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H D Basler

Publications and source records attributed to H D Basler.

At least 19 recordsLinked to original sources
PubMed2003

[Comorbidity, multiple medication, and well-being in elderly patients with chronic pain].

Consecutive patients with a minimum age of 65 years and at least one additional diagnosis participated in a standardized interview during the initial assessments in two geriatric hospitals ( n=86), a multidisciplinary pain center ( n=60), and three primary care practices ( n=117). The average age of the total sample was 76.29 years (SD=7.40); females constituted 73.3% of the sample. The average number of drugs consumed by the patients amounted to 7.31 (SD=2.66) with a maximum number of 19 drugs. Nearly three-quarters of the patients indicated a reduction in their pain by avoiding physical activity. Every second patient often felt depressed and without energy. The most frequent symptoms were a dry mouth, sleep disorders, fatigue, constipation, and dizziness. Patients from the geriatric hospitals were older and better educated, reported fewer painful body regions, indicated lower intensity and duration of pain as well as a lower number of pain medications. On the other hand, they were characterized by a higher intensity of comorbidity and by increased functional impairment. Patients from the pain clinic suffered more frequently from pain in the hip and the pelvis. They took stage I analgesics more often and admitted more frequently to adjusting the drug consumption to changes in well-being and situational factors. They felt the highest amount of impairment in their social activities. Nevertheless, they expressed the highest confidence in future improvement.

Aged↗
PubMed2002

[Deficits in the psychological care of low back pain patients--Comments on the expertise of the expert committee for the health care system regarding low back pain].

A committee of health specialists examined the demand characteristics and efficiency of German health care services and published an expertise on the misallocation of services that among other subjects also covered the area of low back pain. Although we agree with their principal statements, we like to underscore that the objectives mentioned in the report cannot be achieved without the participation of psychologists. The process of chronicity is determined in a significant way by psychological mechanisms. Psychologists investigated these mechanisms, developed interventions for the prevention and treatment of low back pain on the basis of the results, and tested their efficacy in trials with a high methodological standard. Incorporation of psychological expertise does not only optimise prevention and treatment of low back pain and helps to prevent unnecessary suffering of the afflicted, in addition, it offers a contribution a cost containment.

Delivery of Health Care↗
PubMed2002

[Results of early mobilisation of acute whiplash injuries].

BACKGROUND: Diagnostic evaluation and therapeutic management of acute neck pain after whiplash is a frequent but unsolved clinical problem. Long-lasting symptoms and disability are common. Former studies proposed beneficial effects of physiotherapy in the early management of whiplash injury. The purpose of this study was to assess the effects of early active mobilization versus standard treatment with a soft cervical collar. METHODS: Between August 1997 and February 2000 a prospective randomized clinical trial with a total of 168 patients was performed. Of these patients 81 (31 male, 50 female; average age 28,78 years) were randomly assigned to the standard therapy group, which received a soft cervical collar, and 87 (31 male, 56 female; average age 29,62 years) to the early mobilization group, treated by physiotherapy. Study participants documented pain and disability twice (baseline and six week follow-up) during a one week period by diary, using numeric rating scales ranging from 0 to 10. RESULTS: The initial mean pain intensity (4,75) reported by the standard therapy group was similar to disability (4,76). There were no significant differences to initial pain (4,50) and disability (4,39) reported by the early mobilization group. The mean pain intensity reported by the standard therapy group after 6 weeks was 2,66 and disability was 2,40. The mean pain intensity indicated by physiotherapy group was 1,44 and mean disability was 1,29. The differences between the groups were both significant. CONCLUSIONS: Early mobilization is superior to the standard therapy regarding pain intensity and disability. We conclude that mobilization should be recommended as the new adequate standard-therapy in the acute management of whiplash injury.

Adult↗
PubMed2001

[A structured pain interview for geriatric patients].

BACKGROUND: In old age, assessment of pain often is hampered by sensory and cognitive deficits that do not allow the patients to fill in standardized questionnaires without help from significant others. Therefore, as an alternative, we developed a structured pain interview, and examined its properties and acceptance in a sample of geriatric patients with pain. METHODS: The interview covers site of pain, intensity of pain, its duration and persistency, pain related disability and, finally, emotional and cognitive variables. In addition, the interviewer addresses significant others to get information about medication, previous treatment, and residence, and administers the Mini-Mental-State-Examination (MMSE). The analysis includes 128 patients of pain centers older than 74 years, of whom 80% are female. RESULTS: Forty percent of the subjects score below the critical MMSE value < or =23 indicative of cognitive impairment. These patients are responsible for 36 out of a total of 39 missing values. A significant increase of missing values is observed in patients with a MMSE score below 10. Cognitive impairment goes along with greater functional and social disability. On the other hand, cognitive impairment is unrelated to localization, intensity, and duration of pain. The memory item of the MMSE can be used as a screening tool for cognitive impairment. Patients, who are unable to recall any of the three objects, comprise 80% of the total of missing values and demonstrate a low MMSE score. CONCLUSION: As long as geriatric patients are able to communicate verbally, they are most likely to profit from the structured pain interview in spite of existing cognitive impairment. A MMSE score <10 indicates that the interpretation of the data obtained may be difficult, especially due to a high frequency of missing values.

Aged↗
PubMed2001

Readiness to adopt adequate postural habits: an application of the Transtheoretical Model in the context of back pain prevention.

Based on a biomechanical model, an adequate body posture can contribute to the prevention of back pain and back pain chronicity. This study examines the explanatory value of the Transtheoretical Model (TTM) for the adoption of adequate postural habits in a cross-sectional sample of 149 employees of a German administration unit (mean age 40.2 years, 50% female). Using newly developed instruments with satisfactory psychometric properties, basic assumptions of the TTM could be confirmed: self-efficacy and the perceived pros for maintaining a good body posture increased significantly across the stages, while the perceived cons decreased. Additionally, the use of preventive strategies for back pain prevention increased linearly and significantly across the stages of change. The study supports the applicability of the TTM for postural behavior. Considering stages of change as an intervening variable may contribute to clarifying the relationship between participation in low back schools and prevention of back pain chronicity. Longitudinal and intervention study data are needed to support these assumptions.

Adult↗
PubMed1999

[The Marburg questionnaire on habitual health findings--a study on patients with chronic pain].

BACKGROUND: Subjective well-being is an essential ingredient in the quality of life concept. The Marburg questionnaire, a seven item scale for the assessment of the trait dimension of well-being, claims to possess good psychometric properties. This is investigated in two studies with chronic pain patients. METHODS: The first study utilizing a prospective, randomized, and controlled design, served to find out the effects of a pain management program. Included were 236 patients with a diagnosis of chronic low back pain (Toronto classification) or tension type headache (IHS classification). Study 2 employed a cross-sectional design and relied on the data of 186 patients mainly with pain in the back and the head who had filled in a pain questionnaire provided by the Schmerztherapeutisches Kolloquium, a German pain society. RESULTS: Across the studies, internal consistency of the scale with Cronbach's alpha=0.91 proofed to be very satisfactory; retest-reliability after an interval of eight weeks came up to r(tt)=0.81. The scale is one dimensional and demonstrates good replicability of the dimensional structure. The factor accounts for 65% of the variance of the test scores. Moreover, the scale is sensitive to change, and, therefore, can be used as an assessment tool in interventions that aim at an improvement of well-being. Interrelations with variables indicating chronicity support the concept of construct validity. This refers to the stage algorithm provided by the pain clinic in Mainz, to the affective dimension of the pain experience, to disability, depression, and inability to work. CONCLUSION: The good psychometric quality of the questionnaire along with its brevity allows its application as part of a quality of life assessment.

English Abstract↗
PubMed1997

["Pain under discussion--stages of chronicity and treatment outcome].

