Patricia H. Rosenberger

Psychosocial factors and surgical outcomes: an evidence-based literature review.

Abstract The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty‐nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.

Correlates of body image dissatisfaction in extremely obese female bariatric surgery candidates

Background: This study investigated correlates of body image dissatisfaction in 131 extremely obese female bariatric surgery candidates. Methods: Female gastric bypass surgery candidates participating in a comprehensive psychiatric evaluation completed a battery of established self-report measures of body image and psychosocial functioning. Nine predictors of body image dissatisfaction were considered: body mass index (BMI), ethnicity, childhood onset of obesity, childhood teasing about weight, binge eating, depression, self-esteem, shame, and perfectionism. Results: Stepwise multiple regression analysis revealed that the nine variables jointly accounted for 48% of the variance; three variables, depression, self-esteem and perfectionism, made significant independent contributions. Conclusion: Our findings highlight the importance of adult psychological functioning (depression, self-esteem and perfectionism) for predicting body image dissatisfaction in extremely obese female bariatric surgery candidates.

Can we improve cognitive-behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy

OBJECTIVE This study evaluated whether tailored cognitive-behavioral therapy (TCBT) that incorporated preferences for learning specific cognitive and/or behavioral skills and used motivational enhancement strategies would improve treatment engagement and participation compared with standard CBT (SCBT). We hypothesized that participants receiving TCBT would show a lower dropout rate, attend more sessions, and report more frequent intersession pain coping skill practice than those receiving SCBT. We also hypothesized that indices of engagement and adherence would correlate with pre- to posttreatment changes in outcome factors. METHOD One hundred twenty-eight of 161 consenting persons with chronic back pain who completed baseline measures were allocated to either TCBT or SCBT using a modified randomization procedure. Participants completed daily ratings of pain coping skill practice and goal accomplishment during treatment, as well as measures of pain severity, disability, and other key outcomes at the end of treatment. RESULTS No significant differences between treatment groups were noted on measures of treatment engagement or adherence. However, these factors were significantly related to some pre- to posttreatment improvements in outcomes, regardless of treatment condition. CONCLUSIONS Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes.

Physical Activity in Gastric Bypass Patients: Associations with Weight Loss and Psychosocial Functioning at 12-Month Follow-Up

BackgroundThis study examined self-reported frequency and intensity of physical activity in gastric bypass patients, and the relationship between physical activity and weight loss and psychosocial outcomes during 12-month postoperative follow-up.MethodsParticipants were 131 obese patients who underwent gastric bypass surgery and completed psychometrically established measures assessing physical activity, depression, and physical and mental health preoperatively and at a 12-month follow-up assessment.ResultsPreoperatively, 62.6% of patients reported at least one episode of a minimum of 15 minutes of physical activity per week. This figure increased to 92.4% at 12-month postoperative follow-up. Both the frequency and intensity levels of physical activity episodes increased significantly from preoperative to 12-month postoperative assessments. Hierarchical regression analyses, controlling for demographic variables and preoperative body mass index (BMI), revealed that the intensity of physical activity was significantly associated with postoperative weight loss at 12-month follow-up. Both the frequency and intensity of physical activity were significantly associated with depression, and physical and mental well-being at the 12-month postoperative follow-up.ConclusionGastric bypass patients increase both the frequency and intensity of their physical activity during the first 12 months postoperatively. Higher postoperative intensity levels of physical activity are associated with better weight loss outcomes while both increased frequency and intensity levels of physical activity are associated with better psychosocial outcomes.

Physical recovery in Arthroscopic knee surgery: unique contributions of coping behaviors to clinical outcomes and stress reactivity

Few studies have examined whether certain coping behaviors are associated with physical outcomes following surgery. This prospective, longitudinal study investigated the effect of active and avoidant coping behaviors on two physical outcomes over time, pain and knee function, in a group of patients experiencing knee arthroscopic surgery (n = 81). Structured interviews and physician clinical assessments were conducted preoperatively and at 3 and 24 weeks postoperatively. Coping behavior was assessed during the preoperative interview, and patients were divided into high and low avoidant and active coping groups. Using repeated measures MANCOVA/ANCOVA, avoidant coping was significantly associated with knee pain and active coping was associated with knee function. Serum cortisol levels were available for a patient subset (n = 16); higher cortisol was related to both avoidant coping and poorer functioning during early recovery. Results suggest that these divergent coping behaviors are differentially associated with stress reactivity and physical outcomes in healthy patients undergoing minor knee surgery.

