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Lucy Yardley

Publications and source records attributed to Lucy Yardley.

14 recordsLinked to original sources
PubMed2006

How does social comparison within a self-help group influence adjustment to chronic illness? A longitudinal study.

Despite the growing popularity of self-help groups for people with chronic illness, there has been surprisingly little research into how these may support adjustment to illness. This study investigated the role that social comparison, occurring within a self-help group, may play in adjustment to chronic illness. A model of adjustment based on control process theory and response shift theory was tested to determine whether social comparisons predicted adjustment after controlling for the catalyst for adjustment (disease severity) and antecedents (demographic and psychological factors). A sample of 301 people with Ménière's disease who were members of the Ménière's Society UK completed questionnaires at baseline and 10-month follow-up assessing adjustment, defined for this study as functional and goal-oriented quality of life. At baseline, they also completed measures of the predictor variables i.e. the antecedents (age, sex, living circumstances, duration of self-help group membership, self-esteem, optimism and perceived control over illness), the catalyst (severity of vertigo, tinnitus, hearing loss and fullness in the ear) and mechanisms of social comparison within the self-help group. The social comparison variables included the extent to which self-help group resources were used, and whether reading about other members' experiences induced positive or negative feelings. Cross-sectional results showed that positive social comparison was indeed associated with better adjustment after controlling for all the other baseline variables, while negative social comparison was associated with worse adjustment. However, greater levels of social comparison at baseline were associated with a deteriorating quality of life over the 10-month follow-up period. Alternative explanations for these findings are discussed.

Adaptation, Psychological↗
PubMed2006

Patterns of presentations of dizziness in primary care--a cross-sectional cluster analysis study.

OBJECTIVES: Dizziness is a common symptom in adults in primary care. We explored in a sample of people recruited from general practice the existence of patterns of presentations, their characteristics, and clinical and health service predictors. METHOD: We assessed in a cross-sectional random sample of people registered at London general practices in the United Kingdom the following: subtypes of dizziness, effect on personal activity and physical function, relevant medical and drug history, level of anxiety or depression, treatments received, and information on whether help was sought from their general practitioners. RESULTS: Of 1820 subjects, 442 (24.3%) reported symptoms of dizziness. We identified three clinical presentations. Group 1 was a "nonspecific" presentation experienced by 113 (25.5%) people and characterized by true vertigo, presyncope, disequilibrium, and other types of dizziness with severe impact on all aspects of function. The other two groups were characterized by true vertigo and presyncope. In Group 2 [193 (43.7%)], these symptoms had some impact on personal and daily function, whereas in Group 3 [136 (30.7%)], there was no impact. Eighty-four percent of the people in Group 1 consulted their family practitioner on account of their symptoms, 61% did so in Group 2, and only 38% in Group 3. On multinomial logistic regression analysis, current depression, unemployment, and use of prescribed medication were predictors of the Group 1 compared with Group 2, whereas increasing anxiety and depression scores on the Hospital Anxiety and Depression Scale were predictors of the Group 2 compared with the Group 3. CONCLUSIONS: This is the first step in classifying dizziness from a symptomatic and functional point of view. Further research is required on the natural progression of these presentations and their relationship to each other.

Anxiety↗
PubMed2006

Older people's views of falls-prevention interventions in six European countries.

PURPOSE: Our study identified factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. DESIGN AND METHODS: Semistructured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries with 69 people aged 68 to 97 years. The sample was selected to include people with very different experiences of participation or nonparticipation in falls-related interventions, but all individuals were asked about interventions that included strength and balance training. RESULTS: Attitudes were similar in all countries and contexts. People were motivated to participate in strength and balance training by a wide range of perceived benefits (interest and enjoyment, improved health, mood, and independence) and not just reduction of falling risk. Participation also was encouraged by a personal invitation from a health practitioner and social approval from family and friends. Barriers to participation included denial of falling risk, the belief that no additional falls-prevention measures were necessary, practical barriers to attendance at groups (e.g., transport, effort, and cost), and a dislike of group activities. IMPLICATIONS: Because many older people reject the idea that they are at risk of falling, the uptake of strength and balance training programs may be promoted more effectively by maximizing and emphasizing their multiple positive benefits for health and well-being. A personal invitation from a health professional to participate is important, and it also may be helpful to provide home-based programs for those who dislike or find it difficult to attend groups.

