Philip Keeley

Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain

&NA; Psychological and social factors have been shown, separately, to predict outcome in individuals with chronic low back pain. Few previous studies, however, have integrated both psychological and social factors, using prospective study of clinic populations of low back pain patients, to identify which are the most important targets for treatment. One hundred and eight patients with chronic low back pain, newly referred to an orthopaedic outpatient clinic, completed assessments of demographic characteristics, details of back pain, measures of anxiety and depression (Hospital Anxiety and Depression Scale, HADS), fearful beliefs about pain (Fear Avoidance Beliefs Questionnaire), social stresses (Life Events and Difficulties Schedule) and physical aspects of health‐related quality of life [SF‐36 Physical Component summary Score scale (PCS)]. Six months later subjects completed the SF‐36 PCS and the number of healthcare contacts during follow‐up was recorded. Independent predictors of SF‐36 PCS at 6‐month follow‐up were duration of pain [(standardised regression coefficient (β) = −0.18, p = 0.04), HADS score (β) = −0.27, p = 0.003] and back pain related social difficulties (β = −0.42, p < 0.0005). Number of healthcare contacts over the 6 months ranged from 1 to 29, and was independently predicted by perceived cause of pain [Incident Rate Ratio (IRR) = 1.46, p = 0.03], Fear Avoidance Beliefs about work (IRR = 1.02, p = 0.009) and back pain related social difficulties (IRR = 1.16, p = 0.03). To conclude, anxiety, depression, fear avoidance beliefs relating to work and back pain related stresses predict impairment in subsequent physical health‐related quality of life and number of healthcare contacts. Interventions targeting these psychosocial variables in clinic patients may lead to improved quality of life and healthcare costs.

The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study)

Summary Amongst the oldest old, severe back pain (but not back pain overall) is most common, and primary care consultation is more likely to result in pharmacological‐only management. ABSTRACT The aim of the current study was to determine: the prevalence of low back pain (LBP) and associated disability; the frequency of consultation to general practice; whether there were differences in management by age. We conducted a cross‐sectional population study in Aberdeen city and Cheshire County, UK. Participants were 15,272 persons aged 25 years and older. The 1‐month period prevalence of LBP was 28.5%. It peaked at age 41–50 years, but at ages over 80 years was reported by 1 in 4 persons. Older persons were more likely to consult, and the prevalence of severe LBP continued to increase with age. Management by general practitioners differed by age of the patient. Older persons (>70 vs ⩽40 years) were more likely to only have been prescribed painkillers (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.28–2.35) or only pain killers with other medications (OR 1.45, 95% CI 1.07–1.98). They were less likely to be prescribed physiotherapy or exercise (OR 0.63, 95% CI 0.46–0.85) or to be referred to a specialist (OR 0.77, 95% CI 0.57–1.04). Older persons were more likely to have previously received exercise therapy for pain, were less likely to be enthusiastic about receiving it now (P < 0.0001), and were less likely to think it would result in improved symptoms (P < 0.0001). It is important that older persons, who have the highest prevalence of LBP with disability and are most likely to consult, are receiving optimal pharmacological and nonpharmacological management.

Strain in nursing care of people with dementia: Nurses' experience in Australia, Sweden and United Kingdom.

Objectives: The aim of this study was to explore nurses’ experience of strain in dementia care. Method: Focus groups were held with 35 nurses in Sweden, Australia and UK, who care for people with dementia. The discussions were tape-recorded and analysed using qualitative content analysis. Results: The nurses described the complexity of their situation and referred to environmental factors such as ‘the system’, community attitudes, other staff, residents’ family members and also their own family. With regard to caring for people with dementia, three main sources of strain could be identified: Being unable to reach; Trying to protect; and Having to balance competing needs. Conclusion: The nurses’ experience could be understood as a desire to do the best for the people in their care by trying to alleviate their suffering and enhance their quality of life. When they did not have the resources, opportunity or ability to do this, it caused strain.

Modest Association of Joint Hypermobility With Disabling and Limiting Musculoskeletal Pain: Results From a Large‐Scale General Population–Based Survey

To determine the population prevalence of joint hypermobility (JH) and to test the hypothesis that JH would be associated with reporting musculoskeletal pain.

Pitfalls, perils and payments: Service user, carers and teaching staff perceptions of the barriers to involvement in nursing education

BACKGROUND There is an impetus to involve service users and carers in the education of nurses and a general consensus in the literature about the benefits that this brings to all involved. Whilst these benefits are well rehearsed in the literature there is little written about the potential barriers to service user and carer involvement in nurse education. OBJECTIVE The objective of this study was to investigate service users, carers and staff views on the potential barriers to becoming engaged in nurse education. DESIGN A qualitative study using focus group discussions (FGD) was used to canvas the views of service users, carers and teaching staff. SETTING A large school of nursing in the North West of England. PARTICIPANTS 38 service users and carers recruited from the North West of England and 23 nursing and midwifery teachers and lecturers. METHODS Focus group discussions were employed as the main data collection method. The data were analysed using thematic analysis. RESULTS Six themes occurred in the data as being negatively associated with potential and actual involvement: not knowing the context of the group, lack of preparation of the group, not being supported, not being allowed to be real, not receiving feedback, not being paid appropriately. CONCLUSIONS The process of involvement is not without difficulties. These data show that some consideration needs to be given to the potential barriers to involvement if the engagement of service users and carers is to be effective.

