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PubMed1994

Reliability of goniometric measurements of active arm elevation in the scapular plane obtained in a clinical setting.

Our purpose was to determine the intratester and intertester reliability of measurements of both scapular and glenohumeral rotation during active arm elevation in the scapular plane with a new device, the scapulohumeral goniometer (SHG). Ten physical therapists, with 1 to 29 years of clinical experience, obtained repeated measurements on 45 subjects who were 27 to 82 years old. All subjects were tested in a uniform standing position with the handheld SHG, which was positioned over the subject's scapula and posterior shoulder according to operationally defined landmarks. For both scapular and glenohumeral rotation, 50% of the time the first and second measurements made on a patient by the same physical therapist differed by 3 degrees or more. Ten percent of the time, these measurements differed by 8 degrees or more. Measurements of active range of movement of scapular and glenohumeral rotation made by the same physical therapist during arm elevation in the scapular plane are clinically unacceptable when obtained with the current techniques for positioning the SHG. Clinical decisions based on results of active scapular and humeral motion in the scapular plane as measured on a patient by the same therapist with an SHG should be made with caution, because of the variability associated with this procedure.

Adult↗
PubMed1995

Kinematic and electromyographic characteristics of children with cerebral palsy who exhibit genu recurvatum.

The objective of this article was to determine, using selected computerized gait analysis procedures, whether variation exists in the gait patterns of children with cerebral palsy who exhibit genu recurvatum. This descriptive study compared differences in kinematic, temporal-distance, and electromyographic (EMG) variables between two groups of children with cerebral palsy who exhibited genu recurvatum and age-matched controls. The setting was a motion analysis laboratory. Six children with cerebral palsy who showed genu recurvatum and a control group of four normal children participated in this study. Main outcome measures were hip-knee angle-angle diagrams, knee phase plane plots, knee angle versus time diagrams, stride length, cadence, single-limb support, and EMG data. Through use of hip-knee angle-angle diagrams, knee phase plane plots, and knee angle versus time diagrams, distinctive kinematic patterns emerged, allowing for grouping of subjects. Kinematic measures of knee angle at foot-floor contact and knee angle at greatest extension provided further support for the groups created, as did temporal-distance measures of stride length, cadence, and single-limb support. Analysis of variance procedures for the EMG data showed selected time points in the gait cycle during which differences between the groups were observed. Because differences in kinematic, temporal-distance, and EMG variables existed in this study to warrant grouping into two categories, physical therapists and orthopedic surgeons may need to vary the treatments they introduce dependent on the nature of the child's gait pattern.

Case-Control Studies↗
PubMed1998

Some comments on empirically supported treatments.

A number of developments have occurred in the field of psychotherapy in recent years. One pertains to the emphasis on empirically supported or validated therapies for specific psychiatric disorders. Although this emphasis on empirical support is a positive one, the creation of numerous forms of therapy for specific psychiatric categories, and the possible implication that training in such therapies becomes the basis for accreditation of university programs, is viewed critically. A focus on forms of psychotherapy also tends to diminish the importance of patient and therapist characteristics in producing positive outcomes. Future research needs to ascertain the variables that actually produce positive patient change.

Empiricism↗
PubMed1999

The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression.

This study attempted to replicate an earlier study (R. J. DeRubeis & M. Feeley, 1990) of the prediction of symptom change from process variables in cognitive therapy for depressed outpatients. Measures of in-session therapist behavior and therapist-patient interactions were correlated with prior and subsequent symptom change. One of the positive findings was confirmed, but the other received only marginal support. A "concrete" subset of theory-specified therapist actions, measured early in treatment, predicted subsequent change in depression. The therapeutic alliance was predicted by prior symptom change in 1 of the 2 later assessments, but only at a trend level. Several negative findings were similar to those obtained in the earlier study. Specifically, the alliance, an "abstract" subset of theory-specified therapist actions, and facilitative conditions did not predict subsequent change. Implications for causal inferences in psychotherapy process research are discussed.

Adult↗
PubMed2005

Occupational therapy during the first 10 years of rheumatoid arthritis.

