Ann Marie Carosella

Pain expectancies, pain, and functional self-efficacy expectancies as determinants of disability in patients with chronic low back disorders.

This study tested the relative predictive power of self-efficacy expectations of physical capabilities (functional self-efficacy [FSE]), expectations of pain, and expectations of reinjury on physical function in chronic back patients. Before behavioral assessment of function, 85 patients rated their abilities to perform essential job tasks (FSE) and the likelihood that their performances would be accompanied by pain and reinjury. Partial correlations revealed that FSE was significantly related to function when reinjury and pain were partialed out. Neither reinjury nor pain expectancies correlated significantly with function when FSE was partialed out. Further support for an FSE approach came from regression analyses that found pain intensity, gender, and FSE--not expected pain or reinjury--related consistently with physical performance. Thus, performance-specific cognitions may have greater explanatory power over disability than pain-specific ones.

Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain

&NA; The need to document cost‐benefit of comprehensive work rehabilitation services represents a critical requirement for its long‐term viability as a treatment option for injured workers. One approach to improving cost‐benefit is to identify patients who experience difficulty completing a rigorous goal‐oriented treatment approach. This study examined a set of psychological, pain, perceived work environment, and patient expectation measures in order to determine whether such factors were associated with failure to complete rehabilitation. Patients (n = 168) presenting with low back pain who participated in a multidisciplinary work rehabilitation program (physical conditioning, work conditioning, work‐related pain and stress management, ergonomie consultation, and vocational counseling) were categorized into 2 groups based upon whether they completed the 4 week, 5 day per week program (n = 84) or were discharged prior to program completion (n = 84). T tests were computed for return to work expectation, pain (average pain intensity, fear of re‐injury), psychological measures (somatization, dysthymia), perceived work environment (work pressure, control, supervisor support), and disability (duration of work disability, physical disability, perceived disability) variables found in previous studies to affect successful rehabilitation and return to work. The discharged group was marked by lower return to work expectations, and heightened somatization, pain intensity, and perceived disability. In addition, this group was significantly younger and had been out of work longer. The groups did not differ on gender, marital status, ICD‐9 diagnoses or perceived work environment. These findings indicate that patients displaying the pattern of low return to work expectations, heightened perceived disability, pain and somatic focus experience compliance problems in an intensive work rehabilitation program. Efforts should be made to identify these factors prior to program entrance and to provide interventions directed at increasing the likelihood of success.

The role of stress in symptom exacerbation among IBS patients.

Over 200 treatment-seeking irritable bowel syndrome (IBS) patients completed 4 weeks of daily prospective measures of stress and gastrointestinal symptoms as well as retrospective measures of stress (life events over 12 months, hassles over 1 month). We also obtained the stress measures on 66 nonill controls. Irritable bowel syndrome patients report more frequent hassles than controls and a greater stress impact than controls. Using structural equation modeling, we found that the data were consistent with a model of robust autocorrelation effects of both week-to-week gastrointestinal (GI) symptom indices (r=.84) and stress indices (r=.73), as well as strong concurrent effects of stress on IBS symptoms (r=.90) and vice versa (r=.41). The data also were consistent with a model where there were effects of stress in Week t upon GI symptoms in Week t+1 and t+2, but they were mediated through the concurrent week effects and/or autocorrelation effects. There were no statistically significant independent pathways from stress in Week t to GI symptoms in Week t+1 or t+2. Thus, there is more support for a reciprocal relation between stress and symptoms than there is for a causal relation.

Smoking attitudes, beliefs, and readiness to change among acute and long term care inpatients with psychiatric diagnoses

The present study represents an initial assessment of barriers and motives for quitting, health risk knowledge, and readiness to change in a hospitalized acute and long term care population with psychiatric diagnoses, and dual diagnoses of substance abuse and psychiatric disorders. Ninety-two patients residing in admissions, long term care, and mentally impaired/chemically addicted (MICA) units of a VA Medical Center were interviewed by nursing staff. Among the 78% of patients who smoke (smokers), 68% believed smoking was harmful and quitting would benefit their health. The majority of smokers were in Precontemplation (53%) or Contemplation (24%). Smokers in the MICA unit were more similar to the general population in smoking related beliefs and were more likely than other smokers to be in Preparation. These results indicate a need for educational and motivational enhancement interventions for the majority of smokers hospitalized for psychiatric disorders.

