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PubMed1994

Isokinetic testing of ankle strength in older adults: assessment of inter-rater reliability and stability of strength over six months.

The study purposes were (1) to estimate the inter-rater reliability of isokinetic strength tests at the ankle in older adults (test-retest interval of three to 7 days), and to determine whether more experienced examiners were more reliable; and (2) to estimate 6 month stability of strength tests. Inter-rater reliability was high for plantar flexion and dorsiflexion tests where average strength was more than about 10 Newton-meters (Nm) (Pearson R = 0.87-0.95). When average strength was less than 10Nm, reliability was less (R = 0.42-0.75). Experienced examiners (physical therapists) and less experienced examiners (research assistants) were equally reliable. Variability in strength over 6 months was no greater than variability over a few days. We conclude that isokinetic tests of ankle strength in older adults are highly reliable and stable when examiners are adequately trained and subjects maintain usual physical activity levels.

Aged↗
PubMed1997

Performance of a video-image-subtraction-based patient positioning system.

PURPOSE: We have developed and tested an interactive video system that utilizes image subtraction techniques to enable high precision patient repositioning using surface features. We report quantitative measurements of system performance characteristics. METHODS AND MATERIALS: Video images can provide a high precision, low cost measure of patient position. Image subtraction techniques enable one to incorporate detailed information contained in the image of a carefully verified reference position into real-time images. We have developed a system using video cameras providing orthogonal images of the treatment setup. The images are acquired, processed and viewed using an inexpensive frame grabber and a PC. The subtraction images provide the interactive guidance needed to quickly and accurately place a patient in the same position for each treatment session. We describe the design and implementation of our system, and its quantitative performance, using images both to measure changes in position, and to achieve accurate setup reproducibility. RESULTS: Under clinical conditions (60 cm field of view, 3.6 m object distance), the position of static, high contrast objects could be measured with a resolution of 0.04 mm (rms) in each of two dimensions. The two-dimensional position could be reproduced using the real-time image display with a resolution of 0.15 mm (rms). Two-dimensional measurement resolution of the head of a patient undergoing treatment for head and neck cancer was 0.1 mm (rms), using a lateral view, measuring the variation in position of the nose and the ear over the course of a single radiation treatment. Three-dimensional repositioning accuracy of the head of a healthy volunteer using orthogonal camera views was less than 0.7 mm (systematic error) with an rms variation of 1.2 mm. Setup adjustments based on the video images were typically performed within a few minutes. The higher precision achieved using the system to measure objects than to reposition them suggests that the variability in repositioning is dominated by the ability of the therapist to make small, controlled changes in the position of the patient. CONCLUSION: Using affordable, off-the-shelf technology, we have developed a patient positioning system that achieves repositioning accuracy normally associated with fractionated stereotactic systems. The technique provides real-time guidance and can be used to easily and quickly correct patient setup before every treatment, thus significantly reducing overall random positioning error. This improved positioning capability provides the precision required to realize the potential gains of conformal radiotherapy.

Computer Terminals↗
PubMed1978

Reliability of goniometric measurements.

This study determined the intratester and intertester variability and reliability of goniometric measurements taken by four physical therapists on upper and lower extremity motions of normal male subjects. The same subjects were measured once weekly for four weeks by testers with varied experience in goniometry. Data were analyzed by analyses of variance with repeated measures. Intratester variation for all measurements was less than intertester variation. Further, intertester variation was less for the three upper extremity motions than for those of the lower extremity. These findings indicate the necessity for using the same tester when effects of treatment are evaluated. When the same tester measures the same movement, increases in joint motion of at least three to four degrees determine improvement for either the upper or lower extremity. When more than one tester, however, measures the same movement, increases in joint motion should exceed five degrees for the upper extremity and six degrees for the lower extremity to determine improvement.

Adult↗
PubMed1977

A-B status and sex stereotyping among psychotherapists and patients. Toward a model for maximizing therapeutic potential.

