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Biomedical subjects

R J Gatchel

Publications and source records attributed to R J Gatchel.

At least 55 records · Page 3Linked to original sources
PubMed1996

Major psychological disorders in acute and chronic TMD: an initial examination.

This study assessed psychological disorders in 50 patients with chronic temporomandibular disorders and 51 patients with acute TMD. The results revealed a significant psychological comorbidity in both groups of patients. Both groups had high rates of psychopathology that exceeded the base rates of the general population. Such findings are in keeping with an integrated biopsychosocial model of TMD, and have significant implications for treatment of these patients.

Acute Disease↗
PubMed1995

The dominant role of psychosocial risk factors in the development of chronic low back pain disability.

STUDY DESIGN: An inception cohort design was used in which 421 patients were evaluated systematically with a standard battery of psychosocial assessment tests (Structured Interview for DSM-III-R Diagnosis, Minnesota Multiphasic Personality Inventory, and Million Visual Pain Analog Scale) within 6 weeks of acute back pain onset. OBJECTIVES: The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems (as measured by job-work status at 1-year follow-up evaluation). SUMMARY OF BACKGROUND DATA: There has been a relative paucity of prospective research in the United States comprehensively evaluating potential psychosocial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability. Such research has been quite limited because of the time and cost involved in conducting prospective studies. METHODS: All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks. These acute patients were tracked every 3 months, culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status. RESULTS: Logistic regression analyses, conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury, revealed the importance of three psychosocial measures: self-reported pain and disability, scores on Scale 3 of the Minnesota Multiphasic Personality Inventory, and workers' compensation and personal injury insurance status. The model generated correctly classified 90.7% of the cases. Results revealed that major psychopathology, such as depression and substance abuse, did not precede or cause the development chronic pain disability. CONCLUSIONS: These results show the presence of a robust "psychosocial disability factor" that is associated with those injured workers who are likely to develop chronic low back pain disability problems. Based on these data, a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability. The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability, although high rates of psychopathology have been shown in chronic low back pain. Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity.

Adult↗
PubMed1995

Predicting outcome of chronic back pain using clinical predictors of psychopathology: a prospective analysis.

This study evaluated whether a comprehensive assessment of psychosocial measures is useful in characterizing those acute low back pain patients who subsequently develop chronic pain disability problems. A cohort of 324 patients was evaluated, with all patients being administered a standard battery psychological assessment tests. A structured telephone interview was conducted 6 months after the psychological assessment to evaluate return-to-work status. Analyses, conducted to differentiate between those patients who were back at work at 6 months versus those who were not because of the original back injury, revealed the importance of 3 measures: self-reported pain and disability, the presence of a personality disorder, and scores on Scale 3 of the Minnesota Multiphasic Personality Inventory. These results demonstrate the presence of a psychosocial disability variable that is associated with those injured workers who are likely to develop chronic disability problems.

Adult↗
PubMed1994

A male incumbent worker industrial database. Part I: Lumbar spinal physical capacity.

STUDY DESIGN: A group of 160 incumbent male railroad workers volunteered for a study of lumbar spine physical capacity. METHODS: They were initially subjected to inclinometric measurements of sagittal and coronal regional mobility (T12-S1). They also were tested on isokinetic trunk strength measurement devices for sagittal (bending) and axial (twisting) trunk strength at multiple speeds. RESULTS: Results showed that they demonstrated mild deficits of lumbar sagittal extension mobility, trunk extensor strength, and sagittal/axial high speed (150-180 degrees/sec) trunk strength when compared with population averages from a previously derived normative database of a nonhomogeneous male population (matched for age and body weight). CONCLUSIONS: It was hypothesized that instructions about "correct lifting techniques," uniformly provided to these workers, may have resulted in an unintended decrement in trunk mobility and strength.

Adult↗
PubMed1994

A male incumbent worker industrial database. Part II: Cervical spinal physical capacity.

