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PubMed1992

Assistive technology device use in patients with rheumatic disease: a literature review.

Occupational therapists often prescribe assistive technology devices (ATDs) to assist persons with disabilities in performing daily living tasks. Estimates suggest that although most ATDs are used, a substantial proportion are never used or are discarded shortly after they are obtained. A review of the literature on ATDs was carried out to identify factors that contribute to ATD use and disuse. The review focused on persons with osteoarthritis and rheumatoid arthritis, because such persons are frequent users of ATDs. Although the literature review highlighted person-, environment-, and ATD-related factors as relevant to ATD use, it also underscored the dearth of scientific study of the prescription, provision, and use of ATDs. A model is proposed to guide empirical research aimed at identifying non-device users from the outset of treatment so that interventions to improve ATD use may be initiated or alternative interventions implemented. The variables comprising the model pertain to the patient, the patient's living environment, the therapist prescribing the device, and the device itself.

Activities of Daily Living↗
PubMed1998

Ventilatory care in a selection of Ontario hospitals: bigger is not necessarily better! Critical Care Research Network (CCR-Net).

OBJECTIVE: To determine whether there is variability in the structure and process of ventilatory care in intensive care units (ICUs) of the hospitals of Southwestern Ontario. DESIGN: Self-administered questionnaire-based survey. SETTING: ICUs of selected community and teaching hospitals of Southwestern Ontario. PARTICIPANTS: Head of respiratory therapy service of respective hospitals; in those hospitals without respiratory therapists, the ICU nurse manager. INTERVENTION: Self-administered questionnaire. OUTCOME MEASURE(S): The availability of different models of ventilators and respiratory therapist and physician coverage were assessed. In addition, the use of clinical practice guidelines, respiratory therapists, and the nursing role in ventilatory care were determined. RESULTS: In general, the structure of ventilatory care, including availability of different modes of ventilation, and coverage by respiratory therapists and physicians was more comprehensive in larger hospitals. However, the availability of some modes of ventilation varied more than expected among hospitals of comparable size. Similarly, variability in the process of ventilatory care, defined by the availability of clinical practice guidelines and the roles of respiratory therapists varied both within and among hospitals of different size. CONCLUSIONS: The structure and process of ventilatory care in this sample of Southwestern Ontario ICUs was found to be variable. Not all this variability could be accounted for by hospital size, suggesting a potential for improvement in overall ventilatory care. Further study is required before any specific recommendations can be considered.

Critical Care↗
PubMed1979

Specific vs nonspecific factors in psychotherapy. A controlled study of outcome.

This study explored the relative contribution of the therapist's technical skills and the qualities inherent in any good human relationship to outcome in time-limited individual psychotherapy. Highly experienced psychotherapists treated 15 patients drawn from a relatively homogeneous patient population (male college students, selected primarily on the basis of elevations on the depression, anxiety, and social introversion scales of the Minnesota Multiphasic Personality Inventory). By traditional diagnostic categories, they would be classified as neurotic depression or anxiety reactions. Obsessional trends and borderline personalities were common. A comparable patient group was treated by college professors chosen for their ability to form understanding relationships. Patients treated by professors showed, on the average, as much improvement as patients treated by professional therapists. Treated groups slightly exceeded the controls. Group means, however, obscured considerable individual variability.

Adjustment Disorders↗
PubMed2006

Rater bias in a blinded randomized placebo-controlled psychiatry trial.

Rater bias occurs when rater knowledge of treatment assignment modifies the outcome assessment. Raters may be unconsciously influenced by inclinations for or against a particular treatment and consequently may give a more or less generous assessment depending upon these biases. Blinding of raters by keeping raters unaware of treatment assignment is one way to limit bias influencing assessment due to knowledge of treatment assignment. Unblinding may be particularly problematic in efficacy studies comparing placebo to drugs and/or non-drug psychotherapy treatments where subjects may reveal drug side-effects or mention their therapist by name, thus unblinding their treatment assignment. We present a new instrumental variable statistical approach for assessing the association between success in blinding and its impact on efficacy estimates of active drug and/or cognitive behavioural psychotherapy versus placebo in the multicentre comparative treatment study of panic disorder. Despite the uncertainty involved in assessing bias that may be unobserved and unconscious, we will show how to derive a bound for the impact of rater bias.

Bias↗
PubMed2001

The component model of treatment in child and adolescent psychiatry: theoretical concept and empirical results.

