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Exercise-based rehabilitation for injured workers: programme efficacy and identification of factors predicting programme completion and outcome.

A sample of 355 injured workers presenting to a tertiary referral agency for supervised physical activity programmes were assessed for programme completion and changes in work status at the conclusion of the programme. Seventy-five percent of the sample comprised long-term (i.e. greater than six months) injured workers, of whom 45% were unemployed at the commencement of the programme. There was a 15% dropout rate and 49% of completers improved their work status at the end of the programme. A series of stepwise logistic regression analyses were conducted to identify predictors of dropout and improved work status. Joint pathology was the only predictor of dropout. Preprogramme work status, referral source, intervertebral pathology, and time between injury and commencement of the programme predicted post-programme work status. Those workers who were employed, referred by sources other than rehabilitation providers, such as doctors, employers or insurers, did not have a diagnosis including intervertebral pathology and who began their programmes within six months of injury were more likely to improve their work status at the conclusion of the programme. Other factors including age, gender, occupation, insurer category, location of injury (i.e. lumbar or other), and neurological signs predicted neither programme completion nor change in work status.

Adult↗

Encapsulating peritoneal sclerosis in Japan: prospective multicenter controlled study.

OBJECTIVE: Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of peritoneal dialysis. The aim of this study was to determine the incidence, clinical features, and variation in mortality rates for EPS. DESIGN: A prospective multicenter design was used, in which peritoneal dialysis patients were pre-registered by facilities across Japan and the incidence of EPS was observed in the registrants. The registrants were followed for a total of 4 years to accurately observe the onset of EPS. RESULTS: As of April 1999, 2216 peritoneal dialysis patients from 64 facilities were registered. By the end of March 2001, 332 patients had dropped out, and 17 of the dropouts had developed SEP. The incidence was 0.77%. After excluding 110 patients who died, the incidence in 2106 patients was 0.81%. The incidence of EPS increased with the duration of peritoneal dialysis. Of the 17 patients with EPS, 12 developed the condition after discontinuing peritoneal dialysis and changing to hemodialysis. During the 2-year survey period, 6 of the 17 EPS patients died. The interval from onset to death was 10.8 +/- 5.8 months (range: 3-19.5 months). CONCLUSIONS: From this prospective multicenter study, the current incidence of EPS is 0.77% (0.81% when dropout owing to death is censored). After a follow-up of 2 years, we conjecture that the incidence of EPS will increase. The incidence, etiology, and prognosis of EPS will be further clarified by periodic observation of dropouts until the end of March 2003.

Adult↗

[The impact of substitution treatment by methadone among opiate-dependent subjects evaluated by Addiction Severity Index and by urine tests].

Methadone maintenance treatment (MMT) has been evaluated in the United States and in a few other countries. MMT has been developed in France since 1995, and over 5 000 patients receive this treatment. However no French study has yet been published on the efficacy of MMT as assessed by a validated scale. Retention in treatment for one year has been considered as a threshold to define maintenance of treatment benefits after discharge from a methadone program; determination of retention predictors is important. Over a three year period, we evaluated patients at admission and during treatment using the Addiction Severity Index (ASI), and urine drug screening was performed weekly; 95 patients (66 males and 29 females) were evaluated at intake. Their mean age was 30.2 5.5, and they had used opioids for a mean of 10.6 5.7 years. Their ASI severity scores for drugs were over 5, showing a clear need for treatment. Female patients differed from males only in the employment-finances ASI score; 43 patients completed at least one year of treatment, after which their drug and legal composite scores significantly improved. No significant changes in their consumption of cocaine, alcohol, benzodiazepines or cannabis were found, but they smoked fewer cigarettes at 12 months. Demographics, ASI severity scores, and history of suicide attempts did not differentiate one-year completers from dropouts (n=16). However, dropouts had used more buprenorphine and less methadone in the 30 days preceding their admission, and they received a lower dose of methadone during treatment. Our population is comparable to other French MMT populations; they enter treatment after a long history of opioid dependence. The improvement found on the ASI composite scores is also similar to the improvement described in other international studies. Dropouts in our study seem to be more treatment-resistant patients, in the sense that they had used more buprenorphine before intake and were not stabilized with it; and they may have had a more negative attitude towards methadone.

