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At least 379 records · Page 21Linked to original sources
PubMed1999

Conditions not attributable to a mental disorder in Dutch psychiatric out-patients.

BACKGROUND: According to DSM-III-R V-code conditions refer to marital relationships, family circumstances, interpersonal relationships, or stressful life events that are not attributable to a mental disorder but that are the focus of treatment. The purpose of the present study was to assess the prevalence and patient and treatment characteristics of adult psychiatric out-patients diagnosed with V-code conditions. METHODS: The records of all 5660 consecutive admissions to a psychiatric out-patient clinic over a 12-year period were studied retrospectively. On the basis of both primary and secondary DSM-III-R diagnoses on Axis I, two subgroups of patients were compared: (1) patients with V-code conditions; and (2) patients with mental disorders. RESULTS: Fourteen per cent of the patients had a V-code condition and no mental disorder, while the remaining patients were diagnosed with mental disorder (with or without an additional V-code condition). Comparisons of sociodemographic and clinical severity characteristics of the two groups indicated that patients with V-code conditions tended to have a higher socio-economic status and to present with less severe problems as assessed both by the primary therapist and the Symptom-Checklist-90. With respect to service use and treatment outcome variables, it appeared that V-code patients tended to be more frequently treated by couple/family therapy and to receive a slightly lower number of treatment sessions. CONCLUSIONS: The pattern of results in The Netherlands seems comparable to results of previous North American studies. Implications of these findings for future studies and for use of mental health services are discussed.

Adult↗
PubMed1994

Stroke disability.

Stroke is the third leading cause of death in the United States and a major cause of disability in the elderly. Although the incidence of stroke is decreasing, its prevalence in the population is increasing because of enhanced survival and a growing elderly population. Estimating and understanding disability following stroke should be a high priority in health care. To better characterize stroke-related disability, physical therapists should use a conceptual model of disablement and measure functions across all domains of disablement (impairments, functional limitations, disability, and quality of life). Therapists need to use the measurements obtained and knowledge of stroke recovery and of the variables that influence this recovery to stage patients for prediction of outcomes. Using predicted outcomes to stage patients may result in effective treatment plans and more accurate targeting of intensive rehabilitation to those patients most likely to benefit.

Activities of Daily Living↗
PubMed2004

Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders.

OBJECTIVE: This study compared the effectiveness of short-term dynamic psychotherapy and cognitive therapy for outpatients with cluster C personality disorders. METHOD: Patients (N=50) who met the criteria for one or more cluster C personality disorders and not for any other personality disorders were randomly assigned to receive 40 weekly sessions of short-term dynamic psychotherapy or cognitive therapy. The most common axis I disorders in the patient group were anxiety and depression diagnoses. Therapists were experienced, full-time clinicians and were receiving manual-guided supervision. Outcome variables included symptom distress, interpersonal problems, and core personality pathology. Measures were administered repeatedly during and after treatment, and change was assessed longitudinally by means of growth modeling procedures. RESULTS: The overall patient group showed, on average, statistically significant improvements on all measures during treatment and also during a 2-year follow-up period. Significant changes in symptom distress after treatment were found for the group of patients who received short-term dynamic psychotherapy but not for the cognitive therapy patients. Despite these differences in intragroup changes, no statistically significant differences between the short-term dynamic psychotherapy group and cognitive therapy group were found on any measure for any time period. Two years after treatment, 54% of the short-term dynamic psychotherapy patients and 42% of the cognitive therapy patients had recovered symptomatically, whereas approximately 40% of the patients in both groups had recovered in terms of interpersonal problems and personality functioning. CONCLUSIONS: Both short-term dynamic psychotherapy and cognitive therapy have a place in the treatment of patients with cluster C personality disorders. However, factors other than treatment modality may discriminate better between successful and poor outcomes. Such factors should be explored in future studies.

Adult↗
PubMed1994

Designing studies to investigate client-treatment matching.

