Elena Dragioti

Disclosure of researcher allegiance in meta-analyses and randomised controlled trials of psychotherapy: a systematic appraisal.

Objective Psychotherapy research may suffer from factors such as a researcher’s own therapy allegiance. The aim of this study was to evaluate if researcher allegiance (RA) was reported in meta-analyses and randomised controlled trials (RCTs) of psychotherapeutic treatments. Design Systematic approach using meta-analyses of different types of psychotherapies. Data sources Medline, PsycINFO and Cochrane Database of Systematic Reviews. Methods We evaluated meta-analyses of RCTs regarding various types of psychotherapies. Meta-analyses were eligible if they included at least one RCT with RA and they were published in journals in Medline, PsycINFO and Cochrane Database of Systematic Reviews with an impact factor larger than 5. Results We identified 146 eligible meta-analyses that synthesised data from a total of 1198 unique RCTs. Only 25 of the meta-analyses (17.2%) reported allegiance and only 6 (4.1%) used a proper method to control its effect. Of the 1198 eligible primary RCTs, 793 (66.3%) were allegiant. Authors in 25 of these 793 RCTs (3.2%) reported their allegiance while only one study (0.2%) controlled for its effect. Conclusions The vast majority among a group of published meta-analyses and RCTs of psychotherapeutic treatments seldom reported and evaluated the allegiance effect. The results of the present study highlight a major lack of this information in meta-analyses and their included studies, though meta-analyses perform slightly better than RCTs. Stringent guidelines should be adopted by journals in order to improve reporting and attenuate possible effects of RA in future research.

Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials

To map and evaluate the evidence across meta‐analyses of randomized controlled trials (RCTs) of psychotherapies for various outcomes.

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

Background and objective There is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects ≥65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7) living in southeastern Sweden. Methods Sex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP) (24.1%), regional pain medium (RP-Medium) (20.3%), regional pain heavy (RP-Heavy) (5.2%), and widespread pain (WSP) (1.7%). Results RP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all p<0.01). RP-Heavy was less likely in the 80–84 and >85 age groups compared to the 65–69 age group (both p<0.01). Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all p<0.001). An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all p<0.01). Depressive disorders were associated with all pain categories, except for LP (all p<0.05). Disorders of the central nervous system were associated with both RP-Heavy and WSP (all p<0.05). Medication for peripheral vascular disorders was associated with RP-Medium (p<0.05), and hypnotics were associated with RP-Heavy (p<0.01). Conclusion More than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain spread from LP to RP-Medium, RP-Heavy, and WSP. Effective management plans should consider these observed associations to improve functional deficiency and decrease spreading of pain-related disability in older adults.

The Swedish version of the Insomnia Severity Index: Factor structure analysis and psychometric properties in chronic pain patients

