Anna Cheshire

The psychosocial well-being of parents of children with cerebral palsy: a comparison study.

Purpose. Parents of children with cerebral palsy (CP) may be at risk from poor psychosocial well-being, compared with parents of children without a long-term health condition (LTHC). However, research has produced some conflicting findings on the topic and no comparison studies have been conducted in the UK. Furthermore, studies have only used measures of negative psychosocial well-being. The aim of this study was to conduct a comparative study of parents of children with CP and parents of children without a LTHC in the UK. Method. Seventy parents of children with CP and 70 parents of children without a LTHC completed self-administered questionnaires, comprising measures of psychosocial distress and positive psychosocial well-being. Results. This study demonstrated that parents of children with CP have significantly poorer psychosocial well-being compared with parents of children without a LTHC: parents of children with CP had lower satisfaction with life and higher levels of anxious and depressed mood. Conclusions. These results suggest caring for a child with CP may put parents at risk from poor psychosocial well-being. Interventions to improve parental well-being are urgently needed.

Coping using positive reinterpretation in parents of children with cerebral palsy.

Use of the coping strategy positive reinterpretation was examined among parents of children with cerebral palsy (CP). Survey data (n = 66) were used to gain a general picture of positive reinterpretation use, which was then explored in greater depth using semi-structured interviews (n = 13). Positive reinterpretation was positively correlated with self-efficacy and negatively correlated with depression and stress. Interviews identified two types of positive reinterpretation: focusing on the positive aspects of the situation and finding meaning (in caring for a child with CP). Positive reinterpretation appeared to be an adaptive coping strategy used to deal with emotional stresses experienced by parents.

A Preliminary Evaluation of a Massage Program for Children Who Have Been Sexually Abused and their Nonabusing Mothers

The aim of this study was to conduct a pilot evaluation of the Mosac Massage Program, a novel program that uses massage to address some of the difficulties faced by children who have been sexually abused and their nonabusing parents. Interviews were conducted with four participating mothers immediately before and after the program. Benefits included improved bonding and communication between mother and child and a relaxing and enjoyable therapy for both mother and child. The program appeared to be a useful complement to talking therapies. Further evaluations are needed to confirm the potential benefits.

Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study

Background Chronic fatigue syndrome, also known as myalgic encephalomyelitis (CFS/ME), is characterized by chronic disabling fatigue and other symptoms, which are not explained by an alternative diagnosis. Previous trials have suggested that graded exercise therapy (GET) is an effective and safe treatment. GET itself is therapist-intensive with limited availability. Objective While guided self-help based on cognitive behavior therapy appears helpful to patients, Guided graded Exercise Self-help (GES) is yet to be tested. Methods This pragmatic randomized controlled trial is set within 2 specialist CFS/ME services in the South of England. Adults attending secondary care clinics with National Institute for Health and Clinical Excellence (NICE)-defined CFS/ME (N=218) will be randomly allocated to specialist medical care (SMC) or SMC plus GES while on a waiting list for therapist-delivered rehabilitation. GES will consist of a structured booklet describing a 6-step graded exercise program, supported by up to 4 face-to-face/telephone/Skype™ consultations with a GES-trained physiotherapist (no more than 90 minutes in total) over 8 weeks. The primary outcomes at 12-weeks after randomization will be physical function (SF-36 physical functioning subscale) and fatigue (Chalder Fatigue Questionnaire). Secondary outcomes will include healthcare costs, adverse outcomes, and self-rated global impression change scores. We will follow up all participants until 1 year after randomization. We will also undertake qualitative interviews of a sample of participants who received GES, looking at perceptions and experiences of those who improved and worsened. Results The project was funded in 2011 and enrolment was completed in December 2014, with follow-up completed in March 2016. Data analysis is currently underway and the first results are expected to be submitted soon. Conclusions This study will indicate whether adding GES to SMC will benefit patients who often spend many months waiting for rehabilitative therapy with little or no improvement being made during that time. The study will indicate whether this type of guided self-management is cost-effective and safe. If this trial shows GES to be acceptable, safe, and comparatively effective, the GES booklet could be made available on the Internet as a practitioner and therapist resource for clinics to recommend, with the caveat that patients also be supported with guidance from a trained physiotherapist. The pragmatic approach in this trial means that GES findings will be generalizable to usual National Health Service (NHS) practice. Trial Registration International Standard Randomized Controlled Trial Number (ISRTCTN): 22975026; http://www.isrctn.com/ISRCTN22975026 (Archived by WebCite at http://www.webcitation.org/6gBK00CUX)