OBJECTIVE: To describe disease development and occupational therapy during the first 10 years of rheumatoid arthritis (RA), and to assess patients' experiences of occupational therapy and comprehensive care. METHODS: A total of 168 early RA patients with variable disease severity were followed up with regular team visits. The occupational therapist evaluated hand function and activity and performed the necessary interventions. These were recorded and the number of visits generating interventions was calculated. Semi-structured interview of 11 patients regarding their views of occupational therapy and team contact was performed. RESULTS: Impairments of hand function were in general mild to moderate and remained fairly unchanged over time. Activity limitations increased slowly. Half of the follow-up visits generated interventions. Most common were prescriptions of assistive devices and orthoses, hand-training instructions and patient education. The patients interviewed were positive regarding occupational therapy and felt safe with comprehensive care. CONCLUSION: RA patients in all stages of the disease benefit from regular contact with an occupational therapist and team care.

Adult↗
PubMed1987

Some principles of an ecological model of the person as a consequence of the therapeutic experience with systems.

How do systems therapists' ideas of an individual differ from those of individually oriented therapists? Systems therapists are less interested in stable personality structures than in the contextual variability of a person's behavior. They think that although partnership may restrict, it also triggers the personality's development and shapes and models self-realization. The coevolution of partners can neutralize neurotic dispositions and can have a healing effect. On the other hand, it is the individual who largely decides in what systems he or she will participate, and to what extent and in which manner. In modern, Western society, personal regulations through social systems are becoming increasingly weaker, and the possibility for individuals to realize themselves in interactions is more and more restricted. According to an ecological model of the person, self-realization has to rely on relations to other persons in order to make it more real.

Attitude of Health Personnel↗
PubMed1978

Causes for the premature interruption of psychotherapy by private practice patients.

Thirty patients who discontinued private psychotherapy prematurely were evaluated. Factors stemming from the dynamic interaction between the patient and the treatment process were the most common reasons for dropping out, followed by chronic character traits such as impulsivity and masochism. It is hoped that this assessment of variables in the premature termination of therapy will serve to alert the therapist to the probability that treatment will be aborted, suggest which mechanisms will cause interruption, and enable the therapist to use preventive measures sooner.

Adult↗
PubMedDate not supplied

Exploratory analysis to identify factors impacting return-to-work outcomes in cases of cumulative trauma disorder.

Current findings suggest that cumulative trauma disorders are multifaceted and have less predictable outcomes than trauma cases. The purpose of this study was to attempt to identify emerging patterns and predictive relationships in this diagnostic group that might be worthy of eventual prospective research. The data source was a comprehensive electronic database containing clinical information collected at point of care over a four-year period. A retrospective analysis was performed on 459 workers' compensation cases with upper extremity cumulative trauma disorders and a subset of 312 with carpal tunnel syndrome. The outcome criterion was return to work as a dichotomous variable. Only two significant correlations with return to work were found: the therapist's estimate of rehabilitation potential and the patient's outcome expectation of the ability to work. Further investigation of the role of beliefs and expectations in the therapeutic process would be a productive area for prospective study.

Adult↗
PubMed1990

Can reliance be placed on a single meta-analysis?

Meta-analysis replaced statistical significance with effect size in the hope of resolving controversy concerning evaluation of treatment effects. Statistical significance measured reliability of the effect of treatment, not its efficacy. It was strongly influenced by the number of subjects investigated. Effect size as assessed originally, eliminated this influence but by standardizing the size of the treatment effect could distort it. Meta-analyses which combine the results of studies which employ different subject types, outcome measures, treatment aims, no-treatment rather than placebo controls or therapists with varying experience can be misleading. To ensure discussion of these variables meta-analyses should be used as an aid rather than a substitute for literature review. While meta-analyses produce contradictory findings, it seems unwise to rely on the conclusions of an individual analysis. Their consistent finding that placebo treatments obtain markedly higher effect sizes than no treatment hopefully will render the use of untreated control groups obsolete.

Bias↗
PubMed1992

Treatment integrity of relaxation training for tension headaches.

Treatment integrity procedures, generally lacking in previous research, were employed for evaluation of relaxation training for tension headaches. Treatment integrity is the extent to which the therapist implements the relaxation procedure as described, and the degree to which the patients comply with the therapist's instructions. Objective compliance with the home practice of relaxation training was assessed using a microcomputer-based method which required the patient to squeeze a hand control when instructed to tense a muscle. A single-case replication design with three tension headache patients was used. The dependent variables were taken from patients' self-reported daily headache data. Results indicate that: (a) the therapist accurately adhered to the relaxation training protocol; (b) headache frequency decreased in all patients from baseline to 1-year follow-up (improvements ranged from 72.7% to 98.2%); and (c) improvement was greater with higher compliance.

