Biomedical subjects

M E Robinson

Publications and source records attributed to M E Robinson.

At least 37 records · Page 2Linked to original sources

PubMed1999

Predicting treatment compliance following facial pain evaluation.

The purpose of this study was to document compliance to treatment follow-up for facial pain patients referred for outside services. In addition, we generated a multidimensional model of the psychosocial constructs associated with chronic pain to determine whether these factors were predictive of compliance across recommended therapy modalities or with an overall measure of compliance. These constructs included pain report, depressive symptoms, anxiety, cognitive coping strategies, and physical activity reduction. The sample consisted of 80 facial pain patients evaluated at a tertiary care, facial pain clinic at a large university medical center. Compliance ratings ranged from 93% to 50% and are consistent with the literature that indicates that compliance differs across treatment modality. Furthermore, compliance rates were lower for the more nontraditional facial pain treatments performed by physical therapists or psychologists. Depression was negatively associated with compliance to medication changes, therapeutic injections, and splint therapy, but not psychological counseling or physical therapy. Increased pain was only associated with physical therapy. Measures of psychological distress (depression and anxiety) and pain were predictive of the overall measure of compliance. These results suggest that psychological distress can be a barrier for positive patient outcomes through reduced treatment compliance.

Adaptation, Psychological↗

PubMed1999

Empirical test of the factor structure of the West Haven-Yale Multidimensional Pain Inventory.

OBJECTIVE: Although the West Haven-Yale Multidimensional Pain Inventory (MPI) is frequently used in clinical evaluation and research with chronic pain patients, few studies have reported item-level factor analyses. After performing such an analysis, Bernstein et al. (Spine 1995;20:956-63) reported lack of independence between the solicitous and distracting response scales in section II as well as the activities away from home and social activities scales in section III. They suggested that the combination of these scales would improve the internal structure of the MPI. The purpose of this study was to perform a confirmatory factor analysis testing whether the MPI would be improved by the consolidation of these scales. In addition, a third, empirical model was generated for comparison with the West Haven-Yale and Bernstein models. DESIGN: This study used exploratory and confirmatory factor analysis on two independent samples of chronic pain patients (n = 472 and n = 346) to test hypotheses regarding the factor structure of the MPI. RESULTS AND CONCLUSION: Principal axis factor analysis resulted in an empirical model that suggested that the primary psychometric problem of the MPI was lack of item-factor discrimination for several items. When the three models were tested using confirmatory factor analysis, improvement in model fit occurred when cross loading items were excluded. Nevertheless, the goodness of fit of original factor structure was adequate, suggesting it would be premature to suggest changes in this instrument.

Activities of Daily Living↗

PubMed1999

Empirical subgroups of the Coping Strategies Questionnaire-Revised: a multisample study.

OBJECTIVE: The purpose of this study was to examine the dimensions of coping, measured by the subscales of the new revised Coping Strategies Questionnaire (CSQ-R) using factor analysis, and to perform cluster analysis on these factors to explore the existence of distinct subgroups. No published studies have identifed subgroups of chronic pain patients based on the use of CSQ coping strategies. SOURCE: A sample of 419 chronic low back pain patients from a multidisciplinary pain rehabilitation clinic and a sample of 556 chronic pain patients of mixed pain etiology presenting for treatment at an anesthesia pain clinic were used to establish reliability of factors and clusters. RESULTS: Both samples yielded very similar two-factor solutions, with initial solutions accounting for 67.1% and 69.1% of the total variance. The factors were characterized as cognitive coping and distraction. Three homogeneous subgroups were then identified that consisted of a group high on cognitive coping, a group with low overall ratings of response CSQ-R items in general, and a group with frequent endorsement of catastrophizing and distraction-related items. CONCLUSION: This paper is the first to report empirically derived subgroups from scores on the CSQ or CSQ-R. In addition, the three clusters were significantly different across measures of pain, psychological distress, and levels of physical functioning, demonstrating validity for the clusters.

Adaptation, Psychological↗

PubMed1998

Sex differences in the perception of noxious experimental stimuli: a meta-analysis.