Abstract Objective Insomnia is the most commonly diagnosed comorbidity disorder among patients with chronic pain. This circumstance requests brief and valid instruments for screening insomnia in epidemiological studies. The main object of this study was to assess the psychometric properties and factor structure of the Swedish version of the Insomnia Severity Index (ISI). The ISI is a short instrument designed to measure clinical insomnia and one of the most common used scales both in clinical and research practice. However there is no study in Sweden that guarantees neither its factor structure nor its feasibility in chronic pain patients. We further examined the measurement invariance property of the ISI across the two sexes. Methods The ISI was administered to 836 (269 men and 567 women) chronic pain patients from the Swedish Quality Registry for Pain Rehabilitation. This study used demographic data, the Hospital Anxiety and Depression Scale (HADS), the Mental Summary Component (MSC) of the Health Survey (SF-36) and the item 7 from Multidimensional Pain Inventory (MPI). The sample was divided into two random halves: exploratory factor analysis (EFA) was performed in the first sample (N1 = 334, 40%) and confirmatory factor analysis (CFA) in the second half of the sample (N2 = 502, 60%). The measurement and structural invariance of the proposed structure (4-item version) between the two sexes as well as reliability and validity indexes were further assessed. Results Exploratory factor analysis using the principal axis factoring method generated one global factor structure for the ISI, explaining 63.1% of the total variance. The one factor solution was stable between the two sexes. Principal component analysis was also applied and indicated almost identical results. The structure was further assessed by CFA, resulting in an adequate fit only after omitting three items. The difference on structural and measurement invariance in the loadings by participants’ sex was not significant (Δχ2 = 10.6; df = 3; p = .69 and Δχ2 = 2.86; df = 3; p = 41 respectively). The shorter version four-item Insomnia Severity Index (ISI-4) was analysed further. The Chronbach’s alpha for the global ISI-4 score was 0.88. The construct validity of the ISI-4 was also supported by the, Hospital Anxiety and Depression Scale, the Mental Summary Component of quality of life and quality of sleep data. Pain intensity was significantly associated with the ISI-4 score (beta = .29, p < 001) whereas no significant correlation between four-item Insomnia Severity Index score and age was observed (p > 05). Conclusions and implications Although short, the four-item Insomnia Severity Index (ISI-4) version seemed to effectively assess insomnia in chronic pain patients. An important clinical implication is that the four-item Swedish Insomnia Severity Index can be used in chronic pain cohorts when screening for insomnia problems. Its measurement and structural invariance property across the two sexes shows that the ISI-4 is a valid measure of the insomnia across groups of chronic patients. Our results also suggest its utility both in pain clinical practice and research purposes.

Spreading of pain and insomnia in patients with chronic pain: results from a national quality registry (SQRP).

OBJECTIVE To explore how demographics, pain, psychosocial factors and insomnia relate to the spread of chronic pain. METHODS The study included 708 patients (68% women; median age 46 years; interquartile range 35-57 years) with chronic pain who were referred to a multidisciplinary pain centre. Spreading of pain was assessed using a questionnaire covering 36 anatomically predefined pain regions. Data were collected on demographics, pain symptoms, psychological distress, and insomnia (Insomnia Severity Index). Four sub-categories of chronic pain were established: chronic local pain, chronic regional pain medium, chronic regional pain heavy, and chronic widespread pain. RESULTS The median number of pain regions was 10 (interquartile range 6-18). Prevalence of chronic pain was as follows: chronic local pain 9%, chronic regional pain medium 21%, chronic regional pain heavy 39%, and chronic widespread pain 31%. In the regression models, being a woman and persistent pain duration had the strongest associations with spreading of pain, but anxiety, pain interference, and insomnia were also important factors. CONCLUSION Spreading of chronic pain can only partly be explained by the simultaneous levels of insomnia. Female sex, pain duration, pain interference and anxiety appear to have more significant relationships with the spread of pain. Targeting these factors may lead to improvements in treatment and prevention strategies.

An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction

BackgroundPsychological interventions are widely implemented for pain management and treatment, but their reported effectiveness shows considerable variation and there is elevated likelihood for bias.MethodsWe summarized the strength of evidence and extent of potential biases in the published literature of psychological interventions for pain treatment using a range of criteria, including the statistical significance of the random effects summary estimate and of the largest study of each meta-analysis, number of participants, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance bias.ResultsThirty-eight publications were identified, investigating 150 associations between several psychological interventions and 29 different types of pain. Of the 141 associations based on only randomized controlled trials, none presented strong or highly suggestive evidence by satisfying all the aforementioned criteria. The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence.ConclusionsThe present findings reveal the lack of strong supporting empirical evidence for the effectiveness of psychological treatments for pain management and highlight the need to further evaluate the established approach of psychological interventions to ameliorate pain.

