PubMed · 1899323
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E Hing, B Bloom. 1991. Long-term care for the functionally dependent elderly.. https://doi.org/10.2105/ajph.81.2.223
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BACKGROUND: The management of common low back pain has two principal objectives: to relieve acute pain and to attempt prevention of transition to chronicity. Several studies have shown the ineffectiveness of prolonged periods of bed rest. OBJECTIVE: To compare 4 days of bed rest with continued normal daily activity in acute low back pain, taking into account the type of work (physical or sedentary labor). METHODS: This open, comparative multicenter study enrolled 281 ambulatory patients, ages 18 to 65 years, with low back pain (onset < 72 hours). The subjects did not have pain radiating below the buttocks and did not have work-related injuries. They were randomized into two treatment groups: one instructed to continue normal activity (insofar as the pain allowed), and the other prescribed 4 days of bed rest. After inclusion, patients were seen at three visits: on day 6 or 7, after 1 month, and after 3 months. RESULTS: On day 6 or 7, pain intensity was similar for both groups, as was the overall judgment of the treatment by patients and physicians. At 1 and 3 months, the groups again had equivalent intensity of back pain, functional disability, and vertebral stiffness. A higher proportion of patients in the bed rest group than in the normal activity group had an initial sick leave (86% vs 52%; P < 0.0001). This difference was greater for the patients whose work was sedentary. CONCLUSIONS: For patients with acute low back pain, normal activity is at least equivalent to bed rest. The findings of this study indicate that prescriptions for bed rest, and thus for sick leaves, should be limited when the physical demands of the job are similar to those for daily life activities.
OBJECTIVE: To explore whether baseline memory and executive deficits predicted poor social and clinical outcome over the 2 years following a first admission for psychosis, regardless of categorical diagnosis. METHOD: Cognitive functioning was assessed in first-admitted subjects with psychosis (n=35) with a neuropsychological battery of tests measuring executive, language and memory functions. Social and clinical outcome were assessed at 6-monthly intervals over a two-year follow-up using multiple sources of information. RESULTS: A dose-response relationship was found between visual and verbal memory performance at first admission and clinical outcome over the 2-year follow-up: the poorer the memory performance, the more likely the risk of presenting with psychotic symptoms and rehospitalization. Poor baseline performance on the WCST executive function predicted better medication adherence. No association was found between cognitive performance and occupational or residential outcome. CONCLUSION: Cognitive performance was a better predictor of clinical than social outcome in this sample of first-episode patients. The association between cognitive deficits and poor social outcome may be more marked in subjects with chronic psychosis than in first-episode subjects. The finding that cognitive deficits predict better medication adherence is in need of further exploration.
Existing literature on the neurocognitive correlates of community functioning in schizophrenia has not adequately focused on the relationships among the correlated variables. In a sample of 40 outpatients with schizophrenia and related disorders, we studied two sets of variables that we expected to be related to broad ratings of community functioning: (1) the Wechsler Adult Intelligence Scale-III (WAIS-III) index scores for verbal comprehension, perceptual organization, working memory, and processing speed; and (2) positive, negative, disorganized and affective symptom variables. Of the WAIS-III index scores, working memory and processing speed entered a stepwise regression, together accounting for substantial variance in functional ratings (R(2)=0.37). However, only processing speed remained significantly associated with community functioning after controlling for the other indexes. In relation to community functioning, the remaining indexes appeared to be overlapping markers of general cognitive ability, rather than specific measures of discrete cognitive domains. Addition of positive and negative symptom variables in a further analysis greatly increased the explained functional variance (R(2)=0.65). Processing speed overlapped substantially with negative symptoms in predicting functioning, while the other WAIS-III indexes were independent of symptomatology. Results illustrate the importance of (1) knowing which neurocognitive variables have specific relationships to community functioning and which reflect the influence of more general cognitive ability in daily life, and (2) appreciating areas of overlap and independence among classes of correlates of functioning, such as neurocognitive and symptom variables. This improved understanding has implications for predictive models of community functioning, for cognitive rehabilitation and deficit compensation strategies, and for assessment practice.