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Biomedical subjects

P Keel

Publications and source records attributed to P Keel.

At least 19 recordsLinked to original sources
PubMed2000

[Measuring disability of patients with low-back pain--validation of a German version of the Roland & Morris disability questionnaire].

INTRODUCTION: In this study three instruments measuring disability of patients with low-back pain are presented and evaluated: (1) the Behinderungsfragebogen (RM) - a German version of the Roland & Morris disability questionnaire (RDQ) (2) a numerical rating scale measuring disability in general and (2) eight numerical rating scales measuring specific dimensions of disability (standing, sitting, walking, driving a car, carrying light loads, carrying heavy loads, sleeping, and sexual intercourse). METHODS: The psychometric evaluation, including the item analysis, test reliability, test validity, and responsiveness of the instruments, is based on two samples. Sample A comprises 345 patients with low-back pain: 282 of these patients took part in the Swiss multicentre intervention study testing the effectiveness of in-patient rehabilitation of sub-chronic and chronic low-back pain under an integrative group treatment program. The instruments were administered at different times in the therapeutic process (t1: at hospital admission; t4: follow-up after one year). 63 patients were hospitalized (orthopedic or rheumatological units) for medical examinations (myelography or infiltration of facets) or rehabilitation of low-back pain. The instruments were administered twice within 24 h to measure test-retest correlation. In order to determine the psychometric parameters as accurately as possible, the two samples were examined jointly. Sample B is composed of 41 patients with low-back pain participating in the study "Prädiktoren des Erfolgs bei stabilisierenden Wirbelsäuleneingriffen" (Success predictors of effectiveness of surgical interventions for spinal stabilization). RESULTS: All instruments proved to be generally reliable and valid (high or medium correlations with each other and with a German version of the Oswestry Disability Questionnaire) as well as responsive tools for measuring the momentary disability of patients with back pain. The psychometric examination of the test validity showed that patients' perceptions of their disability were influenced by their psychological well-being. The correlation between the 3 instruments and physical tests was low. The RM is not a homogeneous instrument. Factor analysis (principal component analysis, rotation Varimax) indicated 6 factors. Because of the small number of items for each factor it is not appropriate to treat RM in terms of dimensions of disability. CONCLUSIONS: The RM is an instrument measuring patients' perception of their disability that offers simple, fast practicability for patients and tester. The 2 rating scales: The 8 numerical rating scales measuring specific dimensions of disability (QL3) offer all the advantages of the numerical rating scale measuring disability in general (QL1) (simple instruction, high plausibility for the patients, and simple, fast practicability), but they provide more information about the patient's disability, which allows comparisons of disability at different times in the therapeutic process. Numerical rating scales are not suitable for patients with poor ability to abstract. For these patients it is necessary to use a questionnaire which asks concretely about what the patient can or cannot do (e. g. RM). Because of its better psychometric properties, the QL3 should be favored over the RM.

English Abstract↗
PubMed1999

[Individualized backache. Insurance system plus over-treatment support epidemics in the 90's].

Chronic back pain leading to invalidity has become a social medical problem of enormous proportions. After several months off work, efforts at rehabilitation often fail because secondary effects prevent the return to normal daily activities. For this reason, early detection and prevention of chronicity is of considerable importance. The background to the development of chronicity is complex. In addition to the wide range of somatic and psychosocial factors, the roles played by the physicians and social insurances are also examined.

Attitude to Health↗
PubMed1999

[Back pain--how to prevent disability. Planning for graduated therapy].

Early detection and prevention of chronicity is of prime importance. In the acute phase of the condition, this involves the use of a range of simple diagnostic measures, the aim of which is to search for possible warning signs of a serious disorder with a specific cause. If the patient's complaints are unspecific, a rapid return to his/her usual daily activities should be the aim, supported by patient instruction and management of pain. When the patient's complaints persist for more than 4 weeks, a more comprehensive diagnostic work-up is indicated, with the aim of establishing the underlying cause of persisting problems. In addition to a renewed search for specific causes, this includes the identification of psychosocial factors that might be impediments to the return of the patient to his/her usual activities. For further diagnostic and therapeutic considerations, these points require particular attention.

Acute Disease↗
PubMed1999

Pain management strategies and team approach.

Multimodal pain management programmes have been used for chronic pain conditions such as low back pain or headache for many years with good results. However their effectiveness for treating fibromyalgia has only recently been established and with respect to long-term outcome the evidence is still not convincing. Recent findings, about abnormalities in pain control and neuroendocrine systems, help to understand the symptomatology of fibromyalgia and give theoretical support for these treatment concepts. They might also explain why secondary phenomena like depression, anxiety, deconditioning and disability can make it harder to treat the condition at a chronic stage. The ingredients of such multimodal programmes are described and evidence for their effectiveness is presented.