The process of designing studies of client-treatment matching involves a number of methodological complexities. Besides the large number of potential client characteristics and a range of possible outcome variables, a variety of treatment attributes can be matched including modality, intensity, duration, format, setting, therapist and goal. Hindsight matching designs (which can include hypothesis testing) examine interactions between client characteristics and treatments to which they were not intentionally matched. Foresight matching designs involve a prospective experimental test of a matching hypothesis, comparing the outcomes of cases matched by specific decision rules with other cases not so matched. Under certain conditions, these hindsight and foresight matching designs are logically equivalent. Mathematical modeling of clinical judgment offers yet another promising avenue for future studies of matching schemas. Glaser's core-shell strategy provides a practical model for implementing clinical systems and research on matching within ongoing services.

Alcoholism↗
PubMed1971

Modification of articulation errors of pre-delinquents by their peers.

Pre-delinquent peers in Achievement Place (a community based family style rehabilitation program based on a token economy) were given points (token reinforcement) to modify the articulation errors of two boys. In Experiment I, using a multiple baseline experimental design, error words involving the /l/, /r/, /th/, and /ting/ sounds were successfully treated by both a group of peers and by individual peers. Also, generalization occurred to words that were not trained. The speech correction procedure used by the peers involved a number of variables including modelling, peer approval, contingent points, and feedback. The individual role of each of these variables was not experimentally analyzed, but it was demonstrated that peers could function as speech therapists without instructions, feedback, or the presence of an adult. It was also found that payment of points to peers for detecting correct articulations produced closer agreement with the experimenter than when they were paid points for finding incorrect articulations. The results were replicated in a second experiment with another subject who had similar articulation errors. In addition, the second experiment showed that peer speech correction procedures resulted in some generalization to the correct use of target words in sentences and significant improvements on standard tests of articulation.

Journal Article↗
PubMed2002

Physical therapists' perceptions of factors influencing the acquisition of motor abilities of children with cerebral palsy: implications for clinical reasoning.

BACKGROUND AND PURPOSE: Evidence supporting factors predicting motor change for children with cerebral palsy is minimal. A consensus exercise using focus groups and survey methods was conducted to identify factors perceived to affect the acquisition of basic motor abilities among children with cerebral palsy from the time of diagnosis to 7 years of age. SUBJECTS: Fifty-seven physical therapists participated in one of 12 focus groups, and 60 physical therapists participated in a follow-up questionnaire survey via mail. METHODS: The nominal group technique was used to conduct the focus groups. RESULTS: Participants reached consensus about 12 factors in 4 constructs, which we called: (1) primary impairments (muscle tone/movement patterns, distribution of involvement, balance, and sensory impairment), (2) secondary impairments (range of motion/joint alignment, force production, health, and endurance), (3) personality characteristics (motivation), and (4) family factors (support to child, family expectations, and support to family). DISCUSSION AND CONCLUSION: The recognition of potential determinants of motor change could assist in the clinical reasoning that physical therapists use when planning interventions for children with cerebral palsy. Participants identified a set of variables, some of which are found in the literature, that can provide foundation knowledge for decision making and research on factors that bring about change in motor ability among children with cerebral palsy.

Attitude of Health Personnel↗
PubMed2003

Effects of orofacial myofunctional therapy on speech intelligibility in individuals with persistent articulatory impairments.

This study examined the effects of orofacial myofunctional therapy (OMT) on speech intelligibility in adults with persistent articulation impairments. Six adults in the age range of 18-23 years were selected to receive orofacial myofunctional therapy for a period of six weeks. The results showed that five out of six clients made significant progress in oral postures and speech sound production across all three speech production tasks: single words, sentences, and spontaneous speech. Speech intelligibility increased significantly in all clients except the one diagnosed with developmental apraxia of speech. Orofacial myofunctional therapists, speech-language pathologists, and other professionals need to rule out underlying orofacial myofunctional variables when targeting speech sounds for intervention. Speech production tasks may be considered as important measures to understand the efficacy of OMT in clinical settings.

Adolescent↗
PubMed1989

[Risk factors for three-unit bonded bridges].

Statistical methods of survival-analysis were applied to investigate the effects of anatomical factors and clinical procedures which determine the "life-time" of 3-unit adhesive bridges. Their influences were analyzed until the first loss of retention after insertion. Besides the therapist effect, increased mobility and macromechanical preparation of the abutments could be identified as significant variables. Bridges bonded to one non-mobile and one hypermobile abutment tooth were found to be especially threatened. Extensive macromechanical preparation of the hard tissues reduces the hazard of debonding remarkably; this effect may be replaced by improved retentive mechanism of retainers.

