or ongoing, that assessed the effects of oral nutritional supplements in people with VL who were being treated with anti-leishmanial drug therapy. Thus, we could not draw any conclusions on the impact of these interventions on primary cure of VL, definitive cure of VL, treatment completion, self-reported recovery from illness or resolution of symptoms, weight gain, increased skinfold thickness, other measures of lean or total mass, or growth in children.This absence of evidence should not be interpreted as evidence of no effect for nutritional supplements in people under VL treatment. It means that we did not identify research that fulfilled our review inclusion criteria.The effects of oral nutritional supplements in people with VL who are being treated with anti-leishmanial drug therapy have yet to be determined by rigorous experimental studies, such as cluster-randomized trials, that focus on outcomes relevant for patients.

Long-term follow-up of whiplash injuries reported to insurance companies: a cohort study on patient-reported outcomes and impact of financial compensation

PurposeThe long-term outcome of Whiplash-associated disorder (WADs) has been reported to be poor in populations from medical settings. However, no trials have investigated the long-term prognosis of patients from medico-legal environment. For this group, the “compensation hypothesis” suggests financial compensation being associated with worsened outcome. The aims of this study were to describe long-term (2–4 years) non-recovery rates in participants with WAD recruited from insurance companies and to investigate the association between self-reported non-recovery and financial compensation.Methods144 participants, reporting neck pain after a motor vehicle accident, were recruited from two major insurance companies in Sweden. Self-reported recovery was measured at 6 months and 2–4 years. Those who received financial compensation from an insurance company were compared with those who received no compensation.ResultsThe overall non-recovery rate after 2–4 years was 55.9% (66/118). In the non-compensated group, the non-recovery rate was 51.0% (25/49) and in the compensated group 73% (27/37) (p = 0.039). Adjusted OR was 4.33 (1.37–13.66). High level of pain at baseline was a strong predictor of non-recovery [OR 46 (4.7–446.0)]. However, no association was found between pain level at baseline and financial compensation.ConclusionsThe non-recovery rate among patients making insurance claims is high, especially among those receiving financial compensation even if causal relationship cannot be determined based on this study. However, lack of association between baseline level of pain and compensation supports the compensation hypothesis.

The Recovery Assessment Scale – Domains and Stages (RAS-DS): Sensitivity to change over time and convergent validity with level of unmet need

There is a need for robust outcome measures for use in psychiatric services. Particularly lacking are self-rated recovery measures with evidence of sensitivity to change. This study was established to examine the convergent validity and sensitivity to change over time (responsiveness) of the Recovery Assessment Scale – Domains and Stages (RAS-DS), in comparison to level of unmet need as measured by the Camberwell Assessment of Need – Short Appraisal Scale (CANSAS). Convergent validity was examined through cross-sectional correlations between 540 CANSAS and RAS-DS scores collected on the same day for the same individuals. Sensitivity to change was examined using correlations between change scores in CANSAS and RAS-DS where both were collected on the same day and the two time points were separated by 90 days or more (n = 498). Results demonstrated moderate, significant cross-sectional correlations between CANSAS scores and RAS-DS total and domain scores and between change scores of both instruments. Results suggest that the RAS-DS is sensitive enough to detect change over time. Only moderate correlation between the RAS-DS and CANSAS suggests that, in the context of recovery-oriented service provision, it is important to measure self-reported recovery in addition to level of unmet needs.

Effectiveness of β-Lactam Monotherapy vs Macrolide Combination Therapy for Children Hospitalized With Pneumonia