Accidental Falls↗
PubMed2006

Factors important for the measurement of social comparison in chronic illness: a mixed-methods study.

OBJECTIVES: The aim of this study was to examine social comparison in illness using a mixed-methods approach that combined inductive exploration of how people used social comparison in this self-help group with a quantitative study of social comparison processes and their relationship to quality of life. METHODS: The qualitative study involved 15 semi-structured interviews with people with Ménière's disease. Themes from the analysis of the interviews informed the development of the Social Comparison in Illness Scale (SCIS), which was then validated in a questionnaire study, in which participants with Ménière's disease (n = 196) completed the SCIS, the previously validated Identification/Contrast social comparison scale, and the SF-36 health status questionnaire. RESULTS: The qualitative study uncovered a wide range of forms of social comparison, including upward, downward and lateral comparison on illness and coping dimensions, as well as comparing solely for informational purposes. The quantitative study indicated that these varied directions and dimensions of social comparison could be mapped onto five reliable categories that were related to quality of life: upward positive and downward positive comparison, upward negative and downward negative comparison, and comparing for information. DISCUSSION: These analyses highlight the complexity of socially comparing in chronic illness, but also confirm the validity of the Identification/Contrast model of social comparison in this context.

Adaptation, Psychological↗
PubMed2005

Resisting medicines: a synthesis of qualitative studies of medicine taking.

The study aimed to synthesise qualitative studies of lay experiences of medicine taking. Most studies focused on the experience of those not taking their medicine as prescribed, with few considering those who reject their medicines or accept them uncritically. Most were concerned with medicines for chronic illnesses. The synthesis revealed widespread caution about taking medicines and highlighted the lay practice of testing medicines, mainly for adverse effects. Some concerns about medicines cannot be resolved by lay evaluation, however, including worries about dependence, tolerance and addiction, the potential harm from taking medicines on a long-term basis and the possibility of medicines masking other symptoms. Additionally, in some cases medicines had a significant impact on identity, presenting problems of disclosure and stigma. People were found to accept their medicines either passively or actively, or to reject them. Some were coerced into taking medicines. Active accepters might modify their regimens by taking medicines symptomatically or strategically, or by adjusting doses to minimise unwanted consequences, or to make the regimen more acceptable. Many modifications appeared to reflect a desire to minimise the intake of medicines and this was echoed in some peoples' use of non-pharmacological treatments to either supplant or supplement their medicines. Few discussed regimen changes with their doctors. We conclude that the main reason why people do not take their medicines as prescribed is not because of failings in patients, doctors or systems, but because of concerns about the medicines themselves. On the whole, the findings point to considerable reluctance to take medicine and a preference to take as little as possible. We argue that peoples' resistance to medicine taking needs to be recognised and that the focus should be on developing ways of making medicines safe, as well as identifying and evaluating the treatments that people often choose in preference to medicines.

Adult↗
PubMed2005

Development and initial validation of the Falls Efficacy Scale-International (FES-I).

BACKGROUND: There is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a range of languages and cultural contexts, permitting direct comparison between studies and populations in different countries and settings. OBJECTIVE: To develop a modified version of the Falls Efficacy Scale to satisfy this need, and to establish its psychometric properties, reliability, and concurrent validity (i.e. that it demonstrates the expected relationship with age, falls history and falls risk factors). DESIGN: Cross-sectional survey. SETTING: Community sample. METHOD: 704 people aged between 60 and 95 years completed The Falls Efficacy Scale-International (FES-I) either in postal self-completion format or by structured interview. RESULTS: The FES-I had excellent internal and test-retest reliability (Cronbach's alpha=0.96, ICC=0.96). Factor analysis suggested a unitary underlying factor, with two dimensions assessing concern about less demanding physical activities mainly in the home, and concern about more demanding physical activities mainly outside the home. The FES-I had slightly better power than the original FES items to discriminate differences in concern about falling between groups differentiated by sex, age, occupation, falls in the past year, and falls risk factors (chronic illness, taking multiple or psychoactive medications, dizziness). CONCLUSIONS: The FES-I has close continuity with the best existing measure of fear of falling, excellent psychometric properties, and assesses concerns relating to basic and more demanding activities, both physical and social. Further research is required to confirm cross-cultural and predictive validity.