PROBLEM: "Pain under Discussion" aims at the education of patients with chronic headache and back pain by applying a standardized manual with detailed instructions for seven sessions in a group setting. Apart from encouraging a reconceptualization of the patients' pain experience with reference to a bio-psycho-social model, the program provides information about the vicious circle of pain, avoidance and demoralization and relies heavily on behavioral assumptions about the process of chronicity. Patients are offered participation in progressive relaxation according to Jacobson, they learn to engage in pleasant activities, and are instructed to more and more maintain an upright body position during various activities of every day life. The study evaluates the outcome of the training. Moreover, as an algorithm for grading pain patients according to their level of chronicity has recently been developed by Gerbershagen, we use this algorithm in order to investigate the relationship between the outcome of treatment and the assigned level of chronicity. In addition, we test the assumption that a higher level of chronicity is related to a lower level of psychological functioning pre treatment. METHODS: 35 patients with a diagnosis of a chronic low back syndrome (Toronto classification) and 30 patients with a diagnosis of tension-type headache (IHS classification) have been recruited from six facilities specialized in the treatment of chronic pain patients. An average pain duration of 11 years indicates a long career as a pain patient. At the initial assessment, patients were assigned to three levels of chronicity according to the algorithm. Before and six month after completion of the program, they were asked to fill in a pain diary and well-established pain questionnaires with good psychometric properties under inclusion of pain intensity and control over pain (diary) as well as sensory and affective dimensions of pain, coping, self-instructions, disability, well-being and depression. RESULTS: Analyses of variance indicate a close relationship between a higher level of chronicity and a lower degree of psychological functioning. T-Tests for paired samples and Bonferroni correction show significant changes in the affective dimension of the pain experience, in coping styles and self-instructions, as well as in well-being, when follow-up data are compared with the initial values. This indicates a favorable outcome of the training. Analysis of covariance, on the other hand, demonstrate that the outcome does not depend on the level of chronicity at the first assessment. CONCLUSION: Irrespective of the initial pain grading of the patients the training program has proven to be effective with regard to different outcome measures.

English Abstract↗
PubMed1997

[Do questionnaires for the assessment of change really assess change?].

PROBLEM: Two methods for the assessment of change are evaluated: (1) subjects' ratings of the outcome taken after termination of the treatment, and (2) comparison of test scores taken before the beginning and after termination of the treatment. METHODS: Included in the analysis are 82 subjects with chronic headache and/or back pain who participated in psychological group treatment for pain. They were given an outcome rating scale with 15 items (ORS) after therapy in addition to pain diaries and questionnaires for the assessment of physical symptoms, mood and quality of life. Diaries and questionnaires were filled in twice, before and after therapy. RESULTS: The ORS demonstrates satisfying psychometric properties. Internal consistency is 0.94 (Cronbach's alpha) and retest reliability is 0.74. Correlations of this scale with outcome criteria based on pre-post comparisons, however, are mostly nonsignificant. Significant correlations are found when the ORS scores are related to the questionnaire scores after therapy. CONCLUSION: It is concluded that, contrary to the formulation of the items, the ORS scale does not so much assess change, but rather depicts the state of the subjects at the time the assessment is made.

English Abstract↗
PubMed1997

Incorporation of cognitive-behavioral treatment into the medical care of chronic low back patients: a controlled randomized study in German pain treatment centers.

Cognitive behavioral treatment has been incorporated into standard medical treatment procedures in German pain centers. Acceptance of the treatment by patients and outcome in terms of pain, coping, and disability was investigated. Components of the psychological treatment are education, relaxation and imagery, modifying thoughts and feelings, enhancement of pleasant activities, and training of good postural habits. The program was conducted in a group setting in accordance with a treatment manual and consists of 12 weekly 2.5-h sessions. A two-factor experiment with repeated measures on one factor was applied. Ninety-four consecutive patients with low-back pain were randomly assigned to an experimental group having a combined medical and cognitive-behavioral treatment, or to a control group with medical treatment only. Assessments were taken pre-treatment, post-treatment, and--in the treated group only--at a 6-months follow-up. At each assessment, patients kept a pain diary over a period of 4 weeks, and filled in self-report questionnaires. The sample consisted of 36 experimental and 40 control subjects at post-treatment. Experimental subjects reported less pain, better control over pain, more pleasurable activities and feelings, less avoidance and less catastrophizing. In addition, disability was reduced in terms of social roles, physical functions and mental performance. The results were maintained at follow-up. Patients who only received medical treatment showed little improvement. Data indicate that the program meets the needs of the patients and should be continued.

Adult↗
PubMed1997

Good postural habits: a pilot investigation using EMG scanning of the paraspinals.

The assumption is tested that changes from poor to good postural habits can be identified by specific patterns in paraspinal activity. Paraspinal activity is measured by using an electromyographic (EMG) scanning procedure introduced by Cram. Two samples were addressed. The first sample consists of 32 pain-free medical students. Measurements were taken twice at intervals 3 min apart in a sitting position with arms hanging at the side. The first assessment refers to a normal and relaxed, and the second assessment to an upright "physiological" position of the spine recommended by Brügger. Data indicate that changes to good postural habits are represented by a significant decrease in the activity of the cervical paraspinal area (CPS), whereas in the trapezius and the thoracic area (T1, T6), the activity of the muscles is significantly increased. The hypothesis is put forward that these changes also occur as a consequence of a preventive low back school training. The second sample consists of 26 asymptomatic female employees of a medical hospital who had previously suffered from back pain attacks, but who were without pain during the assessments. Recordings taken before and after participation in the back school at 3 months apart show a similar pattern of significant changes in paraspinal activity (CPS, T6), although their magnitude is less pronounced. No pre-post changes could be observed in the trapezius. The findings partly support the hypothesis. Further research is needed to evaluate the relationship between EMG recording and postural habits.

Adult↗
PubMed1997

Quality of life after cystectomy and urinary diversion: results of a retrospective interdisciplinary study.

PURPOSE: Now that creation of continent urinary reservoirs has become a standardized and clinically well established surgical technique with known morbidity and mortality rates, we reassessed the psychological and social aspects of this treatment compared with wet urostomy. MATERIALS AND METHODS: We developed a questionnaire (102 items) addressing general aspects of quality of life, disease related social support, coping strategies and stoma related issues. It was mailed to 600 patients with ileal conduits and 130 with continent reservoirs. Final analysis was restricted to 192 patients operated upon within the last 5 years (mean followup 2.7 years). RESULTS: The resulting groups were matched and paralleled regarding most treatment related and sociodemographic data. Final analysis did not reveal differences between the groups in disease related social support, coping strategies or quality of life when expressed as a total score. We found statistically significant superiority of continent reservoirs regarding all stoma related items, patient global self-assessment of their quality of life (single item, p < 0.005), physical strength, mental capacity, leisure time activities and social competence (p < 0.05). CONCLUSIONS: Continent diversion is clearly advantageous with respect to all items directly related to the stoma. The significant superiority of continent diversion in patient global self-assessment of their quality of life reflects the highly subjective dimension of the concept. Superiority in self-ratings of physical strength, mental capacity, leisure time activities and social competence could be interpreted as indicators of enhanced vitality in those patients, thus, supporting our understanding that women and men who actively participate in life have a special benefit from continent reservoirs.

Adolescent↗
PubMed1996

[Depressivity and successful outcome of spinal surgery].

INTRODUCTION: The relationship between depression and the outcome of low back surgery was investigated. Data analysis was based on two assumptions: (1) Presurgical assessments of depression are correlated with the outcome of surgery, and, therefore, depression can be interpreted as a risk factor for surgical failure. (2) Postsurgical assessments of depression are correlated with the outcome of surgery, and therefore, depression can be interpreted as a response to treatment failure. METHODS: The sample was made up of 78 patients who had undergone lumbar nucleotomy and 132 patients with lumbar spondylodesis. Treatment outcome was evaluated 6 months after surgery in the nucleotomy group and 9 months after surgery in the spondylodesis group. Depression was assessed with the Beck Depression Inventory (BDI). Measures of treatment outcome were an objective rating system for the surgical result, functional impairment, return to work, subjective estimations of the patient, and pain intensity. RESULTS: Presurgical depression scores showed no significant relationship with surgical outcome in nucleotomy patients. In spondylodesis patients, however, there was a significant negative correlation with the patients' subjective outcome ratings. Postsurgical depression scores, on the other hand, were significantly related to almost all of the outcome variables in both treatment groups. Patients with clinically relevant postsurgical depression scores were significantly more likely not to benefit sufficiently from surgery than those with clinically not relevant depression scores. DISCUSSION: Our findings favour assumption 2 over assumption. 1. In the light of our findings, depressiveness is interpreted as a response to a non-beneficial outcome of surgery. The need for an interdisciplinary approach combining psychological counseling or treatment and physical therapy for those patients who do not benefit from surgery is discussed.