Acid Etching, Dental↗
PubMed1984

Some factors associated with compliance in the treatment of alcoholism.

The investigation set out to examine the extent of problems of low compliance at an alcoholism clinic, to investigate some variables that might differentiate referral failures and initial clinic attenders as well as categories of patients who attend for treatment, and to generate hypotheses concerning these differences as a means of developing a compliance-enhancement strategy. Information, including sociodemographic and personality variables, patient self-reports of drinking behaviour, self-perceptions of their need for help and of drinking problem severity, and therapist ratings of drinking problem severity, was gathered on one hundred referrals to a clinic for new patients. Results showed that 46% of patients were referral failures and that, in comparison with attenders, the former group had both waited longer for the initial appointment and were younger. Few variables differentiated the categories of attenders. A greater proportion of those remaining in treatment contact for longer than a month rated the change in their drinking problem over the previous year as 'worse' and more of them had been arrested for public drunkenness. Those who made five or more clinic visits had waited a shorter time for their initial appointment, and a greater proportion rated the effects of their drinking on their work as 'serious' and the change in their social life as 'worse' than patients who had made fewer visits. The findings suggest that variables related to personal perceptions of drinking problems offer a better account of compliance behaviour than the sociodemographic variables which have been the focus of previous research.

Alcohol Drinking↗
PubMed2003

Fatigability and variable-frequency train stimulation of human skeletal muscles.

BACKGROUND AND PURPOSE: The quadriceps femoris (QF) and tibialis anterior (TA) muscles are often activated through the use of electrical stimulation by physical therapists. These 2 muscles are fundamentally different in regard to their fiber-type composition. Whether protocols developed using a given muscle can be applied to another muscle has seldom been questioned, even if they differ in fiber type. The purpose of this study was to test the hypothesis that torque augmentation during variable-frequency train (VFT) stimulation as compared with constant-frequency train (CFT) stimulation in the fatigued state would not differ between these muscles, even though the TA muscle has 50% relatively more slow fibers than the QF muscle relative to each muscle's overall composition. SUBJECTS: Ten recreationally active men with no history of lower-extremity pathology participated in the study (mean age=25 years, SD=4, range=19-31; mean height=179 cm, SD=5, range=170-188; mean body mass=80 kg, SD=15, range=63-111). METHODS: The subjects' TA and QF muscles were stimulated with CFTs (six 200-microsecond square waves separated by 70 milliseconds) or VFTs (first interpulse interval=5 milliseconds) that evoked an isometric contraction. RESULTS: After potentiation, the torque-time integral and peak torque were not different for the VFT and CFT stimulation. Rise time was longer for the TA muscle than for the QF muscle and for CFT stimulation versus VFT stimulation (both approximately 40%). After 180 CFTs (50% duty cycle), peak torque decreased 56% overall, with no differences between muscles. Enhancement of the torque-time integral (25%) by VFT stimulation was not different between fatigued QF and TA muscles. Torque augmentation was due to the VFT stimulation evoking 27% greater peak torque and less slowing of rise time than the CFT stimulation (15% versus 30%). DISCUSSION AND CONCLUSION: The results indicate that the QF muscle may not necessarily fatigue more than the TA muscle. The results suggest that VFTs augment the force of fatigued, human skeletal muscle irrespective of fiber type.

