Malcolm J. Bond

Pain provocation tests for the assessment of sacroiliac joint dysfunction

A double-blind trial was carried out to determine the sensitivity and specificity of three commonly used pain provocation tests for sacroiliac joint dysfunction. The trial involved 40 patients, all of whom reported pain when they were subjected to each of the three tests. Half of the patients (20) had the symptomatic sacroiliac joint injected with 4 ml of 1% lignocaine, whereas the other 20 patients received 4 ml of normal saline to the painful joint. The level of pain produced by each of the three tests was assessed pre- and posttest injection using a visual analogue scale of 0-100. If the pain could be suppressed by 70% with injection of either normal saline or 1% lignocaine into the symptomatic sacroiliac joint under image intensification, the test was considered to be positive for pain arising from the sacroiliac joint. None of the patients receiving normal saline had their pain suppressed to any significant degree, whereas those patients receiving 1% lignocaine had their pain suppressed sufficiently for the three pain provocation tests to have a specificity of 100% for each test and a sensitivity range of 77-87%. This study indicates that the three tests, when used in combination, have a high predictive value for pain arising from the sacroiliac joint.

The measurement of dietary restraint, disinhibition and hunger: an examination of the factor structure of the Three Factor Eating Questionnaire (TFEQ)

OBJECTIVE: To conduct separate factor analyses of the Three Factor Eating Questionnaire (TFEQ-R, TFEQ-D and TFEQ-H) scales and provide initial evidence of the construct validity of the obtained solutions.DESIGN: A cross-sectional survey with a 12 month retest of a subsample of subjects.SUBJECTS: A total of 553 undergraduate university women with a mean age of 25.0 y. The retest sample comprised 64 subjects with a mean age at retest of 25.7 y.MEASUREMENTS: In addition to the TFEQ, age, body mass index (BMI), satisfaction with current weight, nutrition knowledge and current exercise level were recorded.RESULTS: Three restraint (strategic dieting behaviour, attitude to self-regulation, avoidance of fattening foods), three disinhibition (habitual susceptibility, emotional susceptibility, situational susceptibility) and two hunger constructs (internal locus for hunger, external locus for hunger) were identified. Initial evidence of the validity of these constructs was provided.CONCLUSION: The explanation of disordered eating behaviour is likely to be refined more by specific constructs, such as those presented, rather than by the more general constructs measured by the original TFEQ-R, TFEQ-D and TFEQ-H scales. Further examination of the factor structures presented is therefore encouraged.

The Adelaide Activities Profile : a measure of the life-style activities of elderly people

A new instrument for the measurement of life-style activities of the elderly is described. The Adelaide Activities Profile (AAP) was developed in response to the shortcomings of the Frenchay Activities Index. The AAP was validated on a random sample of 1799 people aged 70 years and over, living outside of institutional care. Principal components factor analysis revealed four consistent factors from which four scales were derived; these scales were named domestic chores, household maintenance, service to others, and social activities. Analyses demonstrated the construct validity of the four life-style scales by showing them to be differentially sensitive to a range of domestic, health and social circumstances. It was concluded that the distinct and meaningful clusters of activities represented by the AAP scales should have broad application as health and social indicators. (Aging Clin. Exp. Res. 7: 174–184, 1995)

Telepsychiatry: ‘tele’ yes, but what about the ‘psychiatry’?

To investigate what is lost or gained in a psychiatric evaluation when it takes place via telepsychiatry we compared the inter-rater reliability between two psychiatrists interviewing 63 subjects in an observer/interviewer split configuration in telepsychiatry and same-room settings. The measures used were the BPRS and interviewer ratings from a semi-structured interview. Patients also rated their experience. There were some clear differences between the telepsychiatry and same-room evaluations. Despite these variations, diagnoses were as reliably made by telepsychiatry. Patient acceptance of telepsychiatry was high.