Development and pilot investigation of behavioral activation for negative symptoms

Negative symptoms cause functional impairment and impede recovery from psychosis, not least, because of limited developments in empirically validated treatments. This article details a pilot evaluation of a behavioral activation (BA) treatment with eight people presenting with psychosis and marked negative symptoms. The rationale for this development was that BA is effective in treating depression, a condition that shares overlapping features with negative symptoms. Results provide preliminary support for feasibility and effectiveness of BA for negative symptoms in terms of treatment adherence, retention, and initial outcomes. However, additional advantages may accrue from revisions to the BA treatment.

Young People's Preferences for Emotional Well-Being Support in High School—A Focus Group Study

PROBLEM Schools have been identified as a suitable setting for the delivery of emotional well-being (EWB) support, but in the United Kingdom there is little empirical evidence from young people that can inform the development of appropriate school-based interventions. METHODS Fifty-four students (11-16 years) from three U.K. high schools discussed the content, delivery, and evaluation of acceptable, school-based, EWB support. Focus group methods were matched to the school setting and sensitive topic. FINDINGS Participants identified emotional difficulties in school, home, and with peer relationships. They said that some problems were too sensitive for them to seek help in school setting. They valued confidentiality, support, and effective help that were offered by people they experienced as friendly, trustworthy, and skilled. Teachers and peer mentors were not thought to fit these criteria, although trusted adults in mentor roles could meet their criteria. Participants recognized that they could hide their emotions, so their EWB would be difficult to assess. They described how the effect of emotional distress on their behavior is idiosyncratic, and therefore their EWB should not be judged simply on their behavior. CONCLUSION The way in which EWB support is delivered in school is an important aspect of the role of practitioners and educators attempting to provide it. Because young people are sensitive to the personal qualities and skills of people offering them help, programs to train school staff in emotional support roles are important to ensure trust and an environment open to students seeking assistance. Interventions for school-based EWB support need to consider subjective well-being as well as behavioral change.

Clinician views of referring people with negative symptoms to outcome research: A questionnaire survey

This paper reports on a survey of mental health clinician views of including people with psychosis and negative symptoms in outcome research. A questionnaire was forwarded to clinicians (the majority of whom were mental health nurses) completing post-registration undergraduate and postgraduate degree courses in psychosocial interventions for psychosis. Fifty questionnaires were returned (a response rate of 84.7%). A total of 47% of respondents indicated that they might refrain from offering this group as potential participants to clinical trials. Thematic analysis suggests views that negative symptoms are not amenable to treatment inform such decisions. The results highlight the potential difficulties faced by researchers investigating new treatments for people with negative symptoms, and suggest further exploration of clinician views of referring this group to research and psychosocial treatments is warranted.

Evaluation of an Online Study Skills Course.

This article describes the evaluation of an online study skills course unit designed, using evidence-based principles, to support undergraduate students. A mixed-methods approach was employed to establish the extent to which the unit was (a) fit for purpose and (b) effective. Data were obtained from an online survey (n = 63) conducted on entry to the unit and on exit several months later and from face-to-face interviews with students (n = 12). Moderate to large positive and statistically significant changes between entry and exit measures of student knowledge and confidence in a variety of study-related skills were identified in the survey data. Positive data regarding confidence were also evident in the interview data, which further revealed that, although the unit was generally seen as fit for purpose, there were some issues regarding feedback to students and the supporting face-to-face tutorials that were provided. The literature would benefit from larger-scale and more robustly designed research in this area.

Assessing parenting capacity: are mental health nurses prepared for this role?

Mental health nurses in the UK are involved in the assessment of the parenting capacity of mothers with a serious mental illness in psychiatric facilities. There is evidence that child and family social workers, as the frontline professionals in safeguarding children, rely heavily on the mental health parenting assessment. Parenting assessments have potentially major implications for mother and baby and can lead to the separation of mother and baby. However, there is little or no provision for mental health nurses to undertake this role. In the UK, as in many other countries, there is currently no data as to which psychiatric facilities are conducting parenting assessments nor about the quality of the assessment. There are significant tensions for mental health nurses undertaking parenting assessments and there is no specific training for the role. This paper challenges existing practice, highlights the need for an audit of the current services and recommends the development of a recognized training programme.