How do we improve men’s mental health via primary care? An evaluation of the Atlas Men’s Well-being Pilot Programme for stressed/distressed men

BackgroundOver three-quarters of all suicides are men (England and Wales), this is despite higher levels of anxiety and depression being reported by women. This disparity may in part be explained by atypical presentations of distress in men, and gendered issues around help-seeking. Consequently, the Atlas Men’s Well-being Programme was designed to engage stressed/distressed men who were patients at a London-based GP surgery. Atlas encouraged GPs to identify and refer men for counselling and/or acupuncture by raising their awareness of men’s distress. The aim of this pilot study was to evaluate Atlas in terms of patients’ characteristics, service utilisation, patient outcomes and cost implications.MethodsAll patients using the Programme were asked to complete a questionnaire before and after their Atlas sessions. Outcome measures included the Hospital Anxiety and Depression scale, Perceived Stress Scale, Warwick-Edinburgh Mental Well-being Scale, a 11-point scale measuring physical health, and the Psychological Outcome Profiles (PSYCHLOPS), a patient-generated outcome measure. Additionally, for cost calculations, participants were asked about their employment, number of days off work due to illness, and their health and social care service use.Results102 participants were recruited, 82 completed pre- and post-treatment questionnaires. Comparisons pre- and post-treatment revealed a statistically significant improvement in anxious mood (p <0.001), perceived stress (p < 0.001), positive well-being (p = <0.001), PSYCHLOPS (p = <0.001) and physical health (p = 0.001), though not depressed mood (p = 0.660). Additionally, reductions in costs related to lost employment and health and social care use, exceeded the cost of Atlas counselling and acupuncture sessions, with an average saving of nearly £700 per patient.ConclusionsAtlas attendance was associated with improvements in patients’ mental and physical health, and demonstrated likely cost savings. It is now important to understand patient and stakeholder perspectives. Further research could compare usual care with the Atlas approach, and investigate full cost-effectiveness.

An Individualized Yoga Programme for Multiple Sclerosis: A Case Study.

PURPOSE Despite the evidence that yoga is beneficial for people with multiple sclerosis (MS), substantial in-depth qualitative studies of yoga and MS-and individualized yoga programmes (IYP), in particular-are lacking. The aims of this paper are (a) to conduct a case study on an IYP for one participant with MS in terms of her experience of yoga and how yoga affected her particular symptoms of MS, and (b) to better understand the unique and changing needs of someone with MS in the context of an IYP. DESIGN AND METHOD Data collected for this study were sourced from a qualitative case study design with data collected via a participant diary completed over the 24-week duration of an IYP; an exit interview after the final IYP session; and weekly records completed by the yoga teacher. Data were analysed using thematic analysis. FINDINGS Over the course of the IYP, the female participant experienced an increased awareness of negative thoughts and feelings about MS and how it affected her and her body. As the programme progressed, she began to work through these feelings and, by the end of the programme, reported experiencing improvements in muscle tone, strength, balance, psychological wellbeing, and confidence. CONCLUSION Our findings highlight the importance of a programme individualized to meet the complex health and psychological needs of individuals with MS.

Children's experiences of their participation in a training and support programme involving massage

This study reports on a research project that aimed to extrapolate the value of the Training and Support Programme (TSP), involving massage, among children with cerebral palsy (CP). Data gathering included information from interviews with a sub-sample of children and the TSP therapist observation forms. Data were analysed using standard thematic content analysis to identify key themes and issues of importance to children. Results showed that children enjoyed the relaxing aspects of massage and reported a number of improvements in their health such as improved muscle relaxation, mobility and bowel movements, and reduced pain. Future studies may need to explore other ways of extrapolating data from this population and similar populations where communication is impaired due to disability, but at the same time ensure that their views are listened to and acted upon.