Environmental stress, psychological stress and allostatic load

Abstract The mechanism by which chronic caregiving stress results in poor health is not well understood. The objective was to determine whether such a mechanism may be allostatic load, a novel concept specifying physiological systems that may suffer cumulative wear and tear following chronic stress, leading collectively to poor health. The study examines the association of allostatic load with environmental and psychological stress in the contexts of dementia caregiving and relinquishment of care, and is a 2-year longitudinal comparison of three groups: 80 new dementia spouse caregivers, 120 veteran caregivers, and 60 non-caregivers. Data comprised allostatic load markers and environmental and psychological stress measures. Cross-lagged analyses produced a statistically significant association between psychological stress and one allostatic load component (primary mediators). Psychological stress was a better predictor of primary mediators than environmental stress. Primary mediators rose with time for caregivers, but not for non-caregivers. A greater rise was evident for caregivers who had relinquished their role by the second year, although the level of psychological stress actually declined. Primary mediators are a key component of the relationship between allostatic load and prior stress. When allostatic load is treated as an outcome of stress, it is important to distinguish environmental and psychological stress.

Reducing the anxiety of children undergoing surgery: Parental presence during anaesthetic induction

Objective: The primary aim was to determine whether child anxiety could be reduced by the presence of a parent during anaesthetic induction. Secondary aims involved clarification of the effect of the timing of parental separation, the use of premedication, the seriousness of the surgical procedure, and the flow‐on effect of parental anxiety on the level of child anxiety.

The quality of life of spouse dementia caregivers: changes associated with yielding to formal care and widowhood.

The focus of the study was the effect on spouse dementia caregivers of relinquishing care. The study used a longitudinal design, in which a group of 150 dementia caregivers were interviewed 2 years apart (designated Time 1 and Time 2), with data collected from both continuing caregivers and those who had relinquished care. The aims were to determine the extent to which changes over time in quality of life differed between continuing caregivers, those who had yielded to formal care, and those who had been widowed; and to examine whether change in quality of life variables was associated with time since yielding to formal care and time since death of the spouse. Quality of life was defined in terms of health status, psychological well-being, and activity participation. All participants were interviewed in their own homes. Three groups of participants were identified at Time 2: those who continued to provide care for their spouses (n=60); those who had yielded their caregiver role by admitting their spouses to permanent residential care (n=53); and those who had admitted their spouses to permanent institutional care, but whose spouse had then died (n=37). Different patterns of quality of life changes were observed between the three groups, with both positives and negatives associated with disengagement from the caregiving role. Positive changes were particularly evident in psychological well-being and activity participation. These findings were discussed in terms of their relevance for a life transitions approach to the relinquishment of caregiving.

An examination of the factor structure of the Frenchay Activities Index

The Frenchay Activities Index (FAI) was administered to an elderly non-stroke subject group with the objective of evaluating the underlying factor structure of the index. Data analysis yielded three factors which were labelled indoor domestic chores, outdoor domestic chores, and outdoor social activities. This factor structure is compared with that previously published. It is argued that lifestyle activities should be considered within a framework which distinguishes between indoor/outdoor and work/leisure activities.

Lifestyle activities of the elderly: Composition and determinants

Recent work suggests that lifestyle can be considered using a 2 x 2 model of indoor/outdoor and work/leisure activities. This paper replicates the factor analysis of the Frenchay Activities Index (FAI) reported by Bond et al., using a group of subjects living independently in the community. Results confirmed empirically the existence of the four hypothesized dimensions of lifestyle. Further analyses demonstrated the construct validity of these dimensions by establishing their sensitivity to age, sex, domestic circumstances, and physical and cognitive status. We discuss ways in which various deficiencies in the FAI might be rectified in a revised index of activities designed to retain and clarify the four established dimensions of lifestyle. Future directions include the development of such an instrument, and its application as a rehabilitation outcome measure.

Implementation science: a role for parallel dual processing models of reasoning?

BackgroundA better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making.DiscussionParallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctors judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice.SummaryIt is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice.