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Biomedical subjects

H D Basler

Publications and source records attributed to H D Basler.

At least 37 records · Page 2Linked to original sources
PubMed1997

Does dysphoric mood really predict the outcome of lumbar surgery? Methodological pitfalls in psychological research.

This study investigates the relationship between depression and continuous pain after lumbar surgery by means of the Beck Depression Inventory (BDI). To assess the possibility that some somatic symptoms are confounded with pain, the items of the inventory were divided into a cognitive-affective and somatic subscale. Data analysis is based on two assumptions: (1) continuous pain after surgery is more closely related to the somatic subscale than to the cognitive-affective subscale of the BDI; and (2) postsurgical pain can be better predicted by the somatic than by the cognitive-affective subscale presurgery. The sample consisted of 61 patients with lumbar nucleotomy and 107 patients with lumbar spondylodesis. Treatment outcome was evaluated 6 months after surgery in the nucleotomy patients and 9 months after surgery in the spondylodesis patients. At follow-up, subjects conducted a pain diary over a period of 2 weeks. Correlational methodology was applied. Data analysis of both samples confirms the first assumption, whereas the second assumption is only partly confirmed. Only in the spondylodesis sample was pain intensity at follow-up predicted by the total BDI score. Regarding the subscales, the cognitive-affective scale, but not the somatic scale, was related to surgical outcome in this sample. The relationship between presurgical depression and pain at follow-up failed to reach statistical significance in the nucleotomy sample. It is concluded that lack of awareness of the confounding effects of somatic items in questionnaires for the assessment of mood may contribute to erroneous conclusions drawn from studies reported in the literature.

Journal Article↗
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↗
PubMed1996

Predicting subjective disability in chronic pain patients.

Subjective disability is considered as the variable that reflects the impact of chronic pain on a patient's life. This study examines the questions of which syndrome or patient characteristics determine subjective disability and whether there are differences between samples of patients with chronic headaches and low back pain. Direct pain variables and depression, pain coping strategies, and pain-related self-statements (including catastrophizing) are introduced into multivariate regression analyses as potential predictors of disability using a sample of 151 pain patients. Disability is not predicted by pain severity in patients with headaches or back pain. Psychological variables, especially coping strategies, are far more influential. Coping explains more variance in disability in the headache sample than in the chronic law hack pain group, whereas depression is more relevant for the degree of disability in the back pain sample. In this study, we present a critical analysis of possible interpretations of our results. We point to an overlap of concepts underlying some of the variables used: this overlap also considerably invalidates conclusions drawn from a multitude of studies done in this field, including the one presented. We strongly argue for a conceptual clarification, and consequently for the revision of assessment instruments, before further empirical work in this area is done.

Journal Article↗
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↗
PubMed1992

Nicotine gum assisted group therapy in smokers with an increased risk of coronary disease--evaluation in a primary care setting format.

Smoking cessation with the aid of nicotine chewing gum in a primary care setting format is reported to be more effective when additional behavioural training is introduced. We developed a standardized comprehensive treatment programme using nicotine chewing gum (Nicorette 2 mg) in conjunction with nutritional information for the prevention of weight gain, behavioural training for the promotion of self-management techniques and the prescription of a date when to quit. The programme was conducted by 11 family physicians in a group setting format with 12 weekly 90 min sessions and three booster sessions. After an introduction to the programme, each physician selected smokers with additional risk factors for coronary heart disease from the files. Experimental and control subjects were matched for age, gender, cigarette consumption and duration since smoking onset. Complete data were obtained from 86 treated and 53 control subjects. The drop-out rate among the treated subjects was 5.8%. After the 3 month follow-up, data assessment shows an abstinence rate of 63.9% in the experimental subjects, a fact verified by CO measurements. Compared to the control group, blood pressure, heart rate, cholesterol and glucose levels did not change significantly during treatment. Weight increased by 1.7 kg. After a 12 month follow-up, abstention rates decreased to 52.3%. Abstainers reported less physical complaints and increased well-being when compared to control subjects or to treatment failures at both follow-up assessments. Changes in the risk profile, apart from smoking, were not verified.