The paper describes the theoretical concept and practical realization of the component model of treatment in child and adolescent psychiatry. Treatment procedures in a university department of child and adolescent psychiatry are analyzed based on a sample of 4545 patients in different settings (inpatient, day patient, and outpatient settings) and applying five different treatment components (individual psychotherapy with the patient, functional therapies, parent- and family-oriented interventions, other environmental interventions and psychotropic medication). These five treatment components were applied in variable combination to different disorders and in various settings. Treatment success based on therapists' ratings is described regarding a variety of ICD-9 diagnoses. Effect sizes were calculated for outpatient treatments (total sample 1682) and for inpatient treatments (total sample 1490). The effect size in the outpatient setting was 1.01 for normal completers vs. drop-outs, 1.27 for normal completers vs. non-beginners, and 0.34 for non-beginners vs. drop-outs. The corresponding effect sizes for inpatients were 0.74 for normal completers vs. drop-outs 1.27 for normal completers vs. non-beginners, and 0.84 for non-beginners vs. drop-outs. In spite of some methodological restrictions, the results of this naturalistic study can be used to improve empirically based treatment procedures under realistic clinical conditions.

Adolescent↗
PubMed1990

A controlled study of effectiveness and patient suitability for short-term group psychotherapy.

A controlled, clinical trial investigation of short-term psychoanalytically oriented group psychotherapy (STG) was conducted which included eight psychotherapy groups led by experienced therapists. Patient psychological mindedness (PM) was investigated as a selection criterion and prognostic variable. Seventy-nine psychiatric outpatients experiencing prolonged or delayed grief reactions were matched for level of PM and then randomly assigned to STG or a wait list. There was repeated measurement of several areas and sources of outcome. Results indicated a strong main effect for STG but not for PM on outcome, and minimal evidence for an interaction effect. Benefits were maintained at six-month follow-up. Psychological mindedness emerged as highly predictive of attrition. A clinical discussion is presented wherein the efficacy of STG is considered as reflecting a good patient-treatment match.

Adaptation, Psychological↗
PubMed2000

[Comparison of behavior characteristics of the spontaneously alert state and the liberated state in the term newborn].

Occupational therapists evaluate the capacities of infants at younger ages than ever before. The variability of the infants' state has an inevitable influence on the expression of their behaviours. In order to counter the effect of this instability, Grenier (1985) suggests inducing the "liberated state," which optimizes the infant's level of attention. The aim of this study was to identify the behaviours that discriminate this liberated state from the alert state (state 4) as described by Brazelton (1973). Some of the parameters that were defined in the Synactive Theory of Development Model (Als, 1982) were used in order to document the behaviours of the infants observed in the two different states. The average age of the infants, at the time of observation, was 62 hours. The duration of the observation was 5 minutes. Among the 54 newborns that were evaluated, 21 were observed in the two states under study; 33 were evaluated in one state only. The results confirm a greater stability of the "liberated state". Stress and self-regulation behaviours, and the need for external regulation are less frequent in this state; these differences are statistically significant (p < 0.05). Goal-directed movements are more frequent in the "liberated state" (p < 0.001). The authors suggest the use of the "liberated state" to further document the early capacities of infants.

Attention↗
PubMedDate not supplied

Therapists' attitudes as explanation of underservice of elderly in mental health: testing an old hypothesis.

The literature in mental health and aging has long argued that the presumably negative attitudes of therapists toward the aged are a major barrier to the aged receiving psychotherapy services. This investigation compared two measures of attitudes in a college student sample in order to test the reliability and validity of two commonly used measures of attitude in the general population. The same scales were then used in a sample of sixty-six mental health workers. The results suggest that Likert ratings and semantic differentials, although tapping a common dimension, differ in sensitivity to personal experience with the aged, that therapists had more positive beliefs about the elderly than did college students, and that therapist attitudes were not correlated with either proportion of elderly clients seen or desire to work with elderly. Work site emerged as an important predictor of numbers of elderly seen by therapists. It is argued that future research ought to focus on systems level variables in seeking to overcome barriers to therapy.

Adult↗
PubMed1989

A qualitative review of psychosocial treatments for bulimia.

This review covers 32 individual and group therapy studies of the psychosocial treatment of bulimia published between 1976 and 1986. Using 14 criteria to assess the quality of experimental methodology, three studies were rated as high, 17 as medium, and 12 as low. Common methodological problems included the failure to use a control group or to specify the experience level of the therapist, overreliance on self-report outcome measures, and small sample sizes. Great variability was found among studies in inclusion criteria, treatment length, and length of follow-up. Thirty-eight percent of patients in group therapy and 41.5% of those in individual therapy were totally abstinent from bingeing and purging at follow-up. Although most studies used behavioral or cognitive-behavioral strategies, no modality of treatment has shown clear superiority. The results are discussed in terms of their implications for treatment, training, and future research.