Fillingim and Maixner (Fillingim, R.B. and Maixner, W., Pain Forum, 4(4) (1995) 209-221) recently reviewed the body of literature examining possible sex differences in responses to experimentally induced noxious stimulation. Using a 'box score' methodology, they concluded the literature supports sex differences in response to noxious stimuli, with females displaying greater sensitivity. However, Berkley (Berkley, K.J., Pain Forum, 4(4) (1995) 225-227) suggested the failure of a number of studies to reach statistical significance suggests the effect may be small and of little practical significance. This study used meta-analytic methodology to provide quantitative evidence to address the question of the magnitude of these sex differences in response to experimentally induced pain. We found the effect size to range from large to moderate, depending on whether threshold or tolerance were measured and which method of stimulus administration was used. The values for pressure pain and electrical stimulation, for both threshold and tolerance measures, were the largest. For studies employing a threshold measure, the effect for thermal pain was smaller and more variable. The failures to reject the null hypothesis in a number of these studies appear to have been a function of lack of power from an insufficient number of subjects. Given the estimated effect size of 0.55 threshold or 0.57 for tolerance, 41 subjects per group are necessary to provide adequate power (0.70) to test for this difference. Of the 34 studies reviewed by Fillingim and Maixner, only seven were conducted with groups of this magnitude. The results of this study compels to caution authors to obtain adequate sample sizes and hope that this meta-analytic review can aid in the determination of sample size for future studies.

Female↗

PubMed1998

Effects of physical and sexual abuse in facial pain: direct or mediated?

Research has identified a relationship between a history of physical and/or sexual abuse and a range of psychological, functional, and physical factors; however, the nature of this relationship has not been tested. We hypothesize two different mechanisms through which an abuse history could influence later life distress and dysfunction. A history of abuse could increase an individual's vulnerability to emotional distress or could increase an individual's tendency to attend, amplify, and over-interpret somatic symptoms. The purpose of this study was to test the influence of emotional distress and somatic focus on the relationship between a history of physical and/or sexual abuse and later chronic painrelated disability in patients with temporomandibular disorders. The subjects were 139 female patients evaluated at a facial pain clinic. Of the 139 subjects, 49% (n = 69) reported a history of physical and/or sexual abuse. Abused subjects reported significantly higher levels of anxiety, depression, and somatic symptoms than nonabused subjects. Path analysis with latent variables, using the LISREL-8 (Scientific Software International, Inc., Chicago, Illinois) statistical program was used to test the hypothesized relationships. When emotional distress and somatic focus were tested as mediators, the path coefficient from somatic focus to physical functioning was significant (beta = -0.38) while the path coefficient from negative emotion to physical functioning was not significant. These results favor somatization as the hypothesized mechanism over the emotional distress vulnerability hypotheses.

Adolescent↗

PubMed1998

Validity of MMPI-2 profiles in chronic back pain patients: differences in path models of coping and somatization.

OBJECTIVE: To show clinical utility and empirical validity of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) chronic pain patient subgroups by identification of differential multivariate relationships across groups. METHOD: This study used structural equation modeling to test cognitive coping strategies and somatization as mediator variables in path models with pain severity and depression used as exogenous (independent) variables and patient's activity level as the final endogenous (dependent) variable, across MMPI-2 profiles. RESULTS: Hierarchical cluster analysis, performed on a sample of 569 chronic low back patients, resulted in four cluster profiles identifiable as those found in previous work with the MMPI-2 (within normal limits, V-type, neurotic triad, and depressed-pathological). Somatization mediated the relationship between depression and activity level for the neurotic triad group but not the other three groups. A positive linear relationship was found between somatization and depression for the within normal limits, neurotic triad, and depressed-pathological groups, whereas their linear association was negative for the V-type group. Cognitive coping strategies mediated the relationship between depression and activity level for the within normal limits group. In addition, cognitive coping was predictive of activity level for the within normal limits, V-type, and neurotic triad groups but not for the depressed-pathological group. CONCLUSION: Consistent with previous cluster analytic studies, this study replicated four MMPI-2 cluster profile groups in chronic pain patients. These results have also shown that several multivariate relationships between variables are different across MMPI-2 groups, providing evidence for the validity for these MMPI-2 subgroups.

Adaptation, Psychological↗

PubMed1997

The Coping Strategies Questionnaire: a large sample, item level factor analysis.