STUDY DESIGN: Quantified cervical physical examination data are provided for a group of 160 incumbent railroad workers from four laboring crafts. OBJECTIVES: The subjects were tested for cervical mobility and strength, according to standardized protocols as part of a comprehensive physical examination and functional testing procedure to establish normative data associated with the axial musculoskeletal system. RESULTS: Tri-planar cervical inclinometric mobility norms are provided, as are sagittal and coronal isometric cervical strength data.

Adult↗
PubMed1994

Physical progress and residual impairment quantification after functional restoration. Part I: Lumbar mobility.

Quantification of human performance in chronic low back pain (CLBP) patients is essential to initiate effective treatment and guide progress in a disability-oriented functional restoration program, as well as to objectively evaluate impairment and functional limitations at the time of maximum medical improvement. One such important measure of physical ability is range of motion. Patients who suffer from CLBP almost invariably have some disturbance of mobility. The major goals of the present study were to: 1) develop a database of anticipated range of motion levels at different points in time in a representative sample of CLBP patients; 2) within the sample, determine any gender or spinal surgery-induced differences; 3) evaluate change in range of motion produced by participation in a comprehensive functional restoration treatment program; and 4) identify residual impairment of regional range of motion. Four separate groups of CLBP patients were evaluated: Group 1 (n = 92), unoperated men; Group 2 (n = 26), postdiscectomy men; Group 3 (n = 59), unoperated women; and Group 4 (n = 17) postdiscectomy women. Patients in each group were assessed for spinal range of motion measures at three points in time, for sagittal/coronal motion and validity (employing the relationship between pelvic motion and supine leg raising). Results demonstrated dramatic patient improvements in range of motion from initial referral to program completion. The most significant gains were made in pelvic motion, which returned to near normal levels, indicating that the vast majority overcame low effort or movement inhibition produced by pain or fear of injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Physical progress and residual impairment quantification after functional restoration. Part II: Isokinetic trunk strength.

The current study evaluated human skeletal muscle performance through isokinetic trunk strength testing before and after a comprehensive functional restoration program for a group of 191 chronic low back pain (CLBP) patients. Four groups of patients were identified: 1) postdiscectomy men (n = 26); 2) unoperated men (n = 90); 3) postdiscectomy women (n = 17); and 4) unoperated women (n = 58). Patient test scores were expressed as work normalized to body weight at 60 and 150 degrees/second. The absolute scores were also expressed as "percent normal" relative to a population average normative database (specific to age and gender). An "effort factor" based on the average points variance (APV) of computer-generated curves was also calculated. Results demonstrated improvements in trunk strength measures at all speeds in flexion and extension for all groups. All groups also demonstrated a decrease in APV mean scores after functional restoration, with only 1 of 191 patients remaining in the POOR effort (strength inhibited) group after treatment. The postoperative men showed the greatest effort improvement, with APV scores in the "good" range increasing from 57% to 91% of the group over the course of treatment. There was virtually no difference in gender-specific trunk strength scores between postdiscectomy and unoperated patients, either at program entry or program discharge. However, compared with the normative database of program completion, even in the presence of good effort, persistent residual (and, possibly, permanent) strength impairment was identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Physical progress and residual impairment quantification after functional restoration. Part III: Isokinetic and isoinertial lifting capacity.

There is currently a great need to expand the knowledge base of various functional capacity measures used in the rehabilitation of chronic low back pain (CLBP) patients. In the current study, the functional performance of lifting capacity differences among four separate CLBP patient groups were examined by using standardized isokinetic and isoinertial lifting performance measurements. One hundred ninety-three consecutive patients were assessed at three separate points in time: at initial evaluation (PRE), at admission to the intensive 3-week phase of a functional restoration program (ADM), and after program discharge and follow up (FU) (an average of 12 weeks later). Group 1 (n = 26) consisted of postdiscectomy CLBP men; Group 2 (n = 91) consisted of nonsurgical CLBP men; Group 3 (n = 17) consisted of postdiscectomy women; and Group 4 (n = 59) consisted of nonsurgical women. Results comparing admission scores to postdischarge scores revealed that all four groups demonstrated a significant increase (P < 0.01) in Liftask and progressive isoinertial lifting evaluation performance. Increases in performance were virtually identical for nonoperative and postoperative patients, with postdiscectomy men and women actually achieving peak isokinetic lifting forces higher than unoperated patients at the program's conclusion. This achievement in human performance was not found for the progressive isoinertial lifting evaluation test. Overall, these findings illustrate the utility of quantitative functional capacity measures, and provides objective evidence of the gains achieved by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Psychopathology and the rehabilitation of patients with chronic low back pain disability.