Adult↗
PubMed1991

Cognitive-behavioral therapy in patients with ankylosing spondylitis in a German self-help organization.

A cognitive-behavioral treatment program for pain control was administered to 22 subjects with a diagnosis of ankylosing spondylitis (AS) in a self-help setting of the German Rheumatism League. A sample of 17 AS subjects from the same setting served as waiting-list controls. The program consisted of training in progressive muscle relaxation, cognitive restructuring, attention related techniques and pleasant activity scheduling, and was aimed at an improvement of self-control strategies. Ratings of pain severity, anxiety, depression, psychophysiological complaints, and sleep disturbances were used to evaluate the outcome. Follow-up assessments were conducted six months post treatment. A significant interaction between treatment condition and assessment period was demonstrated. Further analyses indicate a beneficial effect of the treatment in all outcome measures apart from general symptoms during pain attacks at the follow-up assessment. Reductions of pain intensity, anxiety, and psychophysiological symptoms were maintained at 12 month follow-up. Although pain reduction was statistically significant, it did not exceed 14% in the pain diary. The more important aspect of the treatment appears to be emotional stabilization and increased feelings of well-being.

Adaptation, Psychological↗
PubMed1988

[Modification of the risk profile of obese essential hypertensive patients by the group "hypertension discussion" program].

The programme "Discussions on Hypertension" is a programme for group treatment of obese essential hypertensives in medical practices on the basis of behavioural therapy. A co-operation model was developed between the Department for General Medicine of the "Medizinische Hochschule Hannover", the Institute for Medical Psychology of the "Philipps-Universität Marburg" and the company Galenus Mannheim and was offered to doctors in general practice. The effects of the programme on the modifying of the risk profile for coronary heart disease was investigated in a controlled study in 137 patients by nine general practitioners. 81 patients were enrolled in the experimental group and 56 patients were assigned to a control group that was not using the programme. The experimental and control groups were comparable with respect to sociodemographic, psychological and medical parameters. Three months after completing the programme, the results of the study was shown in specific effect both on the psychological criteria of success (well-being, health knowledge, healthy behaviour, salt use and compliance) and in a reduction of the diastolic blood pressure in spite of a reduction of the antihypertensive drug treatment. The blood lipid levels (cholesterol and triglycerides) and the blood glucose level were also favourably affected. Patients in the experimental group had reduced their weight by an average of 5.6 kg. The patients in the control group only by 0.8 kg. Overall, there was a marked reduction in the proportion of patients with several risk factors in the experimental group, so that the programme can be attributed a preventive effect.

Antihypertensive Agents↗
PubMed1987

The safety of and the strain on the donor during thrombocytapheresis on the cell separator. A psychological study.

The study deals with the question as to what extent and under which existing personal characteristics does thrombocytapheresis on the cell separator (Fenwal CS-3000) lead to psychological stress for the blood donor? A comparison is made with the stress experienced during the established 450 ml full-blood donation. Because of the different procedural conditions, it was postulated that the donation on the cell separator creates greater psychological stress than the established type of donation. To examine this hypothesis, a sample group of 76 cell-separator and full-blood donors were asked to complete a questionnaire concerning the stress they experienced and their attitude before, during, and after the donation. Their personalities were also examined. A control group of 45 full-blood donors was examined in the same way. No significant statistical difference was found regarding the extent of stress under both conditions of donation. These findings are verified by the general satisfaction expressed by the cell-separator donors. Although it is confirmed that the personal cost to the donor is greater, it involves, on the other hand, a greater commitment, a positive evaluation of the more intimate involvement of the donor, and an increase in self-esteem. Since it could not be proven that there is an increase in the amount of stress during cell-separator donation, it also seems plausible that no clear decrease in stress would be observed after repeated donations. On the whole, it seems that the cell separator is well accepted by the donors. The extent of experienced stress is related to the donor's habitual anxiety and negative expectations. Since negative expectations can be influenced, it is to be expected that an informative conversation in a quiet atmosphere would further decrease the stress experienced.

Adaptation, Psychological↗