OBJECTIVE: The Coping Strategies Questionnaire (CSQ), a measure of coping in chronic pain patients, was subjected to item-level exploratory factor analysis. SUBJECTS: A sample of 965 chronic pain patients were used in the analysis. RESULTS: Principal components analysis using a varimax rotation procedure identified nine factors that accounted for 54.5% of the variance. Of these nine factors, the first five represent subscales of the original CSQ subscales. The catastrophizing subscale replicated with significant loadings for all six original items, and ignoring sensations replicated with five of six items. Factors representing reinterpreting pain sensations, coping self-statements, and diverting attention subscales also appeared. The items from the praying and hoping subscale split into separate praying and hoping factors (factors 6 and 8). When reliability coefficients were calculated, factors 7 through 9 had unacceptably low internal consistency and thus were not considered stable factors. Correlations between factors 1 through 6 and other measures of psychological and physical functioning were calculated in the construct validation portion of this study. Previously found relationships were replicated in that the correlations between CSQ factor scores and measures of pain, depression, and disability were in the same direction in this data set as those previously reported.

Adaptation, Psychological↗

PubMed1997

Bias effects in three common self-report pain assessment measures.

OBJECTIVE: Past research has shown response biases to influence the accuracy of results from self-report measures. In pain assessment, where a percentage of patients have financial and other reasons to minimize or exaggerate psychological disturbance, it becomes especially important to identify the influence of response bias in self-report of adjustment. This study investigated the susceptibility of three commonly used self-report pain assessment measures to response bias. DESIGN: This study used a within-subjects (asymptomatic subjects) design with two experimental conditions and nonequivalent control group (chronic pain patients). SUBJECTS: Experimental group: 40 students enrolled in an occupational therapy program at a major southeastern United States university. CONTROL GROUP: 200 subjects referred to a multidisciplinary pain clinic at a major teaching hospital. MEASURES: Coping Strategies Questionnaire, Multidimensional Pain Inventory, and Pain Beliefs and Perceptions Inventory. RESULTS: With few exceptions, asymptomatic subjects scored significantly differently on these measures while portraying themselves as either coping well or coping poorly. In addition, when using the "coping poorly" response set, asymptomatic subjects reproduced scores similar to those of symptomatic chronic pain patients. CONCLUSION: The susceptibility to manipulation appeared constant across the three measures, a finding that highlighted the difficulties clinicians and researchers encounter in accurate interpretation of results from these measures in the absence of validity indicators. This study also emphasizes the ease with which subjects with sufficient motivation can present themselves in an untruthful and manipulative manner and can generate scores that are, on their own, difficult to distinguish from those of a group of typical chronic pain patients.

Adaptation, Psychological↗

PubMed1997

CSQ: five factors or fiction?

OBJECTIVE: The Coping Strategies Questionnaire (CSQ), a rationally constructed pain coping assessment instrument, was conceived to measure the extent to which patients used six different cognitive coping strategies and two behavioral coping strategies. A number of studies have factor analyzed the original scales but have not found a reliable factor structure. Recent studies by Turtle et al. and Swartzman et al. have obtained a five-factor solution performing exploratory factor analysis on the individual items. Robinson and associates from the University of Florida performed an item level exploratory factor analysis on a much larger sample (n = 965) and found a six-factor solution that was relatively supportive of the original rationally derived scales. The purpose of the present investigation was to perform a confirmatory factor analysis using the LISREL structural equation modeling program to compare these three different factor structures. PATIENTS: A sample of 472 chronic patients was used. RESULTS AND CONCLUSIONS: The results indicated that the Florida six-factor model was a better fit to the sample data than either of the five-factor models. Creation of the Coping Strategy Questionnaire Revised (CSQ-R), which retains 27 of the original items, is suggested.

Adaptation, Psychological↗

PubMed1997

Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis.

OBJECTIVE: This study examined the ability of two self-report questionnaires, the Beck Depression Inventory (BDI) and the Center for Epidemiological Studies-Depression Scale (CES-D), to discriminate between chronic pain patients with and without major depression. Since previous research has suggested that medical conditions such as chronic pain can influence the endorsement of items that measure neurovegetative symptoms of depression, the accuracy of each of these questionnaires was also assessed eliminating these items. SUBJECTS: These included 132 consecutive patients with chronic pain, 44 of whom were diagnosed as suffering from major depression according to DSM-IV criteria. METHODS: Patients were administered a battery of questionnaires that included the CES-D and BDI. They were also interviewed by a clinical psychologist to determine the presence or absence of major depression. RESULTS: Both questionnaires were able to discriminate significantly between persons with and without major depression. Removal of the somatic items on each questionnaire did not improve their accuracy. Discriminant function analysis revealed an optimal cut-off score of 21 for the BDI, and 27 for the CES-D. Overall hit rates at these cut-offs for the two questionnaires were comparable, while the CES-D had somewhat better sensitivity (81.8% vs. 68.2%). Conversely, the BDI had slightly better specificity (78.4% vs. 72.7%). CONCLUSION: The results suggest that both questionnaires have good predictive validity among chronic pain patients, and decisions regarding the use of one questionnaire rather than the other may depend upon the goals of the user and the setting within which the questionnaire is used.

