Catherine A. Warms

Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury.

&NA; Little research has examined the role of patient cognitive and behavioral responses, including catastrophizing, in adjustment to chronic pain associated with spinal cord injury (SCI). The objective of this study was to examine the associations of catastrophizing and specific pain coping strategies with pain intensity, psychological distress, and pain‐related disability among individuals with chronic pain and SCI, after controlling for important demographic and SCI‐related variables that might affect outcomes. Participants in this study were 174 community residents with SCI and chronic pain who completed a mailed questionnaire that included the SF‐36 Mental Health scale, Coping Strategies Questionnaire, and Graded Chronic Pain Scale. The pain coping and catastrophizing measures explained an additional 29% of the variance in pain intensity after adjusting for the demographic and SCI variables (P<0.001). The coping and catastrophizing scales accounted for an additional 30% of the variance in psychological distress (P<0.001) and 11% of the variance in pain‐related disability (P<0.001), after controlling for pain intensity and demographic and SCI variables. Catastrophizing, but not any other single pain coping strategy, was consistently strongly and independently associated with the outcome measures. Potentially, the assessment and treatment of catastrophizing may reduce psychological distress and pain‐related disability among individuals with chronic pain and SCI.

Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.

ObjectiveTo test the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) for diagnosing major depressive disorder (MDD) among persons with traumatic brain injury (TBI). DesignProspective cohort study. SettingLevel I trauma center. Participants135 adults within 1 year of complicated mild, moderate, or severe TBI. Main Outcome MeasuresPHQ-9 Depression Scale, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). ResultsUsing a screening criterion of at least 5 PHQ-9 symptoms present at least several days over the last 2 weeks (with one being depressed mood or anhedonia) maximizes sensitivity (0.93) and specificity (0.89) while providing a positive predictive value of 0.63 and a negative predictive value of 0.99 when compared to SCID diagnosis of MDD. Pearsons correlation between the PHQ-9 scores and other depression measures was 0.90 with the Hopkins Symptom Checklist depression subscale and 0.78 with the Hamilton Rating Scale for Depression. Test-retest reliability of the PHQ-9 was r = 0.76 and κ = 0.46 when using the optimal screening method. ConclusionsThe PHQ-9 is a valid and reliable screening tool for detecting MDD in persons with TBI.

Bodies in motion: monitoring daily activity and exercise with motion sensors in people with chronic pulmonary disease.

A primary goal of pulmonary rehabilitation is to improve health and life quality by encouraging participants to engage in exercise and to increase daily physical activity. The recent advent of motion sensors, including digital pedometers and accelerometers that measure motion as a continuous variable, have added precision to the measurement of free-living daily activity. Daily activity and exercise are variables of keen interest to proponents of the national health agenda, epidemiologists, clinical researchers, and rehabilitation interventionists. This paper summarizes issues related to conceptualizing and monitoring activity in the rehabilitation setting; reviews motion sensor methodology; compares motion-sensing devices; presents analysis issues and current and potential applications to the pulmonary rehabilitation setting; and gives practical applications and limitations.

Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial.

&NA; Chronic pain in persons with spinal cord injury (SCI) is a difficult problem for which there is no simple method of treatment. Few randomized controlled trials of medications for pain in persons with SCI have been conducted. This study was designed to determine whether amitriptyline, a tricyclic antidepressant, is efficacious in relieving chronic pain and improving pain‐related physical and psychosocial dysfunction in persons with SCI. Eighty‐four participants with SCI and chronic pain were randomized to a 6‐week trial of amitriptyline or an active placebo, benztropine mesylate. All pre‐ and post‐treatment assessments were conducted by evaluators blind to the allocation. Regression analyses were conducted to examine whether there was a medication group effect on the primary (average pain intensity) and secondary outcome measures. No significant differences were found between the groups in pain intensity or pain‐related disability post‐treatment, in either intent‐to‐treat analyses or analyses of study completers. These findings do not support the use of amitriptyline in the treatment of chronic pain in this population, but we cannot rule out the possibility that certain subgroups may benefit.

Physical activity measurement in persons with chronic and disabling conditions: methods, strategies, and issues.

Measuring the physical activity of persons with chronic and disabling conditions presents complexities related to measuring instruments, the intensity of the activity being measured, the population being measured, and individual behavior and health status. They often have limitations in mobility that do not preclude physical activity but contribute to the complexity of measuring it, such as slow or altered gait, inability to walk, and the need for assistive devices. This article reviews currently available ways to measure physical activity, describes strengths and weaknesses of various measures, and provides examples of complexities in measuring physical activity in people who move differently.