Adult↗

Long term follow up study of prognostic significance of exercise duration during treadmill stress test in patients with stable coronary heart disease.

Treadmill stress tests provide useful noninvasive prognostic information in patients with coronary heart disease (CHD). The present study has prospectively analysed the long term prognostic value of exercise tolerance as measured by exercise time during treadmill stress test in 335 consecutive patients with stable CHD. 161 had exercise time of 6 minutes or less (mean 4.58 +/- 1.54 minutes) on a modified protocol (Group A) and 174 had exercise time of more than 6 minutes (mean 9.30 +/- 0.74 minutes)(Group B). Both groups were matched for major coronary risk factors (hypertension, smoking, diabetes and cholesterol levels) and type of drug therapy (betablockers, nifedipine, diuretics and aspirin). The patients have been followed up for upto 9 years with a mean of 6.28 +/- 2.99 years (Group A) and 7.87 +/- 1.98 years (Group B). Actuarial analysis shows that the overall survival after dropout due to death or coronary artery bypass surgery was significantly lower in group A [dropouts = 66 (41.0%)] than in Group B [dropouts = 19 (10.9%)] (Logrank test = 39.94, p < 0.001). The mortality was significantly higher in Group A with 58 deaths (36.0%) as compared to Group B with 16 deaths (9.2%) (x2 = 34.98, p < 0.001). The crude death rate was 5.73% per year in Group A as compared to 1.17% per year in Group B. The incidence of sudden deaths was also higher in Group A with 28(17.4%) instances as compared to 5(2.9%) in Group B (x2 = 19.85, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

Fluorescein angiographically evident diabetic maculopathy.

Diabetic maculopathy seen in the Philippines, specifically, the associated factors, the various lesions seen on fluorescein angiography, and the visual acuity associated with these lesions were characterized using 127 patients (254 eyes) with diabetic retinopathy based on the fluorescein angiography done at the Eye Referral Center in 1993. Results showed that 116 (91.34%) patients have maculopathy, the majority of which is bilateral (84.25%). Age (p=0.675), sex (p=0.357), hypertension (p=0.742), duration of diabetes (p=0.778) and myopia (p=0.742) were not significantly associated with maculopathy. However, severity of retinopathy (p=0.001) was significantly associated with it. Fluorescein angiographic findings are macular staining (83.86%), perifoveal capillary dropout or macular ischemia (10.76%), and preretinal traction and membrane (5.38%). Microaneurysm (72.65%) is the most common lesion associated with macular staining, followed by capillary leakage (4.04%), cystoid macular edema (3.59%), perifoveal capillary dropout with microaneurysm (2.24%), and capillary with microaneurysm leakage (1.34%). Exudates are associated with microaneurysm, perifoveal capillary dropout or a combination of the two. Vision was found to be marginally statistically different between the normal and maculopathy group (p=0.0505). The worst vision was seen in macular ischemia and preretinal traction and membrane, with mean visual acuity of 0.18 and 0.25, respectively. It is concluded that severity of retinopathy is the only variable significantly associated with maculopathy in this study. Good vision does not necessarily indicate a normal macula. Detailed examination and fluorescein angiography should be carried out, regardless of duration of diabetes.

Adult↗

[Lamotrigine in refractory epilepsy].

INTRODUCTION: Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. AIMS: We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. PATIENTS AND METHODS: We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction>50% of the seizures), inefficacy (reduction<50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). RESULTS: In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 +/- 13.7 years; mean follow up time: 27.6 +/- 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 56.4%:23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. CONCLUSION: Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate.

Adolescent↗

Vaccination coverage survey in Dhaka District.