β-Lactam monotherapy and β-lactam plus macrolide combination therapy are both common empirical treatment strategies for children hospitalized with pneumonia, but few studies have evaluated the effectiveness of these 2 treatment approaches. To compare the effectiveness of β-lactam monotherapy vs β-lactam plus macrolide combination therapy among a cohort of children hospitalized with pneumonia. We analyzed data from the Etiology of Pneumonia in the Community Study, a multicenter, prospective, population-based study of community-acquired pneumonia hospitalizations conducted from January 1, 2010, to June 30, 2012, in 3 children's hospitals in Nashville, Tennessee; Memphis, Tennessee; and Salt Lake City, Utah. The study included all children (up to 18 years of age) who were hospitalized with radiographically confirmed pneumonia and who received β-lactam monotherapy or β-lactam plus macrolide combination therapy. Data analysis was completed in April 2017. We defined the referent as β-lactam monotherapy, including exclusive use of an oral or parenteral second- or third-generation cephalosporin, penicillin, ampicillin, ampicillin-sulbactam, amoxicillin, or amoxicillin-clavulanate. Use of a β-lactam plus an oral or parenteral macrolide (azithromycin or clarithromycin) served as the comparison group. We modeled the association between these groups and patients' length of stay using multivariable Cox proportional hazards regression. Covariates included demographic, clinical, and radiographic variables. We further evaluated length of stay in a cohort matched by propensity to receive combination therapy. Logistic regression was used to evaluate secondary outcomes in the unmatched cohort, including intensive care admission, rehospitalizations, and self-reported recovery at follow-up. Our study included 1418 children (693 girls and 725 boys) with a median age of 27 months (interquartile range, 12-69 months). This cohort was 60.1% of the 2358 children enrolled in the Etiology of Pneumonia in the Community Study with radiographically confirmed pneumonia in the study period; 1019 (71.9%) received β-lactam monotherapy and 399 (28.1%) received β-lactam plus macrolide combination therapy. In the unmatched cohort, there was no statistically significant difference in length of hospital stay between children receiving β-lactam monotherapy and combination therapy (median, 55 vs 59 hours; adjusted hazard ratio, 0.87; 95% CI, 0.74-1.01). The propensity-matched cohort (n = 560, 39.5%) showed similar results. There were also no significant differences between treatment groups for the secondary outcomes. Empirical macrolide combination therapy conferred no benefit over β-lactam monotherapy for children hospitalized with community-acquired pneumonia. The results of this study elicit questions about the routine empirical use of macrolide combination therapy in this population.

Prognostic factors for recovery following acute lateral ankle ligament sprain: a systematic review

BackgroundOne-third of individuals who sustain an acute lateral ankle ligament sprain suffer significant disability due to pain, functional instability, mechanical instability or recurrent sprain after recovery plateaus at 1 to 5 years post injury. The identification of early prognostic factors associated with poor recovery may provide an opportunity for early-targeted intervention and improve outcome.MethodsWe performed a comprehensive search of AMED, EMBASE, Psych Info, CINAHL, SportDiscus, PubMed, CENTRAL, PEDro, OpenGrey, abstracts and conference proceedings from inception to September 2016. Prospective studies investigating the association between baseline prognostic factors and recovery over time were included. Two independent assessors performed the study selection, data extraction and quality assessment of the studies. A narrative synthesis is presented due to inability to meta-analyse results due to clinical and statistical heterogeneity.ResultsThe search strategy yielded 3396 titles/abstracts after duplicates were removed. Thirty-six full text articles were then assessed, nine of which met the study inclusion criteria. Six were prospective cohorts, and three were secondary analyses of randomised controlled trials. Results are presented for nine studies that presented baseline prognostic factors for recovery after an acute ankle sprain. Age, female gender, swelling, restricted range of motion, limited weight bearing ability, pain (at the medial joint line and on weight-bearing dorsi-flexion at 4 weeks, and pain at rest at 3 months), higher injury severity rating, palpation/stress score, non-inversion mechanism injury, lower self-reported recovery, re-sprain within 3 months, MRI determined number of sprained ligaments, severity and bone bruise were found to be independent predictors of poor recovery. Age was one prognostic factor that demonstrated a consistent association with outcome in three studies, however cautious interpretation is advised.ConclusionsThe associations between prognostic factors and poor recovery after an acute lateral ankle sprain are largely inconclusive. At present, there is insufficient evidence to recommend any factor as an independent predictor of outcome. There is a need for well-conducted prospective cohort studies with adequate sample size and long-term follow-up to provide robust evidence on prognostic factors of recovery following an acute lateral ankle sprain.Trial registrationProspero registration: CRD42014014471