Previous studies indicate that mental health professionals, when evaluating the mental health of males and females, sex role stereotype to the disparagement of females. Some feminists have further assumed that male therapists in particular discourage self-actualization of females, and have argued that female patients should be seen by female therapists only. This study examined the major hypothesis that among both male and female therapists and among both male and female patients, there may be identifiable kinds of therapists and patients who sex role stereotype more than others. A total of 240 subjects (male and female) were recruited from three populations: professional psychotherapists, medical and nursing students, and psychiatric patients. Each subject was administered an A-B therapist scale and a sex role stereotyping questionnaire. Analysis of variance of this 3 x 2 x 3 factorial study revealed: a) patient groups stereotyped significantly more than professional therapist groups (p less than .01), with student groups stereotyping intermediately; b) within each major group, male subjects stereotyped significantly more than their female counterparts (p less than .01); and c) within each male group and within each female group, A status subjects stereotyped significantly more than B status subjects (p less than .01), with AB status subjects stereotyping intermediately. Previous research has indicated that A status psychotherapists are more effective in treating schizophrenic disorders, while B status therapists are more effective in treating neurotic disorders. Since our results reveal a strong relationship between A-B status and degree of stereotyping, our discussion explores the possibility of differentially matching psychotherapists and patients in order to maximize therapeutic potential. Matching could be done according to complementary differences between psychotherapist and patient (in terms of A-B status and sex role stereotyping) or according to similarities between psychotherapist and patient, depending on whether reconstructive or supportive therapy is the objective. Sex of patient and therapist as well as diagnosis of the patient are other variables considered in the model for maximizing the therapeutic potential.

Adult↗
PubMed1976

Marital therapy when one spouse has a primary affective disorder.

The authors explain why marital disharmony when one spouse has a primary affective disorder is difficult to treat but suggest that such couples can be treated successfully if the therapist is flexible and sets realistic goals. Because of the variability of the disease and the many unsubstantiated etiologies associated with it, the authors recommend a modified general system theory approach to treatment that includes a combination of psychotherapy and somatotherapy.

Bipolar Disorder↗
PubMed1997

Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. I. Study design, procedures, and management.

The design and conduct of a 9-month multi-center clinical trial to evaluate the safety and efficacy of subgingivally delivered 5% sanguinarium chloride (SC) and 10% doxycycline hyclate (DH) from a biodegradable drug delivery system in the treatment of adult periodontitis is described. The 3-group randomized study of 180 adults with moderate to severe periodontitis was a modified double-blind parallel design. One group received DH, one group received SC, and the other group received the vehicle control (VC). Patients selected had two quadrants with a minimum of four periodontal pockets > or = 5 mm in depth with two sites > or = 7 mm. All qualifying sites exhibited bleeding on gentle probing. Qualifying sites were treated at baseline and again at 4 months. Clinical response was assessed by measuring attachment level, probing depth, and bleeding on probing at monthly examinations at qualifying sites and the entire dentition. The plaque index was measured monthly to verify oral hygiene status. The parallel design afforded the opportunity to distinguish between treatment effectiveness of SC, DH, and VC independent of possible crossover effects. Also the effectiveness of oral hygiene in untreated sites of the mouth could be evaluated. Finally, treatment effects in moderate (5 to 6 mm) and deep (> or = 7 mm) pockets in both treated and untreated sites could be compared. The design was capable of simulating a periodontal practice maintenance program and assessing the response according to maintenance and treatment history. Study management procedures that emphasized center examiner and therapist training and adherence to protocol and procedures to reduce variability are described.

Administration, Topical↗
PubMed1991

An experimental analogue examining effects of facilitative behaviors and subjects' warmth on students' perceptions of a counseling relationship.