A survey was conducted in Dhaka District to measure the level of routine immunization coverage of children (12-23 months), to assess the tetanus toxoid (TT) immunization coverage among mothers of children (12-23 month), to evaluate EPI program continuity (dropout rates) and quality (percent of Invalid doses, vaccination card availability etc.) For this purpose, a thirty cluster cross-sectional survey was conducted in October 2002 to assess the immunization coverage in Dhaka. In this survey 30 clusters were randomly selected from a list of villages in 63 Unions of Dhaka following probability proportion to size (PPS) sampling procedure. A total of 210 children was studied using pre-tested structured questionnaire. Descriptive statistics was employed using software SPSS package for data analysis. The study showed that the routine immunization coverage in Dhaka among children by 12 months of age by card + history was 97% for BCG, 97% for Diphtheria, Pertussis Tetanus (DPT 1) and Oral Polio Vaccine (OPV 1), 75% for DPT3 and OPV3 and 67% for measles. Sixty six percent of all children surveyed had received valid doses of all vaccines by 12 months (fully immunized child). Programme access as measured by crude DPT1 coverage was better in Keranigonj (97%). Vaccination cards retention rate for children was 84%. Invalid DPT (1,2 or 3) doses were given to 25% of vaccinated children; 18% of measles doses were invalid. Surprisingly, major cause for invalid doses were not due to early immunizations or due to card lost but for giving tick in the card, instead of writing a valid date. DPT1 and DPT3 and DPT1- Measles drop out rates were 5% and 13% respectively. Major reason parents gave for never vaccinating their children (zero dose children) was (43%), major reasons for incomplete vaccination was lack of knowledge regarding subsequent doses (46%). TT surveys were also conducted for mothers of the children surveyed for vaccination coverage (mothers between 15-49 year old). Valid TT 1-5 coverage by card+ history was 97%, 55%, 44%, 24% and 11%, respectively. Card retention rate for TT was 67%. The findings of this study revealed that access to child and TT immunizations were good. But high dropouts and invalid doses reduced these percentages of fully immunized child to 66%. Programmatic strategy must be undertaken to reduce the existing high dropout rate in both child and TT immunizations.

Adolescent↗

[Postoperative pain therapy. The efficacy of a serotonin antagonist (GR 38032F;ondansetron) and the prostaglandin synthesis inhibitor lysin acetylsalicylate (Aspisol)].

Serotonin is one of the many neurotransmitters involved in nociception. Serotonin antagonists may therefore reduce postoperative pain. In the present study we examined whether the new 5-HT3 receptor antagonist GR 38032F (ondansetron) reduced postoperative pain after minor surgery and compared its effectiveness with that of lysin acetyl salicylate (Aspisol). METHODS. A series of 100 patients of both sexes who were undergoing minor surgery were enrolled in this study. Patients who did not need analgesic medication within the first 3 h after surgery were regarded as "dropouts", and the rest were studied for 24 h. In a preliminary study (n = 19) patients received ondansetron i.v. in increasing dosages (6, 12, 24, 48, 96 and 128 micrograms.kg-1) to evaluate the analgesic potency of this drug. In the main double-blind, randomized, study (n = 81), three groups were formed, and patients received 50 micrograms.kg-1 or 100 micrograms.kg-1 ondansetron i.v. or saline only i.v. Analgesia was evaluated by visual analogue (VAS) and verbal rating scales (VRS). If pain persisted patients received 1.8 g lysin acetylsalicylate (LAS) i.v. RESULTS. There were 6 (out of 19) patients in the preliminary study and 36 (out of 81) patients in the main study who were dropouts; that is to say they did not require any analgesic medication within the first 3 h, but 12 of these dropouts needed analgesic medication more than 3 h after end of surgery. Pain was reduced by 82% from baseline in 7 out of 13 patients in the preliminary study (11 men, 2 women). In the main study (n = 45, 28 men, 17 women) 100 micrograms.kg-1 ondansetron did not show a better analgesic effect than 50 micrograms.kg-1, and there was no significant difference between ondansetron and saline. VAS showed a reduction in pain from 6.9 +/- 2.0, 6.8 +/- 1.5 and 6.6 +/- 1.8 to 4.1 +/- 2.4, 3.4 +/- 2.2 and 3.4 +/- 2.1 in the 50 micrograms.kg-1, 100 micrograms.kg-1 and saline groups, respectively, within 60 min after i.v. application. VRS diminished from 2.5 +/- 0.5, 2.5 +/- 0.6 and 2.4 +/- 0.5 to 1.7 +/- 0.7, 1.5 +/- 0.8 and 1.5 +/- 0.7, respectively. There were 26 patients who experienced no pain relief in response to ondansetron or placebo and who therefore received LAS, and 21 of these then experienced significant pain reduction. CONCLUSION. Pain after minor surgery does not appear to be a major problem. For 42 out of 100 patients no analgesics were needed within the first 3 h after end of surgery. Ondansetron was no more effective than placebo in reducing postoperative pain. Lysin acetylsalicylate, however, may be an effective alternative to opioids for the treatment of postoperative pain.