Factors Influencing Recovery from Fatigue after a 16-hour Night Shift among Female Japanese Nurses

Background: The present study aimed to evaluate self-reported fatigue recovery among Japanese nurses who perform shift work and to evaluate how their fatigue was affected by a day off after a night shift. Methods: We recruited 66 healthy female Japanese nurses at three regional private hospitals. The nurses were divided into a recovery group and a non-recovery group, based on their self-reported experience of fatigue during the interval from the time before their night shift to after a following day off. Unpaired t-test and logistic regression analyses were used to find associations of self-reported fatigue with demographic and lifestyle factors. Results: The recovery group included 45 nurses, and the non-recovering group included 21 nurses. The recovery group exhibited a high degree of fatigue at five assessment points, while the non-recovery group only exhibited a high degree of fatigue at the post–day off assessment. The adjusted odds ratios (95% confidence intervals) for self-reported fatigue during the night shift were 1.27 (1.00–1.61) for the age of the nurse’s youngest child and 1.04 (1.00–1.08) for the nurse’s time spent napping (P < 0.05). Conclusion: Sleeping before a night shift may facilitate recovery after the shift, although fatigue was also influenced by the age of the nurse’s youngest child and the nurse’s napping time.

B-58The Relationship Between Self-Reported Cognitive Recovery Following Injury and Neuropsychological Test Results

B-58The Relationship Between Self-Reported Cognitive Recovery Following Injury and Neuropsychological Test Results

Evaluation of a peer-delivered, transitional and post-discharge support program following psychiatric hospitalisation

BackgroundThe time following discharge from psychiatric hospitalisation is a high risk period. Rates of hospital readmission are high and there is increased risk for homelessness and suicide. Transitional and post-discharge support programs have demonstrated positive results in terms of enhanced wellbeing, improved connection with community-based services and, in some cases, reductions in hospital re-admission. This paper reports on the outcomes of a peer-delivered post-discharge support program.MethodsThe program involved peer workers (individuals with their own lived experience of mental illness and recovery) providing individualised practical and emotional support to individuals for six to eight weeks following discharge from an inpatient psychiatric unit. Outcomes measures included self-reported mental health recovery, personal wellness and self-reported re-admission rates. Process and satisfaction measures were also collected and semi-structured follow-up interviews were completed with consenting participants.ResultsThe program provided support for a total of 64 individuals, 38 of whom consented to participate in the evaluation. Participants reported improvements in terms of functional and clinical recovery and in the areas of intellectual, social and psychological wellness. Participants self-report of hospital readmissions suggested that there was a reduction in hospital bed days following engagement with the program. Themes from the follow up interviews included: Easing the transition to the “real world”; Practical and individualised support; Someone to talk to; Positive qualities of the worker, Workers’ lived experience was a positive thing, and It wasn’t long enough.ConclusionOverall, evaluation data suggest that the program supported positive outcomes for participants in terms of recovery, wellbeing and hospital avoidance. Participant feedback suggested that the use of support workers with their own lived experience of mental illness was a particularly powerful aspect of the program.

Long-term Recovery From Hurricane Sandy: Evidence From a Survey in New York City.

This study aimed to examine a range of factors influencing the long-term recovery of New York City residents affected by Hurricane Sandy. In a series of logistic regressions, we analyzed data from a survey of New York City residents to assess self-reported recovery status from Hurricane Sandy. General health, displacement from home, and household income had substantial influences on recovery. Individuals with excellent or fair health were more likely to have recovered than were individuals with poor health. Those with high and middle income were more likely to have recovered than were those with low income. Also, individuals who had not experienced a decrease in household income following Hurricane Sandy had higher odds of recovery than the odds for those with decreased income. Additionally, displacement from the home decreased the odds of recovery. Individuals who applied for assistance from the Build it Back program and the Federal Emergency Management Agency had lower odds of recovering than did those who did not apply. The study outlines the critical importance of health and socioeconomic factors in long-term disaster recovery and highlights the need for increased consideration of those factors in post-disaster interventions and recovery monitoring. More research is needed to assess the effectiveness of state and federal assistance programs, particularly among disadvantaged populations. (Disaster Med Public Health Preparedness. 2018;12:172-175).