Guided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions

Abstract Purpose: This study explored patient experiences of Guided graded Exercise Self-help (GES) delivered as part of a randomised controlled trial for people with chronic fatigue syndrome/myalgic encephalomyelitis. The trial found that GES was better than specialist medical care at reducing fatigue and improving physical functioning. Methods: Semi-structured interviews were conducted with patients reporting improvement (n = 9) and deterioration (n = 10), and analysis involved thematic “constant comparison.” Results: The improved group described more facilitators to doing GES, and were more likely to describe high levels of self-motivation, whereas the deteriorated group described more barriers to GES (including worse exacerbation of symptoms after GES, greater interference from comorbid conditions, and obstacles to GES in their lives), and had been ill for longer. Having the capacity to do GES was important; of note, those with relatively lower levels of functioning sometimes had more time and space in their lives to support their GES engagement. We identified an important “indeterminate phase” early on, in which participants did not initially improve. Conclusions: GES may be improved by targeting those most likely to improve, and teaching about the indeterminate phase. Implications for rehabilitation Using the Guided Exercise Self-help booklet alone is unlikely to be sufficient to support patients through Guided Exercise Self-help successfully. Additional guidance from skilled physiotherapists/health professionals who demonstrate an understanding of what it is like to cope with chronic fatigue syndrome/myalgic encephalomyelitis is also important. Those using Guided Exercise Self-help may need additional support through a commonly experienced “indeterminate phase” – an initial phase in the programme where few benefits, along with various challenges associated with increasing activity, are experienced. Individuals who have been ill with chronic fatigue syndrome/myalgic encephalomyelitis for a relatively longer period of time and/or have additional comorbid conditions may benefit from more bespoke therapies with greater health professionals input, delivered by appropriate therapists.

REFRAME : resilience training for GPs

We need more GPs in the UK if we are to manage our ageing and increasingly multi-morbid population. However, there is a manpower crisis in NHS primary care, with GP recruitment falling and older doctors taking early retirement. Although there has been considerable research into medical staff stress, there are relatively few studies of coping and resilience in doctors. However, there is some evidence that intensive, brief resilience training can be beneficial. Our aim was to establish if REFRAME could help GPs develop skills that improve their well-being and resilience and to establish whether participants feel the outcome measures employed capture their experience.

Gender comparisons in non-acute cardiac symptom recognition and subsequent help-seeking decisions: a mixed methods study protocol

Introduction Coronary heart disease (CHD) is one of the leading causes of death in both men and women worldwide. Despite the common misconception that CHD is a ‘mans disease’, it is now well accepted that women endure worse clinical outcomes than men following CHD-related events. A number of studies have explored whether or not gender differences exist in patients presenting with CHD, and specifically whether women delay seeking help for cardiac conditions. UK and overseas studies on help-seeking for emergency cardiac events are contradictory, yet suggest that women often delay help-seeking. In addition, no studies have looked at presumed cardiac symptoms outside an emergency situation. Given the lack of understanding in this area, an explorative qualitative study on the gender differences in help-seeking for a non-emergency cardiac events is needed. Methods and analysis A purposive sample of 20–30 participants of different ethnic backgrounds and ages attending a rapid access chest pain clinic will be recruited to achieve saturation. Semistructured interviews focusing on help-seeking decision-making for apparent cardiac symptoms will be undertaken. Interview data will be analysed thematically using qualitative software (NVivo) to understand any similarities and differences between the way men and women construct help-seeking. Findings will also be used to inform the preliminary development of a cardiac help-seeking intentions questionnaire. Ethics and dissemination Ethical approvals were sought and granted. Namely, the University of Westminster (sponsor) and St Georges NHS Trust REC, and the Trust Research and Development Office granted approval to host the study on the Queen Marys Roehampton site. The study is low risk, with interviews being conducted on hospital premises during working hours. Investigators will disseminate findings via presentations and publications. Participants will receive a written summary of the key findings.