Adult↗

Patterns of contraceptive use among clients of the Barbados Family Planning Association.

This is a study of the behavior patterns of lower class Barbadian women during the fecund period of their lives with respect to the introduction of new types of contraceptives within a multiple method family planning program. The behavior patterns of these women are examined through their use of the facilities of The Barbados Family Planning Association (BFPA). In 1955, the BFPA was set up to disseminate information on family planning and to provide the material means for family limitation. From its inception, a variety of contraceptive methods have been made available to women utilizing the services. The study is developed within a diffusion theoretic framework that focuses on the trial and adoption stages of the diffusion process. Data are drawn for this thesis from 2 samples: 1) a systematic sample of records kept by the BFPA on its clients, and 2) a systematic stratified sample chosen from patients of the Population Council Research Project (PCRP). (The PCRP was an affiliate of the BFPA between 1965 and 1967.) Patients were interviewed at both the family planning clinics and in their homes. The BFPA has followed the policy of making available at nominal cost all existing contraceptive methods. This has led to very high dropout rates after admission and a considerable amount of method changing. However, changes take place generally in the direction of increasing the reliability of the method used. The lower the reliability of the method, the greater the rate of dropout as well as the rate of change from it. The longer the time spent in the program, the greater the number of methods used; but the longer the time a method is used, the less likely that it will be given up for another method. The transition probabilities for changing from user to nonuser in a year do not remain constant over the 12 years for which the program has been in operation. This is also true for changing from nonuser to user. In the case of the users these probabilities remain constant for time spans of 4 consecutive years; decreasing from one time span to another. The transition probabilities for going from nonuser to user remain constant for time spans of 4 consecutive years over the first 8 years of operation of the program and for the last 3 years. The year 1964 was found to be deviant. However, the probability of going from nonuser to user increases from one time span to the other. Therefore, 3 time subsystems are delimited, each characterized by constant probabilities. Each subsystem represents a unique period in the development of the program.

Barbados↗

A randomized trial of a health care program for first-time adolescent mothers and their infants.

To test the effectiveness of a special health care program for adolescent mothers (17 years old or younger) and their infants, 243 mother-infant pairs were randomly assigned to one of two groups. All of the mothers were unwed, on Medicaid, and black. The control group received routine well-baby care. The experimental group received routine care and services that included rigorous follow-up, discussions with the mother about her plans for return to school and use of family planning methods, and extra health teaching. The dropout rate in the experimental group (60%) was significantly less after 18 months than the control group (82%). In spite of the high dropout rate, 91% of the mothers were located for the 18 month follow-up interview. The repeat pregnancy rate in the experimental group was 12% after 18 months, and 28% in the control group. There was no significant difference in the percentage returning to school. After 12 months, the infants in the experimental group were more likely to be fully immunized (33%) than the infants in the control group (18%). Mothers in the special care program who continued to attend clinic used the emergency room less than the mothers who continued to attend in the control group. These results suggest that a comprehensive health care program is one way to bring about better outcomes for both adolescent mothers and their infants.

Adolescent↗

Combined pharmacotherapy and psychological treatment for depression: a systematic review.