Implementation of the Veterans Health Administration National Pain Management Strategy

ABSTRACTSince its introduction in 1998, the VHA National Pain Management Strategy has introduced and implemented a series of plans for promoting systems improvements in pain care. We present the milestones of VHA efforts in pain management as reflected by the work of the Strategy. This includes the development of the Strategy and its current structure as well as a review of important initiatives such as “pain as the fifth vital sign” and the stepped care model of pain management.

Psychosocial factors associated with binge eating among overweight and obese male veterans

The studys primary objective is to compare psychosocial characteristics of overweight/obese male Veterans who report binge eating with those who do not report binge eating. Participants include 111 overweight/obese male Veterans who completed questionnaires assessing binge eating, depression, stress, body image, self-efficacy for healthy eating and physical activity, and barriers to physical activity. Of the study sample, 25.2% are classified as binge eaters. Binge eating status is not significantly associated with age, race/ethnicity, weight, or BMI. Binge eating is associated with higher scores on measures of depression, barriers to exercise, self-classified weight, and lower self-efficacy for both healthy eating and exercise, but is not associated with body satisfaction or recent stress. Findings suggest that a sizable minority of overweight/obese male Veterans engage in binge eating. Depressive symptoms, self-efficacy, and perceived barriers all significantly predicted binge eating. These findings have implications both for identification of overweight/obese men at risk for binge eating disorder as well as for weight loss treatment in the Veteran population.

The Moderating Effect of Obesity on Cognitive-Behavioral Pain Treatment Outcomes

OBJECTIVE To assess the effects of body mass index on cognitive-behavioral pain treatment outcomes for chronic low back pain. DESIGN Retrospective analyses of data from a clinical trial were performed, with body mass index used to divide patients into obese and non-obese groups for comparison. SETTING VA medical center outpatient clinic. PATIENTS Veterans (N = 74) receiving outpatient care through the VA. INTERVENTIONS Delivery of a 10-week cognitive-behavioral pain treatment intervention. OUTCOME MEASURES The Numerical Rating Scale (pain intensity), Roland Morris Disability Questionnaire (disability), Veterans SF-36 (health-related quality of life), and Beck Depression Inventory (emotional functioning) were administered pre- and post-treatment. RESULTS The study included 42 obese and 32 non-obese participants, most of whom were male (89%). The average body mass index was 32.44 kg/m², with average pain intensity rated as 6.59 out of 10. There were no pre-treatment differences in outcome measures between the groups. Repeated measures ANOVAs revealed main effects of Time on all but one outcome (Mental Component score), indicating that the cognitive-behavioral interventions were largely effective. However, Time-body mass index (BMI) group interactions revealed that non-obese participants showed greater improvement following treatment than did their obese counterparts on measures of disability (P < 0.05), physical aspects of quality of life (P < 0.01), and emotional functioning (P < 0.05). CONCLUSIONS Standard cognitive-behavioral pain treatment did not yield comparable outcomes for obese and non-obese participants. Results suggest a potential moderating role of BMI in low back pain outcomes. Future work with other pain conditions, including examination of potential mechanisms through which BMI impacts treatment outcomes, is recommended.

MOVE! multidisciplinary programs: Challenges and resources for weight management treatment in VHA

ABSTRACTThe MOVE! program has been a successful weight management and physical activity initiative from the Veterans Health Administration. While it embraces a multicomponent approach to weight management, local facilities have primarily focused on the implementation of delivery of MOVE! educational materials to groups or individuals. We discuss additional MOVE!-related weight management efforts within VHA that reflect treatment strategies beyond delivery of these educational materials. First, we present a case study that highlights the special challenges associated with the Veteran overweight/obese population. Second, we describe the implementation of our local, multidisciplinary, individualized weight management clinic as an example of on-the-ground provision of a higher treatment intensity program as part of MOVE!s multicomponent model. Third, we present program outcomes and consider challenges to program sustainability.