Adult↗
PubMed2005

[Patient and therapist satisfaction in outpatient psychotherapy].

Increasing attention is devoted to the patient perspective in mental health services research. Consequently, patient satisfaction has taken a prominent role and is frequently applied as an indicator of treatment quality and even outcome. However, the suitability of patient satisfaction for assessing quality of mental health services is doubtful, and there is a lack of longitudinal data especially for outpatient psychotherapy. By using data of the TRANS-OP study, we examine the course of patient satisfaction in outpatient psychotherapy over time and its predictors such as symptom change and duration of treatment. Furthermore, the relation between treatment satisfaction ratings of patients and therapists will be scrutinized. This study was conducted by the Center for Psychotherapy Research in Stuttgart (now Heidelberg) in cooperation with the Deutsche Krankenversicherung. N = 714 participants who applied for reimbursement of outpatient psychotherapy were consecutively recruited and asked to provide data at five (therapists two) measurement points during a two-year period. In line with previous evidence, high rates of patient satisfaction have been found, and also therapists appraised favorably the quality of their treatments. Course of patient satisfaction was found to be markedly stable over time. While some variables related to initial patient satisfaction, its course could hardly be predicted. Treatment outcome and session number moderately affected satisfaction at treatment termination. Concordance between patients' and therapists' satisfaction ratings was poor. Implications of these findings for research and practice are discussed.

Adult↗
PubMed1990

A cognitive developmental approach to variability in the psychotherapeutic process with adolescents.

Formulated from a cognitive frame of reference, psychodynamic therapy can be viewed as acting on one of the three aspects (feeling, thought, action) in order to influence or change the client's action and thought schemes. In this paper the consequences of the interaction of cognition and emotion for psychotherapeutic practice with adolescents are explored. Knowledge of cognitive development is supposed to be important for the therapist because, from Piaget's viewpoint, the structures of affect are cognitive structures. Moreover a great variability exists in cognitive development between adolescents. This variability is due to individual, family and social variables. The cognitive structural developmental model, the relation between emotional and cognitive development and the afore-mentioned variables are discussed. Consequences are psychotherapeutic practice with adolescents are described and short case histories are given. The authors conclude that in psychotherapeutic practice psychodynamic theory and cognitive structural theory can complete each other.

Adaptation, Psychological↗
PubMed1983

Effect of therapist expectations and need for approval on self-disclosure.

Previous therapy analogue studies of self-disclosure have treated Ss as a homogeneous group without examining possibly relevant S variables. In the present study, 68 female students identified as high or low in need for approval listened to a tape-recorded interview between a high self-disclosing therapist and a female client under one of two therapist expectation conditions: Clear expectation of high self-disclosure vs. ambiguous expectation. Ss then indicated on the Jourard Self-Disclosure Questionnaire the degrees to which they would be willing to disclose to the therapist. It was predicted that high need for approval Ss would disclose most under the clear expectation condition, while low need for approval Ss would not be affected by the therapist expectation. A significant Need Approval X Therapist expectation interaction supported this prediction. Further analysis indicated that items for the Work, Money, and Personality subsections of the disclosure questionnaire contributed most to the interaction. Implications for differential treatment of high need for approval Ss who were entering therapy were discussed.

Adult↗
PubMedDate not supplied

The effects of cue control relaxation on adults with severe mental retardation.

This study was designed to assess two aspects of behavioural relaxation training with subjects who have severe mental retardation. The first was whether or not cue words could be linked effectively to training so that they would eventually produce a relaxation effect in the absence of a full relaxation procedure. The second was to determine the effects of relaxation training and subsequent cue control on concentration and attention to an occupational task. Five subjects participated, and individual case designs were used. Cue Control, behavioural relaxation training (BRT), and new therapists were introduced at different times for each subject to ascertain the effects of each variable. Subjects were assessed at baseline and following each training session on a behavioural relaxation scale to judge the direct effects of relaxation training and on the amount of time spent concentrating on an occupational task. BRT produced reductions in rated anxiety and improvements in concentration for all subjects. The cue control words were effective only after they had been linked to BRT. In most cases, the introduction of a new therapist had no appreciable effect on anxiety or concentration. There was some suggestion that in the final cue only phases concentration was better and more consistent than during the BRT phases of the study.

Adult↗
PubMed1996

Prevalence and cost of alternative medicine in Australia.