This study examined the effects of students' self-reported ratings on warmth and a female counselor's facilitative behavior on scores measuring the subjects' perception of the counseling relationship. 75 subjects were categorized as warm, neutral, or cool and then randomly assigned to either a facilitative or nonfacilitative counselor condition. Scores from the Barrett-Lennard Relationship Inventory indicate significant main effects for both subjects' warmth and the therapist's facilitative behaviors. In addition, significant interactions between these variables were obtained. The specific interpretations of these results are discussed and methodological issues are identified for further research.

Adult↗
PubMed1977

Cognitive mediators between patients' social class and therapists' evaluations.

Previous research has shown that therapists are more likely to accept middle-class than lower-class persons for psychotherapy and to rate middle-class patients more favorably than lower-class patients. One explanation that has been offered is that lower-class patients may not conceptualize their experiences in a manner compatible with traditional kinds of therapy. This study investigated several cognitive variables that could theoretically serve as mediators between patients' social class and therapists' differential evaluations--specifically, verbal intelligence, psychological differentiation, and locus of control. Therapists evaluated patients after the initial therapy session. Results indicated that psychological differentiation was a mediator for therapists' judgments of both patients' desire for structure and their suitability for psychotherapy. Similarly, a locus of control orientation emphasizing the role of chance functioned as a mediator of therapists' judgments of suitability.

Attitude of Health Personnel↗
PubMed1994

Assessing and programming generalized behavioral reduction across multiple stimulus parameters.

Generalization across three stimulus parameters was examined for 5 individuals whose self-injurious behavior was maintained by escape from task demands. Prior to treatment, three stimulus parameters (therapist, setting, and demands) were systematically varied across baseline sessions. These variables were held constant during treatment, which consisted of escape extinction. When treatment was completed, three novel stimulus parameters were probed. If the rate of self-injury was high during this probe, treatment was reimplemented with one new stimulus parameter (the other two were the same as in the original treatment condition). Following this second treatment, another probe with three novel stimuli was conducted. If the rate of self-injury was again high, treatment was implemented again while a second stimulus parameter was changed. This sequence continued until generalization was observed across the three parameters. Results showed idiosyncratic differences in generalization. The behavior of 2 subjects showed complete generalization during the first novel probe. A 3rd subject's behavior showed generalization following treatment across two stimulus parameters (setting and therapist). The behavior of the 2 remaining subjects showed a complete lack of generalization across the three parameters; both subjects required training for novelty by randomly varying the stimulus parameters for a substantial number of sessions.

Adult↗
PubMed1997

Students' perception of a difficult case in psychotherapy.

Paniagua, et al. suggested that the definition of a "difficult" case in psychotherapy implies a relational definition involving the characteristics of the patient, the case, and the therapist. This study concerned this hypothesis with 44 graduate students in social work who received the Difficult Case Questionnaire representing examples of variables across each domain, e.g., motivation of the client, nature of the disorder, generic factors, and orientation of the therapist. The results were compared with the 1993 findings reported by Paniagua, et al., for a group of professionals in mental health practice. As in the earlier study, the present sample also agreed that, although all such domains are important in the formulation of that definition, their importance is not equal. Whereas professionals rated patient's, case's, and therapist's characteristics as the most important order of domains in that definition, students in this study agreed on the order of therapist's, patient's, and case's characteristics.

Adult↗
PubMed2005

Therapists' communication styles and parents' global trust in the therapists: a comparison between Jewish and Bedouin parents.

PURPOSE: This study was designed to examine the level of global trust in therapists for two groups of Israeli parents, Jews and Bedouin, and to assess which of three interpersonal communication styles significantly explain global trust in the therapists. METHODS: A total of 193 parents of children ranging from six months to six years of age participated in this study. Parents' perceptions regarding their communication with the center's therapists were measured by 15 items clustered into three dimensions of communication: caring, collaboration, and interest. RESULTS: Parents of both cultural groups expressed high levels of global trust in the center's therapists. Jewish parents trusted their children's therapists significantly more than their Bedouin counterparts and ranked the therapists' caring and collaboration more highly. The communication style of caring was found to be the sole contributor to the variability in global trust. CONCLUSIONS: Effort should be undertaken to develop effective communication styles for the dimension of caring to increase therapists' ability to promote global trust in their patients' parents.

Adult↗
PubMed2005

Factors associated with the efficacy of a group intervention for anger in people with intellectual disabilities.

OBJECTIVES: There is a growing literature that suggests cognitive behavioural interventions aimed at reducing inappropriately expressed anger by people with intellectual disabilities are effective. However, interventions provide little information about which aspects of the individual or their treatment may be contributing to the overall efficacy of the approach. DESIGN: A group intervention is compared with a waiting list control. A cross-sectional regressional method was used to explore the relationship between change in a provocation inventory score over the course of an intervention and a number of other variables. METHODS: Data was collected from 50 participants who attended a series of groups with the aim of reducing aggressive behaviour. This was compared with a waiting list control of 36. Outcome was measured by a provocation inventory, which was administered pre-, post-group, and at follow-up. Other variables were also measured including, receptive vocabulary, age, gender, experience of primary therapist and whether staff accompanied participants to the group or not. RESULTS: A 2 x 2 split plot ANOVA identified a statistically significant treatment effect. However, analysis examining clinical significance was more equivocal with only 11 of the individuals in the intervention group showing reliable change as defined by Jacobson and Truax (1991). Regression analysis indicated that 17.5% of the variance in change of provocation inventory scores could be accounted for by the independent variables. Immediately on completion of the group, being accompanied by a member of staff and increased receptive language scores contributed significantly to the variance. CONCLUSIONS: A reduction in provocation inventory scores immediately after the group was more likely to occur if the participant was accompanied by a member of staff who knew them and if they had a higher score on the test of receptive vocabulary. This pattern changed with time. The implications of the results will be discussed and the relatively large amount of variance that is not accounted for will also be considered.

Adolescent↗
PubMed1996

Towards a theory of lumbar mobilisation - the relationship between applied manual force and movements of the spine.

Optimal use of lumbar mobilisation requires a theoretical knowledge of the mechanical effects that occur. When a mobilisation force is applied the target vertebra will move with accompanying intervertebral displacements at many intervertebral joints. In addition, displacements and deformations of other tissues will contribute to the movement of the skin surface under the therapist's hands. The responses can be quantified in terms of the movements of the skin surface (described by the force-displacement relation), the absolute movement of the target vertebra, or the relative intervertebral movements. There are at least seven variables related to the manner of application of the mobilisation force that can be controlled by the therapist to alter the nature of the response. The patient's response is also determined by a number of variables related to the mechanical properties of the tissues of the spine, extra-spinal structures and the interaction between the patient and the treatment couch. Currently there is a moderate amount of information available about the effects of technique variations but there is very little data to directly link variations in the properties of specific anatomical structures with variations in either absolute or relative spinal movements or tissue loads.

Journal Article↗
PubMed1997

Clinicians' predictions of length of psychotherapy.

The study examined therapists' accuracy in predicting the length of individual outpatient psychotherapy for 109 clients and attempted to identify variables associated with predicted and actual treatment lengths. The mean predicted treatment length (9.7 months) was significantly longer than the mean length of actual treatment (6.6 months). Therapists correctly predicted treatment length to the nearest month in 26 percent of the cases. Predictions were more accurate for older clients. Treatment tended to be shorter for clients with less than a high school education. Therapists more often predicted shorter treatments for clients with an adjustment disorder and those with less education. Predicting treatment length appears to be difficult.

Adjustment Disorders↗
PubMed1998

Imprecision in lower "inflection point" estimation from static pressure-volume curves in patients at risk for acute respiratory distress syndrome.

BACKGROUND: Static pressure-volume (PV) curves have been promoted as a tool for selecting positive end-expiratory pressure (PEEP) by identifying a lower "inflection point" (Pflex) from these curves. Their visual interpretation is subjective and difficult, however, particularly with subtle changes in the slope of the curves. This study was designed to examine the physician-to-physician variability in estimating the lower Pflex from these curves. METHODS: Static PV curves for eight patients were obtained within 24 hours of admission. Five intensivists and one respiratory therapist independently estimated the lower Pflex from these curves. RESULTS: Pflex estimates for individual patients were highly variable, ranging from 5 to 9 cm H2O. This variability was not attributable to a single discordant estimate, nor was a single physician responsible for consistently high or low estimates. CONCLUSION: Static PV curve interpretation with current methods imprecisely estimates the lower inflection point and is of limited usefulness in PEEP selection.

Humans↗
PubMed1998

Factors related to family therapists' breaking confidence when clients disclose high-risks-to-HIV/AIDS sexual behaviors.

This national survey of 309 marriage and family therapists examined what therapists do when their HIV-positive clients disclose that they are engaging in high-risk sexual behavior. The participants were given vignettes in which a fictitious client told the therapist about engaging in unprotected sex. Although the basic situations were the same, the client variables of age, gender, race, sexual orientation, and HIV status were systematically varied. The participants were more likely to break confidence regarding unsafe sex practices when their clients were male, young, gay, or African American. Moreover, therapists who were more likely to disclose were older, female, had less experience with gay/lesbian populations, were Catholic, were very religious, and were more likely to practice in urban areas. The authors discuss the implications of these and other findings.

Adult↗
PubMed2002

Characterization of tissue resistance during a dorsally directed translational mobilization of the glenohumeral joint.

OBJECTIVES: To quantify forces applied by therapists during dorsal glide translational mobilization of the glenohumeral joint, to determine the relationship of tissue resistance to the load-displacement relation of the glenohumeral joint, and to determine the safety of the forces applied by the therapists during dorsal glide translational mobilization. DESIGN: A fresh cadaver shoulder specimen mounted on a 6-axis load cell was used to register forces applied by therapists during dorsal glide translational mobilization of the glenohumeral joint in a test-retest pattern. SETTING: Biomechanics laboratory. PARTICIPANTS: Twelve experienced orthopedic physical therapists. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Forces exerted by therapists during passive dorsal glide translational mobilization in the loose-packed position and in the end range of abduction, with different grades of movements. The movements did not include any manipulation or thrust-type procedures. Simulated dorsal glide procedures were performed by the material testing system to construct the load-displacement curve of the glenohumeral specimen. The corresponding locations of the forces applied by therapists were interpolated and plotted on the load-displacement curve. RESULTS: The peak force values measured during mobilization were characterized by large intertherapist variability: coefficients of variation ranged from 40.97% to 77.49%. Test-retest reliability for intrasession measures was high (ICC(2,1) range,.90-.94); intersession reliability was poor (ICC(2,1) range,.01-.54). The mean forces ranged from 18.36 to 38.76N. When interpolated to the load-displacement curve, the mean peak forces obtained fell mostly in the toe and the linear elastic regions of the load-displacement curve. CONCLUSION: Force parameters measured during dorsal glide mobilization were characterized by large intertherapist variability with high intrasession and poor intersession test-retest reliability. The mobilization forces applied by experienced orthopedic physical therapists fall safely in the toe and the linear elastic regions of the load-displacement curve.

Adult↗
PubMed1976

Interviewee matching of interviewer temporal speech behaviors as related to perceived empathy, warmth, and genuineness.

The present study used an experimental analogue of the initial interview to examine the relationship of therapist durational speech characteristics to therapist empathy, warmth, genuineness and the state of the "therapeutic relationship" as rated by the interviewee. Cross-validated results revealed a modest direct relationship between interviewee speech modelling (DOU) and all process variables examined, with the exception of genuineness. Efficacy of the automated standardized interview as a research tool also was demonstrated. The results implicate the future examination of the relationship between therapist-client speech and silence measures and process variables.

Empathy↗