Behavior Therapy↗
PubMed1998

Personal, interpersonal, and organizational influences on student satisfaction with clinical education.

BACKGROUND AND PURPOSE: Understanding the factors that contribute to student satisfaction may lead to improved education in physical therapy. This study tested the extent to which variables in the personal, interpersonal, and organizational domains influence satisfaction with clinical experiences. SUBJECTS: Physical therapist students (N = 113) in 2 phases of their clinical experiences at one private school participated. METHODS: A nonexperimental design tested 3 models for predicting overall satisfaction. Students completed 3 surveys and weekly logs during 8-week-long clinical experiences. RESULTS: The survey return rate was 96%. Overall satisfaction with the clinical experience was predicted by life satisfaction, gender, off-site events, on-site events, interaction between negative events and gender, instructor teaching skills, interaction between education phase and gender, variety, and use of selected orientation methods. CONCLUSION AND DISCUSSION: Overall satisfaction is predicted by variables in all 3 domains. Overall satisfaction was best explained by factors in the interpersonal domain and student gender. Causal research is needed to confirm whether satisfaction can be improved and whether the results apply to other students at other schools. The relationships among satisfaction, performance, later job satisfaction, and career commitment need to be explored further.

Adult↗
PubMed2006

Manual forces applied during posterior-to-anterior spinal mobilization: a review of the evidence.

OBJECTIVE: The objective of this review was to evaluate the evidence for the consistency of force application by manual therapists when carrying out posterior-to-anterior (PA) mobilization techniques, including the factors that influence the application and measurement of mobilization forces. METHODS: Studies were identified by searching 6 electronic databases up to April 2005, screening the reference lists of retrieved articles, and contacting experts by e-mail. Relevant articles were defined as those that described the measurement of forces applied during spinal mobilization or discussed the reliability of measurement of manual forces. RESULTS: Twenty studies described the quantitative measurement of applied force during a PA mobilization technique, with most focusing on the lumbar spine. When defined by magnitude, frequency, amplitude, and displacement, PA mobilization forces are extremely variable among clinicians applying the same manual technique. Variability may be attributed to differences in techniques, measurement or reporting procedures, or variations between therapists or between patients. CONCLUSIONS: The inconsistency in manual force application during PA spinal mobilization in existing studies suggests that further studies are needed to improve the clinical standardization of manual force application. Future research on mobilization should include forces applied to the cervical and thoracic spines in addition to the lumbar spine while thoroughly describing force parameters and measurement methods to facilitate comparison between studies.

Evidence-Based Medicine↗
PubMed2000

An interpersonal model of psychotherapy: linking patient and therapist developmental history, therapeutic process, and types of outcome.

This study empirically evaluated a 3-stage causal model based on interpersonal theory that relates patient and therapist early parental relations, the therapeutic alliance, and outcome. Data were from the Vanderbilt II database and encompassed 64 psychodynamic psychotherapies. Interpersonal variables were assessed using the Structural Analysis of Social Behavior. Initial support for the model was found, suggesting a direct effect of patient early parental relations on process and outcome, a direct effect of therapist early parental relations on process, and a direct effect of process on outcome--and thus indirect effects of both patient and therapist early parental relations on outcome mediated by the process. The psychotherapy process was assessed from 3 perspectives: patient and therapist self-report and reports by independent observers. Little convergence was found between the 3 perspectives.

Adult↗
PubMed2004

The relation of client behavior and therapist helping skills to reduced aggression of boys in individual and group treatment.

In this study behavioral processes in the individual and group therapies of aggressive boys were compared and the relationship between these variables and treatment outcome was examined. Level of aggression was the outcome variable, measured by both self-report and teacher-report instruments. Hill's Client Behavior System (CBS; Hill, 1986) with our own ad hoc categories of Reference to Literary Figures and Response to Another, and therapist Helping Skills System (HSS; Hill & O'Brien, 1999) were the behavioral process measures. In terms of the boys' behaviors, discriminant function analyses revealed that Reference to Literary Figures and Response to Another differentiated the treatment formats; with regard to therapists' behaviors, Questions and Challenge differentiated the modalities. Results offered partial support for the greater effectiveness of group, compared to individual, therapy in reducing aggression. Outcome, however, as measured by teacher reports of aggression, was adversely affected in group therapy by the presence of specific behaviors in the boys. Implications of the findings for modifying the group therapy program as well as for the search for process variables appropriate to the treatment of aggressive children are discussed.

Aggression↗
PubMed2002

Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia.