BACKGROUND: To determine the prevalence and cost of alternative medicines and alternative practitioner use in an Australian population. METHODS: We conducted a representative population survey of persons aged 15 or older living in South Australia, which required 3004 personal interviews. We assessed the rates of use and types of alternative medicine and therapists used by this population in 1993, and correlations with other demographic and medical variables. FINDINGS: The overall use of at least one non-medically prescribed alternative medicine (excluding calcium, iron and prescribed vitamins) was 48.5%. The users were more likely to be perimenopausal females, better educated, have a higher alcohol intake, be of normal weight and more likely to be employed than non-users. 20.3% of respondents had visited at least one alternative practitioner, most commonly chiropractors (15%). The users of alternative practitioners were more likely to be younger, live in the country and be overweight. Women were more likely to consult naturopaths, iridiologists, and reflexologists than men. INTERPRETATION: Extrapolation of the costs to the Australian population gives a natural expenditure in 1993, for alternative medicines, of $621 million (Australian dollars) and for alternative therapists of $AU309 million per annum. This compares to the $AU360 million of patient contributions for all classes of pharmaceutical drugs purchased in Australia in 1992/93. The public health and economic ramifications of these huge costs are questioned in view of the paucity of sound safety and efficacy data for many of the therapies and products of the alternative medicine industry.

Adolescent↗
PubMedDate not supplied

Educational preparedness for physical therapists and occupational therapists in burn care.

The background of physical therapy (PT) and occupational therapy (OT) students in burn care training may be variable during their professional education. The purpose of this study was to evaluate whether professional programs in PT and OT are meeting the burn care educational needs of their students. PTs and OTs currently practicing in burn care were asked to give their opinion of the most important curricular topics related to burn care, report their perception of their own entry-level preparedness for burn care, recount therapy interns preparation for burn care internships, and recommend topics that should be included in a therapy program burn care curriculum. Therapists felt prepared in basic sciences and somewhat prepared in specific burn care practice topics. Study participants felt more prepared for burn practice if they completed an internship in burn care. Enhancing content on burn-related treatment interventions was the most common suggestion for curricular revision.

Adult↗
PubMed1996

Reliability of early motor function testing in persons following severe traumatic brain injury.

The purpose of this study was to determine the intra- and inter-rater reliability of selected variables measuring motor function in adults following severe traumatic brain injury (TBI). Twelve adults with a severe TBI participated in the study and were assessed (independently) by two physical therapists with extensive clinical experience. Standardized testing protocols and two- or three-point ordinal rating scales were used to evaluate the following categories of variables: primitive reflexes, equilibrium/protective reactions and several motor skills. Intra-rater reliability was generally high for all variables, with kappa values exceeding 0.65 except for the scoring of equilibrium reactions in sitting and standing. Overall, inter-rater reliability was slightly lower, with kappa values ranging from 0.39 to 1.0, indicating 'fair' to 'almost perfect' agreement. The highest level of agreement was consistently reported for the scoring of motor skills. These results suggest that physical therapists trained in the use of standardized testing and scoring procedures can reliably assess primitive reflexes, equilibrium and protective reactions and a range of motor skills in TBI adults during the acute stage of recovery. Moreover, the results provide important information which will assist in the interpretation of data collected as part of a concurrently conducted longitudinal study of early motor recovery.

Adolescent↗
PubMed2005

Variability of video-based clinical gait analysis in hemiplegia as performed by practitioners in diverse specialties.

OBJECTIVE: Clinical gait analysis is widely used by different therapists working with hemiplegic patients. The purpose of this study was to assess the reliability of video-based clinical gait assessment, as performed by practitioners in diverse specialties. DESIGN: Five neurologists, 5 physiotherapists, and 5 doctors of physical medicine and rehabilitation (physiatrists) were asked to study a videotape of 6 patients with hemiplegia in the act of walking. This activity was chosen due to the wide use of gait information for therapeutic prescription and medical decision-making during medical consultations, at conventions, or in exchanges between therapists. RESULTS: Results highlighted a certain inconsistency in the use of the gait description indicators. The 15 therapists used 396 different locutions to describe the gaits of the 6 patients. These locutions yielded 60 general indicators, or gait disorders, which were grouped in 5 categories. Eleven of them were classified as "controversial" due to the significant inter-subject variability of the evaluations. CONCLUSION: The study identified a large number of indicators that were used relatively inconsistently by the 3 specialties studied. The results of this study would appear to indicate that greater caution is needed when dealing with some of the "controversial" indicators, as well as with the "unusual" gait patterns observed in some patients.

Adult↗