Recent research has clearly demonstrated the important role that psychopathology and other psychosocial factors can play in chronic low back pain disability (CLBPD). The purpose of this study was to evaluate whether diagnosed psychopathology is a significant limiting factor in the successful rehabilitation of patients with CLBPD. One hundred fifty-two CLBPD patients (97 men, 55 women) were given a structured psychiatric interview for official DSM-III-R diagnosis of psychopathology upon entering an intensive 3-week functional restoration treatment program. All patients were assessed for the presence of Axis I clinical disorders and Axis II personality disorders. They were subsequently tracked for 1 year after program completion, with treatment outcome being defined as return-to-work status at this 1-year time period. Results demonstrated that, though more than 90% of patients obtained at least one Axis I diagnosis, and more than 50% obtained at least one Axis II diagnosis, neither type nor degree of psychopathology were significantly predictive of a patient's ability to successfully return to work. These prospective study results suggest that if a treatment program is structured to appropriately manage psychopathology, as is the case of an intensive functional restoration program, then psychopathology does not have to interfere with successful treatment outcome.

Adult↗
PubMed1994

Effectiveness of a videotaped behavioral intervention for dental anxiety: the role of gender and the need for information.

The authors evaluated the effectiveness of a videotaped behavioral treatment program in reducing dental anxiety. They compared patients who witnessed the intervention videotape with patients who saw a placebo program and with a no-treatment control group. The subjects were 66 patients who visited a dentistry clinic for prophylaxis and general dental treatment. Groups were balanced for gender and level of preference for information as measured by the Krantz Health Opinion Survey--Information subscale. Self-report, physiological, and observed behavioral measures were assessed at specified times. Results demonstrated significant Group X Gender interaction effects during the different assessment periods, with men responding best to the treatment videotape, whereas women responded best to the placebo videotape. The level of information preference was found to a be a significant contributing factor at certain assessment periods. Overall, these results suggest that preparatory videotaped interventions are particularly effective in decreasing dental anxiety when patient characteristics are matched with characteristics of the intervention.

Adaptation, Psychological↗
PubMed1993

Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first?

Two hundred chronic low-back pain patients entering a functional restoration program were assessed for current and lifetime psychiatric syndromes using a structured psychiatric interview to make DSM-III-R diagnoses. Results showed that, even when the somewhat controversial category of somatoform pain disorder was excluded, 77% of patients met lifetime diagnostic criteria and 59% demonstrated current symptoms for at least one psychiatric diagnosis. The most common of these were major depression, substance abuse, and anxiety disorders. In addition, 51% met criteria for at least one personality disorder. All of the prevalence rates were significantly greater than the base rate for the general population. Finally, and most importantly, of these patients with a positive lifetime history for psychiatric syndromes, 54% of those with depression, 94% of those with substance abuse, and 95% of those with anxiety disorders had experienced these syndromes before the onset of their back pain. These are the first results to indicate that certain psychiatric syndromes appear to precede chronic low-back pain (substance abuse and anxiety disorders), whereas others (specifically, major depression) develop either before or after the onset of chronic low-back pain. Such findings substantially add to our understanding of causality and predisposition in the relationship between psychiatric disorders and chronic low-back pain. They also clearly reveal that clinicians should be aware of potentially high rates of emotional distress syndromes in chronic low-back pain and enlist mental health professionals to help maximize treatment outcomes.

Anxiety Disorders↗
PubMed1993

Optimal spinal strength normalization factors among male railroad workers.