Delivery of Health Care, Integrated↗
PubMed1998

Psychological and psychiatric aspects of fibromyalgia syndrome (FMS).

Fibromyalgia patients hardly suffer from major psychiatric illnesses. Most often, persistent somatoform pain disorder (ICD-10) and dysthymia are identified by psychiatric assessment. Features of "pain proneness" can also be found regularly, which can explain the elevated levels of stress observed in FMS. Repeated traumatic experiences during childhood and as adults can be discovered in many cases, which helps to understand some of the difficulties met in psychotherapy with FMS patients. Modified psychotherapy techniques are recommended using pain-centered behavioral methods initially, and progressing only later to an insight orientated approach.

Adult↗
PubMed1997

[Long-term follow-up after participation in an integrated group treatment program for patients with intractable musculoskeletal pain].

METHODS: Long-term outcome in terms of well-being, depression and ability to cope was evaluated by means of a mailed questionnaire up to 5 years after participation in an integrated group treatment program for chronic musculoskeletal pain (mostly back pain). Sixty-one completed questionnaires were available for analysis, representing 69% of all 89 participants. RESULTS: Comparison of responders and non-responders yielded no important differences. On the basis of their further need for treatment, their working ability and global rating of outcome, patients were divided into three groups: In 18 cases the situation had further improved, 33 were unchanged and 10 had worsened. Sociodemographic data and pain history did not differ among the three groups. Patients with a favorable outcome scored significantly lower than the rest of the patients on a symptom check list and showed the greatest decrease from pretreatment values (if available). They rated themselves significantly higher on the two-dimensional health locus of control scale and were aware of significantly more factors influencing their pain than were the unimproved (unchanged or worsened) patients. Cognitive-behavioral strategies had been continued long-term by 83.6% of the patients and were rated most helpful. Physical training and at least one relaxation technique were continued in 80.3% of the patients, with a slightly lower rating of helpfulness. Improved patients gave generally higher ratings for helpfulness and applied these strategies also to problems other than pain (e.g. anxiety). CONCLUSIONS: The majority of patients maintained at least two of the self-help strategies over many years and seem to profit from their use. Positive long-term effects on well-being were visible in 30% of all participants, and these were clearly more orientated towards self-control than the unimproved subgroups.

English Abstract↗
PubMed1997

A 10-year longitudinal study of body weight, dieting, and eating disorder symptoms.

This article describes a 10-year longitudinal study of eating attitudes and behaviors. A sample of 509 women and 206 men completed a detailed survey in 1982 while they were in college. The authors contacted participants 10 years later and administered a 2nd questionnaire to assess stability and change in eating behaviors that occurred during the transition to early adulthood. Women in the study had substantial declines in disordered eating behavior as well as increased body satisfaction. However, body dissatisfaction and desires to lose weight remained at relatively high levels. Men, who rarely dieted or had eating problems in college, were prone to weight gain following college, and many of them reported increased dieting or disordered eating. The authors conclude that disordered eating generally tends to decline during the transition to early adulthood. However, body dissatisfaction remains a problem for a substantial segment of the adult population.

Adult↗
PubMed1995

Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992.

OBJECTIVE: The authors sought to examine changes in prevalence of dieting behavior and eating disorder symptoms from 1982 to 1992. METHOD: In 1982, 625 women and 276 men participated in a study examining body weight, eating habits, dieting tendencies, and eating disorder symptoms. Ten years later 564 women and 235 men at the same college completed a nearly identical survey. Similar random sampling methods were used for both studies. All respondents were classified into one of five groups (nondieter, dieter, problem dieter, subclinical eating disorder, or eating disorder according to DSM-III-R criteria). RESULTS: On almost all measures there were significant reductions of problematic eating behaviors and disordered attitudes about body, weight, and shape from 1982 to 1992. The estimated prevalence of bulimia nervosa dropped from 7.2% to 5.1% for women and from 1.1% to 0.4% for men. Binge eating, vomiting, diuretic use, and diet pill use also declined for women during this period. Significantly fewer women and men reported chronic dieting in 1992 than in 1982, and there was evidence of improved body image for both sexes. Subjects in 1992 also reported healthier eating habits in terms of dietary intake and meal regularity. Finally, women in 1992 were more likely to be overweight and were, on average, five pounds heavier than their 1982 counterparts. CONCLUSIONS: The prevalence of problematic eating behaviors and eating disorder symptoms appears to be abating. However, they remain a significant problem that affects a substantial segment of this population.

Adult↗
PubMed1993

[Psychological stress caused by work: burnout syndrome].

