Cary A. Brown

A structured review of the evidence for pacing as a chronic pain intervention

Pacing as an intervention appears with great regularity in the chronic pain management literature and yet what service providers actually mean by pacing is unclear and poorly defined. This short communication reports the findings of a structured review of the literature which examined the strength of the evidence for pacing as an intervention for people with chronic pain. The McMaster critical review guidelines were followed and the relevant electronic databases were searched. Findings revealed a paucity of outcome studies specific to pacing as an intervention. Although background literature demonstrates that pacing is often one part of a multidisciplinary intervention program, the research conducted on these programs presents pacing itself as an ill‐ or undefined construct. It is evident from this review that “pacing,” while a widely employed term, lacks consensus of definition and a demonstrable evidence‐base.

The application of complex adaptive systems theory to clinical practice in rehabilitation

It is increasingly emphasised that effective healthcare for the growing number of chronic disease and lifestyle issues must be grounded in a non-reductionist paradigm focused on understanding relationships and applying flexible problem-solving. To address these needs, key principles of complex adaptive systems theory (CAS) are being applied to healthcare planning and research. The aim of this clinical commentary is to provide a brief overview of complex adaptive systems theory and illustrate its relevance to rehabilitation professionals. Further, the review will explore occupational therapist and physiotherapist profession-specific publications for evidence of CAS theory applications that can be used to illustrate the clinical usefulness of complexity science concepts. The commentary will also identify other resources that can assist healthcare providers in developing an understanding of the frameworks assumptions and principles for affecting change. Lastly, the implications of failing to acquire a competent understanding of CAS principles and command of the terminology will be addressed and therapists challenged to assume an equal role in mapping healthcare delivery in the 21st century.

The beliefs of people with chronic pain in relation to ‘important’ treatment components

Background. The beliefs of people with chronic pain (service users) about the importance of treatment components offered through both multidisciplinary and other types of chronic pain programmes are not widely examined in the literature.

Predictive capacity of pain beliefs and catastrophizing in Whiplash Associated Disorder

INTRODUCTION Beliefs about pain are known to be important factors in recovery, most notably in LBP. Relatively less is known about the role of pain beliefs in Whiplash Associated Disorder (WAD). The widely advocated cognitive-behavioural approach to pain management necessitates cognitive factors such as pain beliefs be examined, even early after injury. The primary purpose of this study was to explore the predictive capacity of early post-injury pain beliefs and catastrophizing in patients with WAD. METHODS Patients (n=72) undergoing treatment for acute WAD in physical therapy and chiropractic clinics were invited to participate in the study. Research participants were asked to complete measures of beliefs (Survey of Pain Attitudes (SOPA) and Pain Beliefs and Perception Inventory (PBPI)) and catastrophizing (Pain Catastrophizing Scale) at baseline (within 6 weeks of injury), and 3 and 6 months post-injury. In addition, pain severity and self-reported disability using the Whiplash Disability Questionnaire (WDQ) were recorded at each measurement occasion. Baseline belief and catastrophizing scores were examined for their relationship with future pain and disability using multiple linear regression. RESULTS Expectancy beliefs (PBPI Permanence and SOPA Medical Cure) were negatively correlated with pain intensity at 6-months and uniquely accounted for 16% and 14% of explained variance, respectively, after controlling for baseline pain intensity, age, sex and history of WAD. Consistent with previous research, catastrophizing was also found to be predictive of future pain. The amount of unique variance explained by beliefs in the prediction of future disability was modest after controlling for baseline disability, age, sex and history of WAD. DISCUSSION These results suggest that expectancy beliefs are potentially important constructs to include in future explanatory prognosis studies. The Medical Cure and Permanence subscales of the SOPA and PBPI are tools that could be used to measure these expectancy constructs.

A critique of the evidence base for non-pharmacological sleep interventions for persons with dementia

Disordered sleep in persons with dementia is a contributing factor for a range of health problems. The evidence base for non-pharmacological interventions has not been evaluated and clearly presented in the literature. This paper provides a structured Critical Literature Review of the evidence for non-pharmacological interventions to reduce disordered sleep in persons with dementia. The systematic search retrieved 29 studies that were evaluated for methodological quality. The quality of evidence ranged from conclusive for light therapy and activity to inconclusive for most other interventions. There is a paucity of conclusive research for non-pharmacological sleep interventions for persons with dementia. Most of the evidence about effective interventions is anecdotal and untested. There is a need for rigorous scientific inquiry, coupled with tacit knowledge to build a strong evidence base on non-pharmacological interventions for disordered sleep for persons with dementia.