Actigraphy as a measure of physical activity for wheelchair users with spinal cord injury

Background:Research has indicated that actigraphy is valid and reliable for measuring low levels of physical activity among ambulatory individuals, and that it may be a valid indicator of energy expenditure for wheelchair users in laboratory conditions, but there are no reports of its evaluation in free-living conditions. Objective:To assess the suitability and validity of actigraphy as a measure of free-living physical activity for wheelchair users with spinal cord injury. Methods:In a methodologic descriptive correlational study, measures of physical activity by an actigraph and a self-report physical activity record were obtained for six individuals in laboratory conditions and 22 individuals in free-living conditions during a 4-day period. At the completion of the home monitoring trial, all the participants completed a questionnaire about their experience wearing the monitor and maintaining the record. Results:Mean activity counts by actigraphy during active tasks were significantly different from the counts during inactive tasks (p = .003). During home monitoring, the participants wore the monitor, on the average, 95% of the prescribed wearing time, rated it as very comfortable, and were willing to wear it again. Pearson correlation coefficients of activity counts with self-reported activity intensity varied from .30 to .77 (p < .01) for individual participants. The mean correlation across the sample was .60 (p < .01). Activity counts varied with reported activity, indicating concurrence between the two activity measurement methods. Conclusions:Actigraphy is suitable as a measurement of activity for people with spinal cord injury. This initial investigation suggests that it has concurrent validity with a self-report measure of activity intensity and frequency, as evidenced in this sample of wheelchair users in free-living conditions.

Blinding effectiveness and association of pretreatment expectations with pain improvement in a double-blind randomized controlled trial

&NA; Patient, provider, and clinical investigator expectations concerning treatments are believed to play important roles in patient response. This study examined the association of patient and research nurse/physician pretreatment expectations of pain relief with actual pain relief, the accuracy of patient and research nurse guesses about patient medication assignment, and changes in research nurse and patient pain relief expectations over the course of a randomized double‐blind trial of amitriptyline versus an active placebo for patients with chronic pain and spinal cord injuries (SCI). Patient expectations of pain relief with amitriptyline were associated significantly with actual pain decrease for patients in the amitriptyline, but not placebo, condition. Research nurse/physician expectations did not predict patient pain relief. Both patients and the research nurse were able to guess patient medication assignment at a rate significantly greater than chance. The research nurses, but not the patients’, expectations of pain relief with amitriptyline decreased significantly over the course of the study. These findings have implications for future randomized controlled trials. Fully double‐blind conditions are very difficult to achieve, and it is informative to assess patient and research clinician expectations and guesses regarding medication assignment.

Lifestyle Physical Activity for Individuals With Spinal Cord Injury: A Pilot Study

Purpose. To evaluate the acceptability and feasibility of a lifestyle physical activity program for people with spinal cord injury (SCI). Methods. Sixteen nonexercising adult volunteers with SCI participated in a single group pre-post–test of the “Be Active in Life Program” comprising stage-matched educational materials, home visit by a nurse, construction of a personal plan to increase activity, and four follow-up phone calls. Program acceptability, stage of change, barriers to health-promoting activities, abilities for health practices, health, depression, and muscle strength were rated. Physical activity was monitored using actigraphy and a self-report record. Results. Participants rated the program positively, although some preferred a structured exercise approach. Eighty-one percent of participants progressed in stage of change and 60% increased physical activity. There were significant changes in motivational barriers, exercise self-efficacy, self-rated health, and muscle strength. Discussion. Lifestyle physical activity is feasible and acceptable and could be effective in promoting greater physical activity among people with SCI.

Correlates of physical activity in adults with mobility limitations.

This study identified the correlates of objectively and subjectively measured physical activity in adult wheelchair users. Fifty participants wore an activity monitor for a week and completed a questionnaire about factors associated with physical activity. Objectively measured activity correlated significantly with body mass index. Subjectively measured activity correlated significantly with age, stage of change, health, healthcare providers discussing exercise, and social support for exercise. Research on the effect of body mass index on activity in this population is needed. Intervention planners should plan programs that place emphasis on modifying the social environment (including healthcare providers) and removing attitudinal barriers.

Measurement and description of physical activity in adult manual wheelchair users

BACKGROUND The purposes of this study were to (1) describe physical activity of adult manual wheelchair users as measured by wrist actigraphy and two self-report measures, (2) compare exercisers and nonexercisers on measures of physical activity, and (3) examine the relationships between three activity measures. METHODS Fifty manual wheelchair users wore an activity monitor and completed a physical activity record for 7 days. At the completion of this period, a questionnaire that included the Physical Activity Scale for Individuals with Physical Disabilities, stage of exercise question, and demographic and health questions was completed. RESULTS Mean daily hours spent in bed or asleep was 9.1, mean hours of light intensity activity was 12.5, mean hours of moderate intensity activity was 1.3, and mean hours of strenuous activity was 0.33. Thirty-eight percent did not report any strenuous activity, and 56% reported less than the 150 minutes weekly of moderate or strenuous activity required to meet public health guidelines. There was variability in both self-reported and objectively measured physical activity. Regular exercisers were not significantly different from nonexercisers on objective measures of physical activity. Measured physical movement was weakly correlated with recall of physical activity or exercise. CONCLUSION Many wheelchair users do not meet public health guidelines for physical activity, but they are not a homogeneous group in intensity and frequency of physical activity. Multiple measurement methods can provide insights into the nature, intensity, and duration of physical activity that is more complex due to variations in abilities and ways of moving.