In a variety of helping professions emotional stress can lead to "burnout". The syndrome is characterised by emotional exhaustion, attitudinal hardening (loss of empathy) and a sense of decreased accomplishment. Longterm consequences of burnout can be mental problems such as depression or psychosomatic disorders. Affected employees are less productive and sick more often. They may even quit their jobs or need early retirement. In spite of this considerable loss of working force often neither those affected nor the employers are aware of the problem in time. Burnout seems to be caused by disproportionally high efforts (time, emotional involvement, empathy) and poor satisfaction (negative outcome) in addition to stressful working conditions (high demands). It affects mainly nurses, physicians, social workers, teachers and other similar professions. In order to prevent burnout, awareness of the problem must be promoted. Examples of job-specific measures for nurses and teachers are given. Their goal is to lower the professional stress and improve satisfaction. Social support and improved team cooperation can further protect against burnout.

Adaptation, Psychological↗
PubMed1992

[Prevalence and persistence of back pain in foreign workers: class or culture-induced?].

Physically working people are more likely to suffer from backache. Not only is their work hard and menial but usually also degrading. Unpleasant circumstances such as an offensive environment, the monotony of work, poor qualifications or unsatisfactory work generally influence the persistence of pain. The course of an illness such as a lingering backache, is hardly ever determined by somatic factors. A prognosis is rather based upon the attitude and behaviour of the single patient and his social surroundings, as well as upon the pathological process. Medication might even worsen rather than improve the patient's condition. The typical foreign worker, who generally merely has an elementary education and whom we therefore assign unqualified work, does not only risk to suffer from backache. His personal strength and his circumstances can seriously hinder his rehabilitation, more than it would be the case with native patients. The accumulation of negative factors is closely connected to his role of a foreign worker, whereas cultural aspects do not seem to be determining. Therefore, the foreign patient's rehabilitation can be fostered and improved by adopting the same methods used with Swiss patients against the chronicisation of backache. Nevertheless, the mentioned unfavourable factors and additional language problems considerably foil all efforts to a successful rehabilitation.

Acculturation↗
PubMed1990

[National Research Program. Part B: Chronicity of backache].

The main goal of part B of the National Research Program No 26 is to investigate the process leading to chronic low back pain. Starting from epidemiological facts the main risk factors are described from a systemic viewpoint. The rapid increase of disabling low back pain in the past decades makes it clear that factors outside the spine have to be made responsible for this process. There are changes in life-style and interpersonal relations, as well as in society and the health-care system. From these factors means of prevention are derived. Besides psychological factors general fitness and the training condition of the back muscles play an important role in effective prevention.

Back Pain↗
PubMed1989

[Chronic backache in migrant workers from Mediterranean countries in comparison to central European patients: demographic and psychosocial aspects].

The standardized interviews of 26 chronic back pain patients from central Europe (Switzerland, Germany, Poland) were compared with those of 28 patients from Mediterranean countries (Italy, Spain, Yugoslavia, Turkey), all of whom had been referred for participation in an integrated treatment program for chronic back pain. The two samples differed significantly in most of the psychosocial aspects studied. Patients from Mediterranean countries had a significantly lower level of education and were mostly employed as unskilled workers, while patients from central Europe were mostly housewives or skilled workers with higher levels of education. In the Mediterranean sample the back pain had generally developed much faster into a disabling disease with the attendant consequences (sick leave, loss of job, litigation). More than one third of the Mediterranean patients lived with a partner who was also sick and unable to work. These patients also adopted a more passive stance towards their illness by rarely using self-help, and showed poor readiness to participate in the self-monitoring orientated treatment program proposed to them. They were less aware of the influence of their own behaviour on pain and of any relation between the illness and their present or previous life situation. They complained less of a broken home in their childhood or earlier medical problems, but more frequently reported suffering from poverty in their childhood. The uneven composition of the two samples reflects the special social situation of foreign workers from Mediterranean countries in central Europe. Unskilled workers are significantly overrepresented in the latter segment of the adult working population of the study area (city of Basel, Switzerland). This overrepresentation is similar to that in our patient sample. The special situation of foreign workers from Mediterranean countries seems to account for their high incidence of chronic intractable back pain.

Adult↗
PubMed1988

[Ambulatory psychiatric care in the Canton of Basel: comparison of the performance of the Psychiatric University Polyclinic and the practicing psychiatrist].

A sample of 500 patients of the university psychiatric outpatient department was used for analysis of the services rendered by this public institution and to compare them with those of the psychiatrists in private practice. The services of the latter were studied with a questionnaire mailed to them. We could demonstrate that the outpatient department has important function in social psychiatry. There are also important tasks to fulfill at the central general hospital, while uncomplicated psychotherapies play a minor role among the duties of this service. In spite of a certain readiness the psychiatrists in private practice are hardly able to fulfill these first two tasks. Their ability for emergency interventions and management of demanding cases with complex social problems is limited. We could state that their main fields of activity are long term analytical psychotherapies. In addition they can take over a limited number of expertise assessments and some crises interventions.

Ambulatory Care↗