Group work in healthcare students’ education: what do we think we are doing?

Group learning activities (GLAs) are integral components of graduate and undergraduate programmes across disciplines. Students’ multidimensional perception of GLAs and preferred learning style influences learning outcomes. Educators need to be aware of the potential for negative learning experiences associated with group activities and provide structured support and feedback to students. Routinely gathered student feedback, revealing unanticipated themes related to group assignments, provided the impetus for the authors to examine the issue in greater depth. This discussion paper will explore the critical elements of successful group learning by comparing themes emerging from analysis of these student preferences related to group learning against evidence from the literature. Student learning style, goals and past experiences with GLAs are critical determinants of the final learning outcome. To decrease negative experiences in GLAs, we recommend: use of group work in formative rather than summative projects; building student confidence by providing a step‐wise introduction to GLAs with open discussion of the positive and negative consequences of conflict; and the use of effective role modelling.

A comparison of the outcomes of two clinical audits of burn pressure garment satisfaction and compliance in Saudi Arabia

The treatment of burns is very important in Saudi Arabia given the high incidence of these injuries and the large proportion of children involved. Currently there are insufficient numbers of Saudi nationals to meet these and other health care needs, and consequently, a large investment in expatriate health care workers continues to be made. Expatriate workers have imported the use of the burn pressure garment (BPG), which is widely accepted as an effective intervention within western countries. However, evidence of effectiveness specific to the unique cultural context of Saudi Arabia is lacking. This paper compares the findings of two audits conducted regarding BPG treatments in two similar hospitals in Saudi Arabia. Although both hospitals were alike in structure, location and client population, Hospital A patient compliance rate was only 15.3% compared to Hospital Bs 81.3%. Dissatisfaction was reported by 77% of the Hospital A group but by only 35% of the Hospital B patients. Hospital A lacked the clear guidelines for practice and follow-up procedures evidenced at the second facility and poorer outcomes could possibly be attributed to this short-coming. However, cross-cultural issues related to skill transfer, the auditing process and the impact of expatriate health care workers were also identified as warranting further exploration.

Non-pharmacological sleep interventions for youth with chronic health conditions: A critical review of the methodological quality of the evidence

Purpose: Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. Method: The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. Results: The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. Conclusions: Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research. Implications for Rehabilitation Methodological Quality of Sleep Research Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains. Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as bright light therapy, activity, massage and behavioral interventions are promising areas. No studies found reasons that a trail of a NPSI matched to the youth’s context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists’ and parents’ needs is required.

The Opt‐in/Opt‐out Feature in a Multi‐Stage Delphi Method Study

Policy Delphi methods have not received the level of methodological scrutiny evidenced by more established techniques. This paper provides an examination of the potential for study participants to opt in/opt out of consecutive Delphi rounds. The literature proposes that this is a positive feature of the approach but evidence to support this position is lacking. This paper provides a brief review of the Policy Delphi method and than presents details of participation patterns in a study where the opt‐in/opt‐out option was available. Findings showed that participants exercised the option of opting in/opting out of different Delphi rounds. Although only 20.6% of the original participants completed all three Delphi rounds, the response rate (regardless of participants’ involvement in previous rounds) across all three Delphi rounds held fairly consistent at around 40%. These findings are significant as they relate to the need for an expanded repertoire of research tools that can address the complex, non‐linear questions emerging in post‐modern society.

Sleep and military members: emerging issues and nonpharmacological intervention.

Background. Many individuals who work in the military experience sleep deficiency which presents a significant problem given the nature of their work. The cause of their sleep problems is likely multifactorial, stemming from the interplay between their personal health, habits and lifestyle juxtaposed with the stress of their military work such as emotional and physical trauma experienced in service. Objective. To present an overview of sleep deficiency in military members (MMs) and review of nonpharmacological treatment options. Discussion. Although there are a number of promising nonpharmacological treatment options available for people working in the military who experience problems sleeping, testing interventions within the context of the military are still in the early stages. Further research utilizing rigorous design and standardized, context appropriate outcome measures is needed to help treat this burgeoning problem.