Brain connectivity changes occurring following cognitive behavioural therapy for psychosis predict long-term recovery

Little is known about the psychobiological mechanisms of cognitive behavioural therapy for psychosis (CBTp) and which specific processes are key in predicting favourable long-term outcomes. Following theoretical models of psychosis, this proof-of-concept study investigated whether the long-term recovery path of CBTp completers can be predicted by the neural changes in threat-based social affective processing that occur during CBTp. We followed up 22 participants who had undergone a social affective processing task during functional magnetic resonance imaging along with self-report and clinician-administered symptom measures, before and after receiving CBTp. Monthly ratings of psychotic and affective symptoms were obtained retrospectively across 8 years since receiving CBTp, plus self-reported recovery at final follow-up. We investigated whether these long-term outcomes were predicted by CBTp-led changes in functional connections with dorsal prefrontal cortical and amygdala during the processing of threatening and prosocial facial affect. Although long-term psychotic symptoms were predicted by changes in prefrontal connections during prosocial facial affective processing, long-term affective symptoms were predicted by threat-related amygdalo-inferior parietal lobule connectivity. Greater increases in dorsolateral prefrontal cortex connectivity with amygdala following CBTp also predicted higher subjective ratings of recovery at long-term follow-up. These findings show that reorganisation occurring at the neural level following psychological therapy can predict the subsequent recovery path of people with psychosis across 8 years. This novel methodology shows promise for further studies with larger sample size, which are needed to better examine the sensitivity of psychobiological processes, in comparison to existing clinical measures, in predicting long-term outcomes.

What helps people recover from floods? Insights from a survey among flood-affected residents in Germany

The number of people exposed to natural hazards has grown steadily over recent decades, mainly due to increasing exposure in hazard-prone areas. In the future, climate change could further enhance this trend. Still, empirical and comprehensive insights into individual recovery from natural hazards are largely lacking, hampering efforts to increase societal resilience. Drawing from a sample of 710 residents affected by flooding across Germany in June 2013, we empirically explore a wide range of variables possibly influencing self-reported recovery, including flood-event characteristics, the circumstances of the recovery process, socio-economic characteristics, and psychological factors, using multivariate statistics. We found that the amount of damage and other flood-event characteristics such as inundation depth are less important than socio-economic characteristics (e.g., sex or health status) and psychological factors (e.g., risk aversion and emotions). Our results indicate that uniform recovery efforts focusing on areas that were the most affected in terms of physical damage are insufficient to account for the heterogeneity in individual recovery results. To increase societal resilience, aid and recovery efforts should better address the long-term psychological effects of floods.

Place satisfaction and perceived recovery after Hurricane Sandy on Staten Island’s East Shore

ABSTRACTIndividuals’ relationships to place play an important role in their interactions with their residential environments. Prior research has suggested that neighbourhood satisfaction is closely related to neighbourhood attachment, and that attachment is linked to disaster recovery. This study uses data from a survey of residents of the East Shore neighbourhoods of Staten Island, New York, an area that experienced severe storm surge flooding during Hurricane Sandy, to test the association between neighbourhood satisfaction and self-reported recovery from the storm. Perceived recovery from Sandy is treated as the dependent variable in several ordinal logistic regression models. The key independent variable measure tested is neighbourhood satisfaction rating. A statistically significant direct positive relationship is found between neighbourhood satisfaction and perceived recovery from Sandy. This finding is robust across multiple models with various controls and other covariates. These results suggest that place satisfaction may contribute to disaster recovery.

Persistent and Developing Sleep Problems: A Prospective Cohort Study on the Relationship to Poor Outcome in Patients Attending a Pain Clinic with Chronic Low Back Pain.