OBJECTIVE: To measure the inter- and intra-rater reliability of cervical auscultation used alone to detect aspiration in dysphagic patients. SETTING: A university teaching hospital. DESIGN: Comparison of the detection of aspiration in 16 recorded swallow sounds by five speech and language therapists on two occasions. Swallow sounds were recorded simultaneously with videofluoroscopy. SUBJECTS: Sixteen patients referred for assessment of dysphagia with videofluoroscopy. RESULTS: The kappa statistic for multiple raters showed fair agreement between raters (kappa = 0.28). There was high agreement when aspiration occurred but in non-aspirating swallows there was significant overdetection of aspiration (p < 0.001 McNemar's test). The intra-rater reliability within different individuals was widely variable (kappa = 0.55 (range 0.31-0.85)). CONCLUSIONS: Presented with the swallowing sounds in isolation speech and language therapists cannot reliably classify swallows into those with accompanying aspiration and those without. There appears to be a problem of over detection of aspiration. Even in this small study, however, some individual therapists achieve such high reliability (kappa = 0.85) that they must be using successful internal criteria to interpret the swallow sounds correctly and further qualitative research may identify these.

Adult↗
PubMed1997

Perseveration and wandering as a predictor variable after brain injury.

Perseveration and wandering are well recognized sequelae of traumatic brain injury. They are believed to arise as a constellation of behaviours from lesions involving the frontal, temporal, or parietal lobes or subcortical motor regions. Attention and memory deficits are believed to contribute to the presence of perseveration and wandering. Patients who perseverate and/or wander after brain injury tend to have poorer outcomes and slower rates of progress. This prospective study is based on 32 consecutive admissions to a brain injury rehabilitation unit over a 4-month period. For each patient data was collected on perseverative behaviours, wandering, Functional Independence Measure, total number of rehabilitative days, supervision requirement at discharge and discharge disposition. Perseveration and wandering were assessed using the Agitated Behaviour Scale and clinical observations of the primary physician, physical and occupational therapist and speech-language pathologist. Correlations between perseverative and wandering behaviours were made with the variables identified.

Adult↗
PubMed1983

Learning style preferences of allied health practitioners in a teacher education program.

This article reports findings of a three-year study of learning style preferences of allied health practitioners in a university teacher education program. The Learning Preference Inventory (LPI) designed by Rezler and French was used as the survey instrument. Ten health fields were represented in the total population of 309 students who participated in the study. Analysis of variance was used to test the significance of the differences of the six LPI mean scores on abstract/concrete, teacher-centered/student-centered, and individual/interpersonal categories across the variables of age, sex, teaching experience, class location, class standing, and health field. Results of this study paralleled the findings of the 1975 Rezler and French study regarding medical technologists and physical therapists in that these two groups indicated they preferred concrete and teacher centered learning styles. Several other significant differences between health fields and other variables are discussed.

Allied Health Personnel↗
PubMed1996

Therapists' attitudes about addressing the role of exercise in psychotherapy.

A questionnaire was mailed to 250 psychotherapists selected from the National Register of Health Providers in Psychology to assess attitudes regarding the discussion of exercise in psychotherapy. Responses were received from 110 (44%) of this group. The study focused on (1) reasons therapists do or do not address exercise in therapy; (2) beliefs about the efficacy of exercise; (3) the relationship between theoretical orientation and the likelihood of discussing exercise; and (4) the relationship between gender and the likelihood of discussing exercise. We found that exercising therapists are more likely to raise the issue and discuss exercise with their clients. In addition, male therapists are more likely to discuss exercise with their male clients than with their female clients. Although cognitive-behavioral therapists are more likely than psychodynamic therapists to use a cognitive-behavioral approach, no relationship was found between exercise variables and primary orientation.

Adult↗
PubMed1979

An interpersonal communication analysis of relationship in psychotherapy.

In psychotherapy theorty, research, and practice, relationship has remained a controversial and elusive construct. Psychoanalytic theorists highlight transference-countertransference factors as central theoretical and technical components, but have yet to translate these constructs into a scientifically useful format. Rogerian theorists have consistently specified the relationship factors of positive regard, empathy, and congruence as "necessary and sufficient conditions" for constructive personality change in therapy and have evolved operational anchorings (e.g. Rogers, Gendlin, Kiesler, and Truax, 1967). Behaviorists (e.g., Wilson and Evans, 1978) conceptualize relationship factors as nonspecific variables which are important in enhancing the social influence and eliciting power of the therapist as an agent of change, while considering most client emotional responses toward the therapist as random factors which are generally irrelevant to the therapeutic process. My purpose in this paper is to offer a conceptual and empirical analysis of relationship in human behavior and in psychotherapy from an interpersonal communication perspective.

Communication↗