EPA-0834 – Documentation of therapeutic investigator allegiance in meta-analyses of randomised controlled trials

Introduction Investigators allegiance is widely discussed as a risk of bias in psychotherapy research. Objective To sum up the best available data concerning allegiance effect. Aim We systematically investigated whether meta-analyses and their included randomised controlled trials (RCTs) of psychotherapeutic treatments were reported and assessed allegiance effect. Method We searched meta-analyses of RCTs of various types of psychotherapies in Medline from 1977 to 2012 and the Cochrane Database of Systematic Reviews (Last update on December 2012). We considered only meta-analyses of RCTs with at least 1 study with allegiance of the experimenter published in journals with impact factor higher than 5 and in Cochrane Database. Results Of 146 meta-analyses reviewed which included 2727 RCTs, only 15 meta-analyses (10.3%) reported RCTs allegiance. Of 1198 metaanalyzed RCTs only 1 (0.1%) was controlled for allegiance and 25 of 1198 (2.8%) were reported allegiance. In all meta-analyses reviewed, 66.2% of primary included RCTs were allegiant studies. Even we found a median of 10 [interquantile range (IQR) 7–15] allegiance RCTs per metaanalysis, only 6 (4.3%) of them used a method to controlling its effects. Conclusions The majority of meta-analyses of psychological interventions published in high-impact specialty psychiatric/psychological, general medical journals as well as Cochrane Database was rarely reported and evaluated allegiance effect. The results of the present study highlight a major gap in this information in meta-analyses of psychotherapeutic interventions.

Association of insomnia severity with well-being, quality of life and health care costs: A cross-sectional study in older adults with chronic pain (PainS65+)

Insomnia is one of the most common complaints in chronic pain. This study aimed to evaluate the association of insomnia with well‐being, quality of life and health care costs.

Quality of life during early radiotherapy in patients with head and neck cancer and pain

Background Patients with head and neck cancer (HNC) have a potentially severe diagnosis and often suffer from tumor-related pain as well as from adverse side effects of treatment such as radiotherapy (RT). Knowledge about quality of life (QoL) during early RT in this group is limited and should be assessed in relation to diagnosis and treatment. Purpose The purpose of this cross-sectional study was to identify potential factors that may influence QoL in patients with HNC during the early stages of RT (no later than two weeks of ongoing RT). We hypothesized that pain intensity, pain interference, catastrophizing, and mood disturbances are associated with QoL during early RT. Patients and methods In this study, 54 patients (53% of eligible patients) diagnosed with HNC were consecutively recruited from the regular flow to the Pain and Rehabilitation Center at Linköping University. The patients completed self-reported questionnaires on sociodemographics, pain intensity, pain interference, anxiety, depression, pain catastrophizing, and QoL. Results The patients in this study scored high for QoL, low for pain intensity, and low for pain interference. The patients reported minor depressive symptoms and anxiety symptoms. Regression analyses showed that pain intensity and depressive symptoms negatively influenced QoL. Conclusion No later than two weeks of RT, pain intensity and depression negatively influenced QoL in patients with HNC. Early screening for pain and depression in a targeted preventive strategy might maintain QoL during the course of the RT for patients with HNC. This assumption needs to be further investigated.

Internet Use Among Patients with Psychotic Disorder

Introduction Our knowledge about the effect of internet use on patients with psychotic disorder has not been fully investigated. Objectives The main objective was to investigate the psychological characteristics associated with Internet use in chronically mentally ill, compared to the general population. Aims To explore the levelsof internet use in patients with psychosis and their association with self-esteemand interpersonal relationships. Methods The study involved 101 participants of which 30 were psychotic outpatients (meanage 39 years, SD = 11) and 71 (mean age 34 years, SD = 8) from the generalpopulation. Participants filled out a questionnaire of a) social-demographicand clinical parameters b) Diagnostic criteria Youngs Internet addiction, c) Internet Addiction Test (IAT) questionnaire for the diagnosis of Internet addiction, d) The Scale in Interpersonal Relationships (ECRI) and e) The Greek version of Self-esteem Questionnaire (SES, Self-Esteem Scale). Results We found significant statistical differences in terms of internetaddiction (Youngs diagnostic criteria: 5/25 vs 6/65, p Conclusions Our results found that a psychotic patient with difficulty ininterpersonal relationships and with low self-esteem is more likely to adopt an addictive behavior in the use of internet in comparison to the general population.