Sleep problems are common in people with low back pain (LBP); however, the mechanisms of how sleep influences pain are complex. To date there is a lack of prospective research on the timing and development of sleep problems in those who have LBP; such information would be useful to identify individuals at risk for poor outcomes. Our aims are to investigate the predictive role of sleep problems on self-report recovery and pain intensity using logistic regression reporting odds ratios (ORs). An observational cohort of 761 chronic LBP patients recruited from a pain management clinic participated, and they completed data at baseline and at 6-month follow-up (n=682). Results show increased odds for reported nonrecovery (OR 1.52) and pain intensity (OR 2.69) among those who reported sleep problems at baseline. Further analysis on the experience of sleep problems through time showed that those with developing sleep problems (ie, no sleep problems at baseline but reported sleep problems at follow-up) were at increased odds for reporting nonrecovery (OR 2.17) and pain intensity (OR 2.95), as were those who reported sleep problems at both baseline and follow-up, for recovery (OR 2.88) and pain intensity (OR 3.45). Those with resolving sleep problems (ie, sleep problems present at baseline but not at follow-up) were at decreased odds for nonrecovery (OR 0.50) and pain intensity (0.49). Presenting, persistent, and developing sleep problems have a significant impact on recovery for those with LBP. Clinicians may wish to consider treatment options that can address sleep problems.

Assessing pre- and postoperative activity levels with an accelerometer: a proof of concept study

BackgroundPostoperative recovery after abdominal surgery is measured mostly based on subjective or self-reported data. In this article we aim to evaluate whether recovery of daily physical activity levels can be measured postoperatively with the use of an accelerometer.MethodsIn this multicenter, observational pilot study, 30 patients undergoing laparoscopic abdominal surgery (hysterectomy, adnexal surgery, cholecystectomy and hernia inguinal surgery) were included. Patients were instructed to wear an Actigraph wGT3X-BT accelerometer during one week before surgery (baseline) and during the first, third and fifth week after surgery. Wear time, steps taken and physical activity intensity levels (sedentary, light, moderate and vigorous) were measured. Patients were blinded for the accelerometer outcomes. Additionally, an activity diary comprising patients’ self-reported time of being recovered and a list of 18 activities, in which the dates of resumption of these 18 activities were recorded after surgery, was completed by the patient.ResultsFive patients were excluded from analyses because of technical problems with the accelerometer (n = 1) and protocol non-adherence (n = 4). Light, moderate, vigorous, combined moderate and vigorous intensity physical activity (MVPA), and step counts showed a clear recovery curve after surgery. Patients who underwent minor surgery reached their baseline step count and MVPA three weeks after surgery. Patients who underwent intermediate surgery had not yet reached their baseline step count during the last measuring week (five weeks after surgery). The results of the activity diaries showed a fair agreement with the accelerometer results (Cohens Kappa range: 0.273-0.391). Wearing the accelerometer was well tolerated and not regarded as being burdensome by the patients.ConclusionsThe accelerometer appeared to be a feasible way to measure recovery of postoperative physical activity levels in this study and was well tolerated by the patients. The agreement with self-reported physical recovery times was fair.

Depression-related difficulties disengaging from negative faces are associated with sustained attention to negative feedback during social evaluation and predict stress recovery.

The present study aimed to clarify: 1) the presence of depression-related attention bias related to a social stressor, 2) its association with depression-related attention biases as measured under standard conditions, and 3) their association with impaired stress recovery in depression. A sample of 39 participants reporting a broad range of depression levels completed a standard eye-tracking paradigm in which they had to engage/disengage their gaze with/from emotional faces. Participants then underwent a stress induction (i.e., giving a speech), in which their eye movements to false emotional feedback were measured, and stress reactivity and recovery were assessed. Depression level was associated with longer times to engage/disengage attention with/from negative faces under standard conditions and with sustained attention to negative feedback during the speech. These depression-related biases were associated and mediated the association between depression level and self-reported stress recovery, predicting lower recovery from stress after giving the speech.