BACKGROUND: Adherence to antidepressant medication use is a problem in clinical practice. Some authors have posited that combined psychological treatment facilitates adherence to pharmacotherapy. OBJECTIVES: To study the relationship between adherence to use of and efficacy of antidepressant drugs plus psychological treatment vs drug treatment alone in depressive disorders. DATA SOURCES: MEDLINE, Current Contents, PsychInfo, Cochrane Library, and reference lists were searched, from January 1980 to November 2002. STUDY SELECTION: Randomized clinical trials comparing antidepressant treatment alone with antidepressant treatment in combination with a psychological intervention in depressive disorders were considered. The decision to include studies in the meta-analysis was performed by 2 reviewers. DATA EXTRACTION: Three independent reviewers extracted the data, using a precoded form. Methodological quality of the studies was evaluated in terms of allocation concealment and independence of evaluators. DATA SYNTHESIS: Sixteen trials met the inclusion criteria, with 932 patients randomized to pharmacotherapy alone and 910 to combined treatment. Overall, patients receiving combined treatment improved significantly compared with those receiving drug treatment alone (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.38-2.52), but dropouts and nonresponders did not differ in distribution between the 2 treatment modalities (OR, 0.86; 95% CI, 0.60-1.24). Studies longer than 12 weeks showed a significant advantage of combined treatment over drug treatment alone (OR, 2.21; 95% CI, 1.22-4.03), with a significant reduction in dropouts compared with nonresponders (OR, 0.59; 95% CI, 0.39-0.88). These estimates were not affected by study quality. CONCLUSIONS: Psychological treatment combined with antidepressant therapy is associated with a higher improvement rate than drug treatment alone. In longer therapies, the addition of psychotherapy helps to keep patients in treatment. Further studies are needed to investigate whether the improvement in response attributable to the combination of drug treatment and psychotherapy can be achieved by a combination of pharmacotherapy and a compliance-enhancing intervention.

Adult↗

Modelling population heterogeneity in sensitivity and specificity of a multi-stage screen for obstructive sleep apnoea.

We propose a model-based approach for modelling population heterogeneity in terms of sensitivity and specificity of multi-stage screening procedures that consists of multiple tests ordered according to criteria such as cost and invasiveness. It is assumed that a patient proceeds to the next test only if they test positive for the current test. An overall positive result occurs if a patient tests positive for all tests. A dropout occurs when a subject tests positive for a test but does not proceed to subsequent tests. Chinchilli proposed estimates of sensitivity and specificity based upon ratios of multinomial sample probabilities for such a multi-stage procedure in a homogeneous population. The method proposed here accommodates population heterogeneity with generalized linear models and transformation-based confidence intervals. In contrast to the approach of Chinchilli, such an approach provides model-based tests of population differences, narrower confidence intervals that satisfy boundary constraints, and a method for accommodating dropouts without the need for prespecified weights. The proposed method is motivated by the need to assess age differences in the accuracy of a multi-stage test for obstructive sleep apnoea.

Adult↗

Personality dimensions related to premature termination from an inpatient drug abuse treatment program.

Comparison of 135 program completers and 65 dropouts from an inpatient drug abuse detox/rehab. unit on 29 variables (MMPI validity and clinical scales, 13 Wiggins Content Items, number of Grayson Critical Items selected, MacAndrews Alcoholism Scale, and Age) revealed few group differences with univariate analyses. Multivariate and stepwise discriminant function analyses resulted in selected variables that achieved 64-87% stay/leave classification accuracy, depending on method of application. However, when these functions were cross-validated on independent samples within the same program at 3-year intervals, the classification accuracy generally was reduced by 50% or more. Results suggest that (a) there are few individual MMPI indices that predict patients at risk for program attrition; and (b) "good" multiple regression equations may not generalize to independent samples across time. Conceptualizing the dropout process ontogenetically will facilitate further experimental refinement and clinical understanding.

Adult↗

An MMPI scale to predict premature termination from inpatient alcohol treatment.

This study developed an MMPI scale to predict premature termination of patients from inpatient alcohol programming. MMPI responses of 93 male veterans hospitalized in a 4-week alcohol treatment program were item analyzed, and 21 items that differentiated Completers from Dropouts were selected. A classification accuracy rate of 91.36% was achieved in the standardization sample using a cut-off score of 8 and comparing only valid profiles. Classificatory accuracy of a cross validation sample (N = 90) was somewhat lower (75.34%). Face validity was absent, an indication of the scale's subtlety, and an analysis of scale items' Social Desirability Scale Values indicated that social desirability did not appear to influence item endorsement. Consistent differences between Completers and Dropouts were noted on Scales F and Sc, but not over other MMPI clinical scales, age, and race. Methodological issues and the use of the scale in alcohol treatment programming also were discussed.

Adult↗

Limitations of successive transradial approach in the same arm: the Japanese experience.

