Douglas J. French

Secondary Prevention of Work Disability: Community-Based Psychosocial Intervention for Musculoskeletal Disorders

Introduction: One objective of the present research was to examine the degree to which psychological risk factors could be reduced through participation in a community-based psychosocial intervention for work-related musculoskeletal disorders. A second objective was to examine whether psychosocial risk reduction had an effect on the probability of return to work. Methods: Participants were 215 Workers Compensation Board claimants with work-related musculoskeletal disorders who had been absent from work for an average of approximately 7 months (M = 28.8 weeks, range = 4–100 weeks) and were referred to a community-based multidisciplinary secondary prevention program in Nova Scotia, Canada. Results: In the current sample, 63.7% of participants returned to work within 4 weeks of treatment termination. The percentage reductions in targeted risk factors from pretreatment to posttreatment were as follows: catastrophizing (32%), depression (26%), fear of movement/re-injury (11%), and perceived disability (26%). Logistic regression indicated that elevated pretreatment scores on fear of movement and re-injury (OR = 0.58, 95% CI = 0.35–0.95) and pain severity (OR = 0.64, 95% CI = 0.43–0.96) were associated with a lower probability of return to work. A second logistic regression addressing the relation between risk factor reduction and return to work revealed that only reductions in pain catastrophizing (OR = 0.17, 95% CI = 0.07–0.46) were significant predictors of return to work. Conclusions: The results of the present study provide further evidence that risk factor reduction can impact positively on short term return to work outcomes. Significance: Outcomes of rehabilitation programs for work disability might be improved by incorporating interventions that specifically target catastrophic thinking. Community-based models of psychosocial intervention might represent a viable approach to the management of work disability associated with musculoskeletal disorders.

Fear of movement/(re)injury in chronic pain : A psychometric assessment of the original english version of the tampa scale for kinesiophobia (TSK)

Abstract The Tampa scale for kinesiophobia (TSK) was developed to measure fear of movement/(re)injury in chronic pain patients. Although studies of the Dutch adaptation of the TSK have identified fear of movement/(re)injury as an important predictor of chronic pain, pain‐related avoidance behaviour, and disability, surprisingly little data on the psychometric properties of the original English version of the TSK are available. The present study examined the reliability, construct validity and factor structure of the TSK in a sample of chronic pain patients (n = 200) presenting for an interdisciplinary functional restoration program. Consistent with prior evaluations of the Dutch version of the TSK, the present findings indicate that the English TSK possesses a high degree of internal consistency and is positively associated with related measures of fear‐avoidance beliefs, pain catastrophizing, pain‐related disability and general negative affect. The TSK was not related to individual differences in physical performance testing as assessed using standardised treadmill and lifting tasks. Confirmatory factor analyses suggest that the TSK is best characterized by a three‐factor traith method model that includes all 17 of the original scale items and takes into account the distinction between positively and negatively keyed items. The results of the present study provide important details regarding the psychometric properties of the original English version of the TSK and suggest that it may be unnecessary to remove the negatively keyed items in an attempt to improve scale validity.

EXPOSURE VERSUS COGNITIVE RESTRUCTURING IN THE TREATMENT OF PANIC DISORDER WITH AGORAPHOBIA

The aim of this study was to assess the rate of change on clinical, behavioral and cognitive variables during exposure therapy and cognitive restructuring in the treatment of panic disorder with agoraphobia. A total of 28 Ss who received a diagnosis of panic disorder with agoraphobia were randomly assigned to either of two treatment conditions: exposure therapy or cognitive restructuring. Treatment conditions were kept as distinct as possible from each other. Subjects were assessed on five occasions: pretreatment, after 5, 10, and 15 (posttreatment) sessions of treatment and at a 6-month follow-up. Analyses of outcome data revealed strong and significant time effects on all measures. However, no group x time interaction reached statistical significance, suggesting that both strategies operate at the same pace. Furthermore, power analyses suggest that any difference that might exist in the rate of improvement between exposure and cognitive restructuring in the treatment of panic disorder with agoraphobia is marginal.

The influence of acute anxiety on assessment of nociceptive flexion reflex thresholds in healthy young adults

&NA; The nociceptive flexion reflex (NFR) is a polysynaptic withdrawal reflex that occurs in response to painful stimulation. In human studies, NFR responsiveness has been used as a direct measure of nociception as well as an indirect measure of supraspinal modulation of nociceptive transmission. Previous studies have suggested that anxiety may influence NFR responding, and therefore it has been recommended that anxiety be reduced by familiarizing participants with assessment methodology prior to formal NFR assessment. The present study was designed to assess the influence of anxiety on NFR threshold. Using a repeated measures design, 40 men and women completed an NFR threshold assessment twice within session one, and twice again during a second session conducted 24 h later. Within each assessment session, state anxiety was measured at the beginning of the session and immediately following each NFR threshold assessment. Results indicated that although anxiety increased in response to NFR threshold assessment and was positively related to subjective pain reports, anxiety was not related to observed NFR threshold levels. These findings suggest that individual differences in anxiety do not significantly affect NFR threshold level determinations under standard testing conditions.

Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity and disability

We examined pericranial muscle tenderness and abnormalities in the second exteroceptive suppression period (ES2) of the temporalis muscle in chronic tension-type headache (CTTH; n = 245) utilizing a blind design and methods to standardize the elicitation and scoring of these variables. No ES2 variable differed significantly between CTTH sufferers and controls (all tests, P > 0.05). We found no evidence that CTTH sufferers with daily or near daily headaches, a mood or an anxiety disorder, or high levels of disability exhibit abnormal ES2 responses (all tests, P > 0.05). CTTH sufferers were significantly more likely than controls to exhibit pervasive tenderness in pericranial muscles examined with standardized (500 g force) manual palpation (P < 0.005). Female CTTH sufferers exhibited higher levels of pericranial muscle tenderness than male CTTH sufferers at the same level of headache activity (P < 0.0001). Elevated pericranial muscle tenderness was associated with a comorbid anxiety disorder. These findings provide further evidence of pericranial hyperalgesia in CTTH and suggest this phenomenon deserves further study. Basic research that better elucidates the biological significance of the ES2 response and the factors that influence ES2 assessments appears necessary before this measure can be of use in clinical research.

The role of home practice in the thermal biofeedback treatment of migraine headache.

The present study examined the role of home practice of hand warming in the thermal biofeedback treatment of migraine headache. Seventeen female migraine sufferers were randomly assigned to one of the following conditions: thermal biofeedback with regular home practice (HP) or thermal biofeedback without home practice (NHP). Biofeedback treatment consisted of 12 training sessions over a 6-week period, and all subjects completed 5 weeks of headache monitoring before and after treatment. Results indicated that subjects in the HP condition experienced decreases in headache activity and medication intake that were both statistically and clinically significant compared with the NHP condition. None of the outcome measures revealed significant improvement in the NHP condition. Thus, regular home practice appears to enhance the efficacy of biofeedback in the treatment of migraine.

Self-efficacy in the thermal biofeedback treatment of migraine sufferers

Despite the demonstrated efficacy of thermal biofeedback (TBF) for the treatment of migraine headaches, therapeutic mechanisms underlying this widely used therapy remain poorly understood. Previous investigations of electromyograph (EMG) biofeedback treatment of tension-type headache have suggested that reductions in headache activity may be mediated primarily by changes in perceived self-efficacy, rather than actual self-regulation ability. The present study examined perceived self-efficacy as a potential therapeutic mechanism in TBF using an experimental manipulation of perceived success. Twenty-seven females meeting International Headache Society (IHS) diagnostic criteria for migraine headache were randomly assigned to one of two TBF conditions. Subjects were shown bogus computer-generated graphs that ostensibly demonstrated that subjects displayed either superior (high success condition) or inferior (moderate success condition) hand-warming skills relative to a fictitious normative sample. Although the manipulation of perceived success produced significant group differences on measures of perceived self-efficacy, the groups did not experience significantly different reductions in headache activity or medication consumption. The present findings suggest that perceived self-efficacy, as measured in the present study, may not be a significant mediator of TBF treatment outcome.

Recent Developments in the Psychological Assessment and Management of Recurrent Headache Disorders

Most people occasionally experience but are seldom disabled by headaches. However, epidemiological studies reveal that more than 8 million females and 2 million males are disabled with some frequency by migraine headaches alone (Stewart, Lipton, Celentano, & Reed, 1992). The number of new cases of disabling headaches each year has been estimated at more than 2 million, almost 1% of the population (Goldstein & Chen, 1982). It is thus not surprising that headache is one of the most frequent complaints presented in outpatient medical settings (DeLozier & Gagnon, 1975; Leviton, 1978). Because the vast majority of patients (probably over 95%) who seek medical assistance have headaches that do not result from any identifiable structural abnormality or disease state, a large industry has arisen to develop, produce, and market headache remedies.

Treatment outcome in psychiatric inpatients: the discriminative value of self-esteem.

Self-esteem has been identified as an important clinical variable within various psychological and psychiatric conditions. Surprisingly, its prognostic and discriminative value in predicting treatment outcome has been understudied. Objective: The current study aims to assess, in an acute psychiatric setting, the comparative role of self-esteem in predicting treatment outcome in depression, anxiety, and global symptom severity, while controlling for socio-demographic variables, pre-treatment symptom severity, and personality pathology. Design: Treatment outcome was assessed with pre- and post-treatment measures. Method: A heterogeneous convenience sample of 63 psychiatric inpatients completed upon admission and discharge self-report measures of depression, anxiety, global symptom severity, and self-esteem. Results: A significant one-way repeated-measures multivariate analysis of variance (MANOVA) followed up by analyses of variance (ANOVAs) revealed significant reductions in depression (η2 = .72), anxiety (η2 = .55), and overall psychological distress (η2 = .60). Multiple regression analyses suggested that self-esteem was a significant predictor of short-term outcome in depression but not for anxiety or overall severity of psychiatric symptoms. The regression model predicting depression outcome explained 32% of the variance with only pre-treatment self-esteem contributing significantly to the prediction. Conclusions: The current study lends support to the importance of self-esteem as a pre-treatment patient variable predictive of psychiatric inpatient treatment outcome in relation with depressive symptomatology. Generalization to patient groups with specific diagnoses is limited due to the heterogeneous nature of the population sampled and the treatments provided. Implications for clinical practice and future research are discussed.

A computer program for automated scoring of exteroceptive suppression periods

Exteroceptive suppression (ES) of temporalis muscle activity has received recent attention as a method of investigating central mechanisms in the pathogenesis of chronic headache disorders. Unfortunately, the resolution of conflicting findings has been hampered by the use of different assessment and scoring methodologies across laboratories, which has limited the direct comparison of findings across studies. A computer program was developed with the goal of providing an automated and reliable method of scoring ES responses. Processing an ES response with this software provides both visual and quantitative information relating to various response parameters. Multiple levels of smoothing the raw waveform data are available, and the software offers scoring on the basis of multiple depth-of-suppression criteria. The program also generates values for a variety of ES parameters: latency, duration, area, maximum level of suppression with its corresponding time (msec), and baseline level of muscle activity. It is likely that a reliable and standardized scoring protocol would enhance comparability of ES data generated across different settings.