In spite of increasing interest in techniques and devices for quantifying trunk strength and lifting capacity, relatively little research has been done to determine optimal normalizing factors for strength. The isolation of the ideal factors is a critical prerequisite for comparison of patient data to expected physical capacities in the uninjured population. In the present study, 160 incumbent railroad workers from four heavy laboring jobs were tested for isokinetic trunk strength and lumbar/cervical isokinetic lifting capacity as part of a study to establish normative data (Union Pacific RR, Omaha, NE). Three variables relating height and weight were studied to determine optimal normalization: actual body weight (BW), ideal weight (IW) and adjusted weight (AW). "IW" is actually a height/weight variable based on a weight control chart specifying ideal weights for given heights and genders. "AW" represents the lesser of BW or IW. Subjects were tested for isokinetic trunk extension/flexion for lumbar (floor-to-knuckle) and cervical (knuckle-to-shoulder) lifts. Results demonstrated that the isolated trunk strength tests showed the best correlation coefficients with BW for flexion-extension work at 60 and 150 per sec. Moreover, the correlation coefficients between the lumbar isokinetic lifting peak force measures and BW were high (ranging 0.49-0.67, P < 0.001), with much lower correlations for AW or IW. By contrast, cervical correlations between Liftask peak force and the height/weight variables were all lower, and were also better for AW than for BW or IW (ranging 0.37-0.50). It appears that body weight is the best normalizing factor for isokinetic trunk flexor/extensor strength and lumbar (floor-to-knuckle) lifting.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Noninvasive measurement of cervical tri-planar motion in normal subjects.

An electronic digital inclinometer was used to obtain normative data on cervical mobility from 58 normal subjects. They consisted of 28 males (age range, 17-61) and 30 females (age range, 19-62). The measurements were taken from occiput to T1 in flexion-extension, lateral bend, and axial rotation, isolating the regional motion by measuring simultaneously the upper and lower margins of the eight mobile segments. A comparison of radiographs and inclinometer measures showed excellent correlations (r < 0.9997, P < 0.05). Normative data are presented. Gender-specific regional mobility differences occurred only in cervical extension, whereas no consistent age-related differences were found. Stiffer individuals could be found in either gender or any age group, but rigidity in one plane did not necessarily predict rigidity in another.

Adult↗
PubMed1992

Reliability problems associated with the modified Schöber technique for true lumbar flexion measurement.

The modified Schöber technique, a method for assessing lumbar spine flexion, was subjected to an analysis of reliability. Fifty normal subjects (21 men, 29 women) were evaluated for lumbar flexion mobility using a blind inter-rater "worst case" protocol. Simultaneously, other sources of error affecting test reliability, such as presence of dimples of Venus, relationship of skin distraction to movement of underlying structures, and upper level of Schöber skin landmarks were also considered. Analysis suggested that systematic error can be introduced that adversely affects inter-rater reliability (r = 0.71). Moreover, skin landmarks are inconsistently present, being completely absent in 26% of cases. Skin tends to distract even over completely immobile bony structures (eg, the sacrum), whereas, on average, only 3.5 of the 6 spinal segments (T12-S1) are included in the Schöber technique for purported measurement of "lumbar spine flexion." The utility of this method is questioned on both scientific and clinical grounds.

Adult↗
PubMed1992

Managing anxiety and pain during dental treatment.

Behavioral techniques can teach patients how to cope with anxiety and tension while undergoing dental procedures. Practitioners need to know which technique best fits each patient. This report reviews the repertoire of procedures.

Behavior Therapy↗
PubMed1991

Effectiveness of a videotaped behavioral intervention in reducing anxiety in emergency oral surgery patients.

This study evaluated the effectiveness of a videotaped behavioral treatment program in reducing dental anxiety in emergency oral surgery patients. It compared a videotaped placebo program and a no-treatment control condition. Anxiety, measured for two periods during the study (an anticipatory phase just before oral surgery and a post oral surgery phase), was evaluated by means of self-report, physiological, and behavioral observation measures. Results revealed significant treatment group as well as Group X Sex interaction effects for the heart rate index of physiological arousal. Results also revealed that the treatment program was reported by subjects to be significantly more helpful than the placebo program. Overall, these results suggest that a short, videotaped behavioral intervention can have a positive effect on the oral surgery patient, and that the sex of the subject may be an important variable to be incorporated in evaluating the effectiveness of this type of treatment program.

Analysis of Variance↗