Accidental Falls↗
PubMed2004

Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness.

BACKGROUND: Dizziness is a very common symptom and is usually managed in primary care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for primary care delivery, but its effectiveness has not yet been determined. OBJECTIVE: To evaluate the effectiveness of nurse-delivered vestibular rehabilitation in primary care for patients with chronic dizziness. DESIGN: Single-blind randomized, controlled trial. SETTING: 20 general practices in southern England. PATIENTS: 170 adult patients with chronic dizziness who were randomly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87). INTERVENTION: Each patient received one 30- to 40-minute appointment with a primary care nurse. The nurse taught the patient exercises to be carried out daily at home, with the support of a treatment booklet. MEASUREMENTS: Primary outcome measures were baseline, 3-month, and 6-month assessment of self-reported spontaneous and provoked symptoms of dizziness, dizziness-related quality of life, and objective measurement of postural stability with eyes open and eyes closed. RESULTS: At 3 months, improvement on all primary outcome measures in the vestibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (38%) usual care patients (relative risk, 1.78 [95% CI, 1.31 to 2.42]). LIMITATIONS: Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well-motivated patients. CONCLUSIONS: Vestibular rehabilitation delivered by nurses in general practice improves symptoms, postural stability, and dizziness-related handicap in patients with chronic dizziness.

Chronic Disease↗
PubMed2004

Constructing agency in treatment decisions: negotiating responsibility in cancer.

People belonging to cancer patient support groups participated in focus groups concerning their experiences of orthodox and complementary medicine. Their accounts of treatment decisions for cancer were analysed through discourse analysis. Accounts of both complementary and orthodox medicine addressed an ideological dilemma concerning the positioning of individuals as active or passive. Active positions were congruent with the everyday value of autonomy and responsible individuality, but conflicted with the established expertise of the medical profession in cancer and entailed being accountable for one's health. Passive positions reversed this situation. Complementary medicine provided an opportunity for people with cancer to negotiate active positions in a limited domain of health care. The responsibility for health associated with taking active treatment decisions was problematic in accounts of both orthodox and complementary medicine.

Aged↗
PubMed2003

Does articulation contribute to modifications of postural control during dual-task paradigms?

Many studies have been carried out to investigate the attentional resources required for postural control, using a 'dual-task' methodology in which performance on mental and postural control tasks is compared when these are carried out separately and concurrently. Most mental tasks used in these dual-task studies have employed verbal responses. However, changes in respiration during speech production are known to produce changes in postural control. Hence, the goal of this study was to determine whether articulation might contribute to the changes found in postural sway when a spoken mental task is being performed and to determine if the type of postural control measurement might also have an impact on the outcome of the study. Twenty young healthy participants were asked to stand on a force platform while executing secondary tasks that were performed silently or required a verbal response, and that required high or low levels of attention. Vision and postural task difficulty were manipulated. Performance of all tasks produced an increased sway frequency and decreased sway amplitude relative to the no task baseline. However, tasks that required articulation resulted in a more pronounced increase in postural sway frequency and sway path than did the tasks that did not require any articulation. These findings could imply that the addition of a secondary task results in increased stiffness, whereas articulation results in a further increased frequency of sway, which leads to an increase in sway path. We conclude that changes in the various parameters of sway that accompany performance of secondary tasks are complex, and are not always wholly attributable to attentional load, but may also be partly due to the motor requirements of the task, such as those involved in articulation.

Adult↗
PubMed2003

Posture and mental task performance when viewing a moving visual field.