Adult↗

PubMed1997

Pain behavior, spouse responsiveness, and marital satisfaction in patients with rheumatoid arthritis.

Although the pain behavior of some diagnostic groups has been shown to be reactive to social influences, the reactivity of pain behavior in a rheumatoid arthritis (RA) population remains an open question. The authors in this article combined laboratory and self-report assessment techniques to examine the extent to which the pain report and behavior of 52 RA patients was susceptible to influence of social factors within the marital unit. The authors' findings suggest that (a) different types of spouse responsiveness (e.g., solicitous, punishing) may be viewed differently by the RA population than more general chronic pain populations; (b) the patient's perception of spouse responsiveness is a significant predictor of the pain behavior, whereas the spouse's perception of these same behaviors is not; and (c) the patient's perception of the spouse's responsive behavior adds significantly to the prediction of pain behavior over a model based on "disease impact" variables alone.

Adult↗

PubMed1996

Pain severity, negative affect, and microstressers as predictors of life interference in TMD patients.

The purpose of this study was to examine the relationships among negative affect (depression, anxiety, and anger), microstressors (hassles), temporomandibular disorder (TMD) pain severity, and life interference, using structural equations modeling. One hundred four subjects were recruited from the Parker Mahan Facial Pain Clinic at the University of Florida. Significant positive direct effects were found for paths between pain severity and life interference; pain severity and negative affect; and negative affect and life interference. These results are consistent with a learning or behavioral model of suffering and suggest that negative affect is an important mediating variable in the relationship between pain and life interference. Microstressors were not a significant predictor and may not be a relevant issue in the TMD population. The results suggest that the impact of chronic pain conditions is influenced by both pain and negative affect, and assessment and treatment of chronic TMD disorders may better benefit from a multidisciplinary approach.

Activities of Daily Living↗

PubMed1996

The effects of depression and chronic pain on psychosocial and physical functioning.

OBJECTIVE: The present study employed causal modeling to examine the impact of somatic and cognitive symptoms of depression on the functioning of patients with chronic pain. DESIGN: Path analyses were conducted to determine whether pain level is directly related to the psychosocial and physical dimensions of functional status or whether this relationship is mediated by depression. SETTING: Subjects were recruited from a facial pain clinic at the University of Florida, an outpatient clinic associated with a tertiary-care health center. PATIENTS: Subjects were 70 patients with chronic pain, 53 of whom had primary facial pain. MAIN OUTCOME MEASURES: All subjects completed a packet of self-report questionnaires, including the Beck Depression Inventory, McGill Pain Questionnaire, and Sickness Impact Profile. RESULTS: Results of path analyses indicated that both somatic and cognitive symptoms of depression significantly correlate with psychosocial functioning even after controlling for the effects of pain level, trait anxiety, and trait anger. Somatic symptoms of depression were significantly correlated with physical functioning after pain level, anxiety and anger were controlled. CONCLUSIONS: This study indicates that depression is directly related to both the physical and the psychosocial functioning of facial pain patients, while self-reported level of pain is not. A better understanding of the impact of depression on chronic pain and the relationship of these two disorders could lead to improved assessment and treatment of chronic pain disorders.

Adolescent↗

PubMed1996

Detection of submaximal effort in isometric and isokinetic knee extension tests.

The use of torque variability and slope measures to detect submaximal efforts has been studied in isometric tests, but not fully investigated in isokinetic tests. The purpose of this study was to investigate differences between maximal and submaximal efforts in isometric and isokinetic knee extension using torque variability and slope measures obtained from 32 volunteers (age = 25.2 +/- 4.7 years). The coefficient of variation of average torque, coefficient of variation of peak torque, and slope to peak torque were obtained from maximal and submaximal torque curves during isometric and two isokinetic tests (60 degrees/sec and 180 degrees/sec). Significant differences between effort levels (maximal and submaximal) were shown for all variables in isometric and isokinetic tests. An optimized cut-off value to determine submaximal efforts without false positives was determined for each variable. The coefficient of variation of average torque detected 75% of submaximal efforts at 180 degrees/sec and slope to peak torque detected 63% of submaximal efforts at 60 degrees/sec. For both speeds, combining the coefficient of variation of average torque with slope improved the submaximal detection rate to 84%. No variable provided a satisfactory detection rate for the isometric test. Therefore, submaximal isokinetic knee extensions are detectable with torque variability and slope measures, but submaximal isometric exercise is not detectable.