Adult↗
PubMed1993

Reliability of the scores for the finger-to-nose test in adults with traumatic brain injury.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the intrarater and interrater reliability of measurements of three clinical features of coordination based on the performance of the "finger-to-nose" test. SUBJECTS: Thirty-seven persons with traumatic brain injury (26 male, 11 female), aged 17 to 64 years (mean = 29.1, SD = 9.9), participated in the study. METHODS: Each subject's performance was videotaped and evaluated for the right and left upper extremities (UEs) (two trials each) with respect to the following variables: time of execution, degree of dysmetria, and degree of tremor (four-point ordinal ratings). One year later, five experienced physical therapists (including the original investigator) independently rated each patient's videotaped performance in the same manner as described above. RESULTS: Intraclass correlation coefficients (ICC[3,1]) for intrarater reliability were .971 and .986 and ICCs for interrater reliability were .920 and .913 for right and left UEs, respectively, for the time of execution. A generalized Kappa statistic of .54 was calculated for the scoring of dysmetria (both UEs), and Kappa statistics calculated for the scoring of tremor were .18 and .31 for right and left UEs, respectively. Interrater reliability was lower for the scoring of these variables and varied from .36 to .40 for dysmetria and from .27 to .26 for tremor (right and left UEs, respectively). CONCLUSION AND DISCUSSION: These results indicate that physical therapists demonstrate low reliability in assessment of the presence of dysmetria and tremor using videotaped performances of the finger-to-nose test. The results suggest, however, that therapists reliably measure the time of execution of this test. If the limitations associated with therapists' capacity for objective measurement of subjective phenomena cannot be overcome (eg, by establishment of more definitive scoring criteria for the measures of dysmetria and tremor), then therapists should seek alternative methods of evaluation of UE coordination.

Adolescent↗
PubMed1981

An empirical investigation of psychotherapy with schizophrenic patients.

We examined the experience of schizophrenic patients who had been in psychotherapy for 1 year or longer. Therapists and their patients in a university-affiliated community mental health center were interviewed. One year later, followup interviews were conducted. Characteristics of participating patients, descriptions of therapy, behavioral changes, and relationships among these variables are reported. A comparison group of schizophrenics not in psychotherapy was interviewed once. The schizophrenic patients who maintain psychotherapies are isolated and quite impaired. Most patients and therapists report that psychotherapy helps; but there is little evidence of improved social functioning. Therapies that are associated with improved patient behavior are often conducted by more experienced therapists, and participants describe the therapeutic relationship in similar terms. Therapies without associated improvement are described in dissimilar terms by the participants. Results support the thesis that the process of psychotherapy with schizophrenics is related to outcome. Implications for training residents are discussed.

Adult↗
PubMedDate not supplied

Perceived risk: effects on reaching and placing performance in persons with cerebrovascular accident.

OBJECTIVE: Developing useful movement with the affected extremity in persons with cerebrovascular accidents (CVAs) is a common occupational therapy goal. The purpose of this study was to examine the effects of perceived risk in an occupational form on upper-extremity movement dynamics in persons who have had CVAs. METHOD: Twenty-eight persons (M = 69.6 years, SD = 15.6 years) with post-CVA participated in the randomly assigned, repeated measures counterbalanced study. In the higher risk condition, participants reached for and grasped a raw egg in an egg carton, transported it, and placed it in a bowl with other raw eggs. The same procedure was completed in the lower risk condition with weight-matched plastic eggs. Participants completed both conditions with their affected and unaffected upper extremities. Dependent variables included total movement time and movement units. RESULTS: The higher risk condition produced statistically significantly longer movement times (p < or = .001), but no difference in movement units (p > .05) compared to the lower risk condition. The affected extremity had significantly longer overall movement times (p < or = .001), but no difference in movement units (p > .05) compared to the unaffected extremity. CONCLUSION: When higher levels of perceived risk are present in an occupational form, slower movements are elicited among persons who have had a CVA. The occupational therapist can grade tasks from relatively lower risk to tasks with relatively higher risk to help patients achieve desired variability in their movement patterns. By doing this, the patient will be better prepared for everyday situations that vary widely in degree of risk.

Adult↗
PubMed2002

The appropriateness of the MMPI-2 K correction.

The extent to which the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) K scale serves as a suppressor variable that influences the validity of clinical scale scores was examined using 274 male and 425 female outpatients from a community mental health center and 105 male and 247 female clients from a university psychological clinic. Hierarchical regression analyses were performed with MMPI-2 K scale scores and clinical scale scores as predictors and therapist ratings as criteria. In most cases, the K scale did not act as a suppressor Optimal K weights were different from the traditional K corrections. In most instances, there were no significant differences between correlations of therapist ratings with K-corrected and uncorrected clinical scale scores. The results do not support the K scale as a suppressor variable in these settings, although additional research is needed in settings where higher levels of defensiveness are common.