The transradial approach (TRA) has been used for diagnostic and interventional cardiology. It has not previously been determined how many times the same radial artery can be cannulated without complications. A total of 812 patients (502 men and 310 women) underwent angiography or angioplasty via the TRA between 1997 and 1999 at our institution with a total of 1,438 procedures. Sheaths were 5 (55%) or 6 Fr (45%). Dropout rates of 3.5% and 7.9% were found at the second TRA attempt in the men and the women, respectively. Of the 62 TRA failures, 56 (90%) were due to narrowing or occlusion of the radial artery after the previous TRA procedure. A third TRA procedure was possible in 90% of the men and 80% of the women. A fifth TRA procedure was possible in 70% of the men and 50% of the women. The dropout rates for TRA increased as successive punctures were performed. This was primarily due to vessel narrowing and occlusion occurring as a function of multiple punctures.

Aged↗

Stage of change as a predictor of response to psychotherapy for bulimia nervosa.

OBJECTIVE: This study was designed to test the hypotheses that stage of change is a useful predictor of dropout and that it is related to treatment outcome in patients receiving brief psychotherapy for bulimia nervosa. METHOD: One hundred ten patients with bulimia nervosa were randomly assigned treatment with cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT). On initial screening, patients were classified as being in the stage of precontemplation, contemplation, or preparation. RESULTS: Initial stage of change was not related to dropout either before or following randomization. Among all treatment completers, stage of change was related to outcome. Of the patients assigned to CBT, stage of change was not related to outcome. However, stage of change was related to outcome in patients randomized to IPT. DISCUSSION: This study suggests that initial stage of change may, under certain circumstances, be a useful predictor of outcome and that its utility as an outcome predictor may vary according to treatment.

Bulimia↗

Travel distance and attrition in outpatient eating disorders treatment.

OBJECTIVE: The purpose of this study was to investigate the impact of the distance patients had to travel for treatment on attendance patterns and treatment attrition. METHOD: Contact information, clinical records, and/or appointment records of 209 adult patients presenting to an outpatient eating disorder treatment center over a specific period of time were reviewed. Information was obtained on demographics, diagnosis, number of appointments attended, cancelled, and failed, and termination status. Patients were classified as treatment completers or dropouts and compared on demographic, diagnostic, attendance, and distance to treatment site variables. RESULTS: Treatment completer and dropout groups did not differ significantly on demographic variables, with the exception of employed patients being more likely to drop out of treatment. Although not statistically significant, patients diagnosed with bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) were more likely to drop out of treatment prematurely. Surprisingly, distance traveled to the treatment site was not significantly different between groups and did not appear to significantly impact attendance patterns. CONCLUSION: Results of this archival investigation were unexpected and likely limited by the design. Results can be useful in understanding motivational factors inherent in noncompliance and premature termination of treatment. A prospective study including fine-grained analysis of variables associated with eating disorder treatment attrition is indicated.

Adolescent↗

Treatment motives as predictors of acquisition and transfer of relaxation methods to everyday life.

This article presents results from four studies of the significance of type and number of initial treatment motives for acquisition and transfer to everyday life of progressive relaxation (PR) and autogenic training (AT). On the basis of theories of treatment motivation and compliance, we hypothesize that motives for participation are determinants of learning and transfer. Results are reported from (1) two studies with 113 participants in introductory courses on AT and 94 participants in introductory courses on PR and (2) two replication studies with 94 (AT) and 101 participants (PR). Participants indicated their motives for participation. Short-term indicators of treatment success include number of dropouts and subjective evaluations of relaxation exercises; long-term outcomes include transfer of relaxation exercises to everyday life and evaluations of exercise evaluations at follow-up 3 to 6 months after the end of course. Results suggest that for both AT and PR, dropout and subjective relaxation exercise evaluations can be predicted from participation motives. Long-term outcomes can be predicted only for AT. However, for both PR and AT it is shown that for up to four motives, the number of initial course motives is correlated with short-term and long-term predictors of course outcome. We conclude that motivation for participation is highly relevant to client-course matching and adaptive indication of relaxation therapies. Results lead to a threshold hypothesis about the relationship between the number of participation motives and short-term as well as long-term learning and transfer outcome.

Adolescent↗