Adult↗

PubMed1995

A time series analysis of the relationship between ambulatory EMG, pain, and stress in chronic low back pain.

Twenty-one subjects with chronic back pain (CBP) participated in an ambulatory electromyography (EMG) monitoring study to ascertain the relationships between muscle activity, physical activity, psychosocial stress, and pain. A time-series analysis approach was adopted to investigate both immediate and lagged associations between these variables in an attempt to determine potential causal relationships. Results for group relationships showed a significant relationship between physical activity and pain, self-report of stress and pain, but no relationship between EMG activity and pain. A lagged relationship between physical activity and pain was found, suggesting a causal relationship between physical activity and pain. However, no time lag was observed between stress and pain, hence no causal relationship can be elucidated. Analysis at the individual level indicated stronger relationships between several combinations of these variables, highlighting the need to consider the heterogeneity of the CBP population and etiology of CBP. The use of ambulatory monitoring of pain, stress, and EMG is suggested as one avenue to further explore the population's heterogeneity.

Adult↗

PubMed1995

Relationship between MMPI-2 cluster profiles and surgical outcome in low-back pain patients.

The purpose of this study was to investigate back surgery outcome differences based on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profile types. Four homogenous subgroups were found from a hierarchical cluster analysis of 201 MMPI-2 profiles. These four clusters consisted of a Depressed-pathological profile, a conversion V profile (V-type), a neurotic Triad profile, and a within normal limit (WNL) profile. Patients in the WNL and Triad subgroups reported significantly more satisfaction with postsurgical improvement than did patients in the Depressed-pathological or V-type subgroups. The Triad subgroup also gave a more favorable subjective rating of surgical outcome than did patients in the Depressed-pathological or V-type subgroups. These groups also differed on measures of work status and nonwork-related physical activity levels but not on indices of pain.

Adult↗

PubMed1994

Comparison of lumbar range of motion using three measurement devices in patients with chronic low back pain.

STUDY DESIGN: A correlational design was used to compare the lumbar spine's total sagittal range of motion (ROM) within a chronic low back pain patient population (n = 42) using three different measurement systems. OBJECTIVES: To compare, within a back pain patient population, the relationship of ROM measurements obtained from a motion analysis system (SPINETRAK), a lumbar extension rehabilitation device (MedX), and liquid inclinometers. METHODS: Total lumbar sagittal ROM was determined with each device in each subject as part of patients' standard clinical evaluation. RESULTS: Results indicated that the motion analysis system is significantly correlated with the liquid inclinometers and mildly correlated with the MedX. Inclinometer and MedX ROM measurements are also significantly correlated. To assess individual differences, dependent t tests were performed. Results indicated that the SPINETRAK yielded significantly lower ROM than the inclinometer or the MedX. The MedX and inclinometer measures did not significantly differ. CONCLUSIONS: This report shows that, depending on the device and procedures used, the lumbar sagittal ROM within a chronic low back pain population vary significantly.

Adult↗

PubMed1994

Cluster analysis of the medical coping modes questionnaire: evidence for coping with cancer styles?

A number of researchers have attempted to understand how individuals cope with having cancer. Unfortunately, this voluminous literature has suffered from a number of problems common to other pre-paridigmic disciples. Studies are generally isolated and fail to build upon other research in the literature. In addition, no guiding theory or conceptualization exists that helps to explain and describe the richness and complexity of observed clinical phenomena. With the understanding that coping with cancer is multidimensional, some researchers have attempted to group coping responses into dominant styles. In an effort to better understand the results of this approach, we performed a cluster analysis on 117 responses to a three scale questionnaire, the Medical Coping Modes Questionnaire. Results indicated that subjects can be grouped into one of four coping categories: confrontive, avoidant, resigned, or with a nondominant style. Future research is needed to explore how these styles influence quality of life during and following treatment.

Adaptation, Psychological↗