English Abstract↗
PubMed1996

[Psychological research on pain in Western Europe].

Utilizing MEDLINE and PSYCLIT, a search for articles covering psychological research on pain in the Western European countries was undertaken for the period from 1 January 1990 to 31 December 1994. A total of 398 publications were identified, of which 44 were classified as experimental research in the laboratory, 33 as psychodiagnostic and 225 as clinical studies. The most frequent diagnosis was back pain, followed by musculoskeletal pain and headache. With regard to the total number of publications, Germany was first, followed by The Netherlands and Great Britain. In an analysis of the subcategories, the leading position of Germany could only be confirmed with respect to laboratory studies; in psychodiagnostic publications, Germany fell back behind Great Britain and The Netherlands. In clinical studies, Germany was second to Sweden. Relating the number of publications to the number of personnel estimated to be engaged in research, The Netherlands and the Scandinavian countries demonstrate very high efficiency. Compared with Germany, these countries facilitate the integration of psychological procedures into an interdisciplinary management of pain.

English Abstract↗
PubMed1995

Patient education with reference to the process of behavioral change.

From a traditional aspect, behavioral change is conceptualized as a shift from one stable state to another, from stable unhealthy behavior to stable healthier behavior. This approach will influence the type of intervention program to be adopted as well as the type of assessment instrument applied. A concept supported by the results of studies involving a large number of subjects, which enable the natural process of behavioral change to be observed, suggests that behavioral change is a non-stable condition with distinct stages called precontemplation, contemplation, action, and maintenance. There may be relapse at any stage and this should be interpreted as a natural part of the change process. Health educators are confronted with different tasks at each level, and by addressing these tasks and tailoring the intervention programs to suit the stage of the individual subject, better support during the process of change can be given. A project involving cooperations between university institutes and the pharmaceutical industry has developed and evaluated education programs which address different stages of change in a primary care setting. Action-oriented programs for the prevention of coronary disease, sleep disturbance, and chronic pain have proven to be effective. Target behaviors are smoking, stress management, nutrition, and physical exercising. These programs have recently been complimented by others addressing precontemplation and contemplation stage subjects. Further research will have to be carried out in order to find assessment instruments designed to assign the right program to the right person.

Health Behavior↗
PubMed1994

[Chronification process of backache].

The high economical costs produced by the impact of low back pain on sick-listing and loss of manpower at work encouraged the search for personal or situational characteristics that indicate an increased risk for an acute onset of back pain or for its continuation towards chronicity. Risk factors for the onset of acute pain identified at the workplace refer to mechanical and psychomental strain. Vibration as well as lifting and carrying of heavy loads, especially if combined with a twisting of the trunk, are the most prominent mechanical risks, whereas dissatisfaction with the job or the working conditions, especially if there is a lack of social support either at the workplace or at home by the family or the spouse, increase the risk on a psychosocial level. Although these risks continue to be effective in the process of chronicity, other risks pertaining to behavioral and emotional reactions to the acute pain episode gain in importance. At the acute level, avoidance of physical and social activities are often encouraged by physicians who prescribe bed rest or give advice to regulate the active reinvolvement in daily life by assessing pain levels ('let the pain guide'). On the other hand, with regard to the prevention of chronicity, a strategy of graded early activation aiming at a reinforcement of healthy behaviors has more beneficial effects. After a short period of bed rest, no longer than two days, if at all necessary, patients are taught to maintain their daily activities and to practice specified exercises, while receiving time-contingent pain medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Back Pain↗
PubMed1993

Group treatment for pain and discomfort.

Rheumatic patients very often suffer from chronic pain and impairment and show psychological reactions as a consequence of their physical condition. These reactions may vary from psychophysiological symptoms to anger, anxiety, or depression. We developed a cognitive-behavioral treatment programme in a group setting format with components of relaxation, cognitive restructuring, and the promotion of well-being. Subjects included in the study were given diagnoses of low back pain, tension headache, rheumatoid arthritis, and ankylosing spondylitis. Treatment effects in different diagnostic groups were compared to each other, supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis. Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being.

Arthritis, Rheumatoid↗