Adult↗
PubMed1989

[The influence of the therapist's personality on the effect of group psychotherapy].

The paper is based on an all-year survey in the course of which the therapists of the psychotherapeutic department for neuroses were divided into two teams of four which differed significantly in some personality characteristics, in particular dominance, extroversion, directiveness and warmth. The authors investigated the influence of differences in these personality variables on the therapeutic results of eight closed patient groups. The results of the work provide evidence that the investigated differences in personality and behaviour of the therapists did not significantly influence the symptomatic effect of six-week group therapy of neurotic patients. Only differences in self-recognition of patients were found. A significantly greater gain in this sphere was recorded in patient groups which had more permissive therapists.

Humans↗
PubMed1999

Subjectivity in interpretation of portal films.

PURPOSE: We have measured the variability in identifying geometric errors and the variability in clinical decision making when using portal films. METHODS AND MATERIALS: Eight observers (four radiation oncologists and four radiation therapists) viewed 40 film pairs from 40 different patients. All films, which were acquired using conventional simulator and portal film cassettes, were selected retrospectively from a large clinical database. The observers compared the simulator and portal films under standard conditions, identified the field placement errors, and decided whether adjustments in treatment were required. In addition, all films were digitized and the field placement errors were measured objectively using image registration software. RESULTS: There was much variability in identifying field placement errors and even more variability in the number of recommended adjustments. The field placement errors identified by the different observers differed by up to 50 mm for the same film pair. The number of adjustments of treatment or block position recommended by the observers also varied between 8 and 25 for the same set of films. The average field placement error, before correction, for AP lung, AP pelvis, and lateral pelvis films was 5.7 mm, 6.3 mm, and 8.9 mm, while the average error after correction (i.e., correcting all errors identified by the observers) was 5.5 mm, 4.9 mm, and 5.7 mm, respectively. Thus, for lateral pelvis films, where the initial errors were larger, the observers were able to make an improvement in patient setup. CONCLUSIONS: The results suggest that human observers have difficulty identifying field placement errors accurately when the errors are around 5 mm or smaller. Although there is some evidence that experience influenced the performance of the observers, the effect of experience is not large. In routine clinical environments, the use of visual inspection will detect large field placement errors. However, tools other than visual inspection will be required if field placement errors 5 mm or smaller are to be identified accurately.

Decision Making↗
PubMed1994

[When patient and therapist disagree--discrepancies in evaluation of change].

The following study concerns the interaction of different measures for therapeutic change. 1377 inpatients of a psychosomatic hospital were examined. Measures for change were the subjective global rating of the inpatient, the subjective global rating the psychotherapist, and the Symptom-Check-List SCL-90-R. To get additional information for possible predictive variables for discrepant judgements, also personality questionnaires and sociodemographic variables were considered. Results demonstrated only medium correlations between subjective ratings for change of the patient and the psychotherapist, although the same categories were used (R = 0.44). The correlations to measures of change of the self-rating-scales are even lower. Therefore we conclude that these measures focus to different information, because the common part of variance is low. Discrepancies between the judgement of therapists and patients can be found after all when the patient makes a negative rating. Predictive variables for discrepancies of the judgements for change of the psychotherapists and patients are: age, sex, phobic anxiety and bodily complaints. While younger patients tend to make better judgements than their therapists we find the contrary for elder patients. Women tend to make better judgements than their psychotherapists. We find also discrepancies in patients with multiple syndromes, when phobic anxiety and bodily complaints exist and are perhaps not adequately concerned in the psychotherapy.

Adult↗
PubMed1999

"Between-group psychotherapy outcome research and basic science" revisited.

Case studies involving the measurement of every plausibly causal variable and every important outcome variable and covering the widest possible range of cases in terms of these variables are the highest priority for psychotherapy research. Such case studies looked at together will give us the best initial understanding of what variables are probably causal and what treatments yield the best results for particular kinds of patients, therapists, and settings. The accumulation of such case studies will show us where we would benefit by doing comparative controlled experiments of distinct therapies or by employing optimum-seeking designs for a particular therapy. Collaboration by the practitioner community will be needed to do this. The truly difficult and necessary work of applied psychotherapy research still lies ahead of us, hardly touched.

Analysis of Variance↗