Occupational Upper Extremity Symptoms in Sign Language Interpreters: Prevalence and Correlates of Pain, Function, and Work Disability

The interactive role of work demands, occupational stressors, and ergonomic risk factors in work-related upper extremity (UE) disorders remains unclear. Professional sign language interpreting, which involves exposure of the upper limbs to a combination of potential ergonomic and psychosocial stressors represents a unique occupational group to investigate the multivariate nature of UE disorders. The present study reports data on the prevalence, patterns of symptoms, associated medical problems, and health care related to upper extremity disorders in sign language interpreters. The contribution of work demands, work style, and psychosocial stressors to the occurrence of self-reported function, pain, muscle tension, and work disability was also studied. A group of 1398 sign language interpreters completed an 83-item national survey on occupational musculoskeletal health (response rate of 58%). Interpreters were asked a series of demographic, workstyle, work environment, medical care, and symptom-related questions. Logistic regression, multivariate regression, and discriminant function analyses were used to examine the data. A large percentage of interpreters reported symptoms in the neck region (73.6%) followed by the hand/wrist (69.6%). Using a NIOSH case definition for work-relatedness, prevalence rates varied from 16% to 32% depending upon the anatomic location. Medical care was primarily sought within the first month of symptoms (21.9%) and nonsteroidal antiinflammatory drugs were the most frequently used treatment (70.3%). A multivariate logistic regression indicated that female gender, number of years worked, pressure at work, fear of developing pain, tendency to work in pain to insure work quality, and increased wrist deviations from neutral were associated with case status. Impact on function, pain, and perceived muscle tension at work were all primarily associated with tendency to work in a painful way to insure work quality and fear of developing a pain problem. Time off work was also associated with these variables as well as with the lack of an opportunity to use ones initiative. Results indicate that upper extremity symptoms are prevalent in this work group and that a combination of work demands, workstyle, and psychosocial stressors are associated with case status and the exacerbation of pain, muscular tension, functional limitations, and work disability.

Relations among alcohol consumption measures derived from the Cognitive Lifetime Drinking History

Few studies have been conducted of chronic alcohol effects on health and social outcomes. To evaluate the utility and feasibility of such studies, correlations between lifetime and current measures of total alcohol consumption (ounces) and times intoxicated were examined to determine whether these dimensions of drinking are distinct. Studies were conducted in 2142 respondents ages 35 to 70 selected from lists of licensed drivers and individuals eligible for Medicare. Lifetime measures of alcohol consumption and times intoxicated were derived from the Cognitive Lifetime Drinking History (CLDH). Depending on age and sex of the subgroups examined, current consumption accounted for only about 10-25% of the variability in lifetime alcohol consumption; current and lifetime times intoxicated were even less highly correlated. Lifetime and current measures of alcohol consumption accounted for approximately 40-50% of the variability in corresponding lifetime and current measures of times intoxicated in younger cohorts, but this fell to 25% and less in older cohorts. These findings support the use of lifetime measures of alcohol consumption and times intoxicated based on the CLDH together with current measures to investigate chronic and acute alcohol effects on health and social outcomes.

The accuracy of patient-reported measures for GI symptoms: a comparison of real time and retrospective reports.

Obtaining accurate information about gastrointestinal (GI) symptoms is critical to achieving the goals of clinical research and practice. The accuracy of patient data is especially important for functional GI disorders (e.g., IBS) whose symptoms lack a biomarker and index illness severity and treatment response. Retrospective patient‐reported data are vulnerable to forgetting and various cognitive biases whose impact has not been systematically studied in patients with GI disorders. The aim of this study was to document the accuracy of patient‐reported GI symptoms over a reporting period (1 week) most representative of the time frame used in research and clinical care.

31 How Accurate Do IBS Patients Recall Past Abdominal Pain Intensity, Stool Frequency, and Stool Consistency?: A Comparison of Real Time Versus End-of-Week Symptom Ratings

while IL-8 (F: 10 pg/ml, NF: 61 pg/ml; p = 0.012) was significantly lower in fatigue pts compared to NF pts. No other significant differences were seen in cytokines or leukocyte subsets profiles. CONCLUSION This study shows for the first time that there are immunological differences between fatigue and non-fatigue IBD patients in remission. The signs of immune stimulation in fatigue could represent an on-going infection or autoimmune response that occurs without any clinical or histological signs of IBD and could even be indirectly or unrelated to the IBD. Further exploration of the underlying immune effects associated with fatigue is warranted to determine potential treatment options.

Predicting post treatment spinal strength and flexibility in work-disabled low back pain patients

This study examined whether posttreatment trunk strength and flexibility could be predicted from initial trunk strength and flexibility, age, gender, pain severity, diagnosis, length of work disability, return-to-work expectations, anxiety, and fear of reinjury among a group of 96 injured workers with chronic occupational low back pain who completed a multidisciplinary work rehabilitation program. The results indicate that initial average torque in trunk extension, age, gender, and average pain severity contribute significantly to prediction of final average torque in trunk extension. Initial average torque in trunk flexion, age, and gender contributed significantly to prediction of final average torque in trunk flexion, and age and initial range of motion contributed significantly to the prediction of final trunk range of motion. The results indicate that prediction of trunk strength and range of motion can be accomplished from measures of trunk strength and flexibility and pain obtained prior to the onset of rehabilitation. Psychological measures were not predictive of posttreatment trunk strength and flexibility. The ability to predict posttreatment trunk strength should facilitate clinical decision making in these complex cases.