We investigated the characteristics of standing posture and performance of concurrent cognitive tasks in subjects confronted by whole field visual motion. Movements of the head and centre of pressure (COP) were recorded in 12 subjects who performed modified Brooks spatial and verbal tasks when in quiet stance viewing a chequerboard pattern, planar, visual field, moving with uniform velocity (25 degrees /s, 50 degrees /s and 76 degrees /s). Eight subjects were also tested seated to control for the effect of stance. Task load was monitored by heart rate and eye movements were recorded to ensure viewing compliance. Subjects rated their quotidian susceptibility to visual disorientation on a validated scale. In both lateral and antero-posterior directions there were small amplitude but significant increases in COP sway path length and standard deviations of both COP and head sway during exposure to visual motion in proportion to visual flow speed. Performing cognitive tasks during visual motion attenuated sway S.D. The effects on sway of task and visual flow were independent. Visual motion induced a slight tilt and turn of the head and body in the direction of flow together with slight neck flexion. Errors on both verbal and spatial tasks increased >250% during visual motion both when standing and when seated. Ratings of subjects' susceptibility to disorientation were un-related to either verbal or spatial task error rates. A current hypothesis is that the enhancement of sway by visual motion is destabilisation. We propose an alternative explanation that sway enhancement could be exploratory 'testing of the ground' movements to check for self motion. Hence decrease in sway magnitude during a cognitive task could be caused by a reduction in exploratory movement because attention is diverted from postural control to a secondary task. Mere passive viewing of a moving visual field may interfere with cognitive tasks possibly because the threat of disorientation by whole field motion diverts attentional resources.

Adult↗
PubMed2002

Attentional demands of continuously monitoring orientation using vestibular information.

The aim of this series of experiments was to determine whether attention is normally required for continuously processing vestibular information concerning orientation, or is required only when orientation is disrupted (eg by vestibular dysfunction or by conflicting visual and vestibular orientation cues). In the first two studies, healthy subjects were passively oscillated, and indicated when they perceived they were passing through their starting position. There was only weak evidence for interference between performance on this 'continuous orientation monitoring task' and on concurrent mental tasks. However, a third study showed that when patients with vestibular imbalance carried out the continuous orientation monitoring task their performance on a concurrent mental arithmetic task was substantially impaired. This dual task interference was correlated with inaccuracy in judging orientation on the continuous orientation monitoring task, which in turn correlated with severity of recent vestibular symptomatology (assessed by questionnaire). In a fourth experiment, disorientation was induced in healthy subjects by rotating the visual field about the line of sight. Bidirectional interference was observed between monitoring orientation (assessed by accuracy in setting a rod to the perceived vertical) and performance of an arithmetic task. Dual task interference was correlated with baseline levels of disorientation induced by the visual field, as indicated by inaccuracy in judging the visual vertical. These findings suggest that monitoring orientation makes significant demands upon cortical processing resources when disorientation is induced, whether the disorientation results from deficient sensory functioning or from ambiguous perceptual information.

Adult↗
PubMed2002

A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people.

PURPOSE: To identify the most common beliefs concerning the negative consequences of falling and determine whether these motivate avoidance of activity. DESIGN AND METHODS: A questionnaire assessing feared consequences of falling was completed by 224 community-living people aged older than 75. Beliefs about the consequences of falling were related to demographic characteristics, falling history, and avoidance of activity. The questionnaires were completed again by 166 participants 6 months later. RESULTS: Commonly feared consequences of falling were loss of functional independence and damage to identity. These fears were correlated with avoidance of activity (after adjusting for age, sex, and recent falling history) and predicted avoidance in activity 6 months later (after adjusting for baseline levels of avoidance). IMPLICATIONS: Concerns about damage to social identity, as well as functional incapacity, are common and may motivate avoidance of activity.

Accidental Falls↗
PubMedDate not supplied

Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial.

OBJECTIVE: This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease. METHODS: Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months. RESULTS: At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome. CONCLUSIONS: Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.

Culture↗