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PubMed1994

Exploring dental operators' perceptions of their clinical tasks.

Clinical variation is a result of the complex interaction of operator, operating environment and client variables. This study explores intra-operator characteristics by applying a technique from psychology known as Repertory Grid to New Zealand dental therapists, in order to elicit the ways in which they view their work. Individual interviews were conducted with 13 dental therapists to elicit the full range of tasks that they perform and the various ways that they describe them. Each therapist then rated her own work activities or tasks on her personal set of bipolar descriptions (personal constructs). Principal components analyses of each individual's set of ratings produced graphs which portrayed the pattern of meanings which therapists attributed to their work activities. Common features among the 13 therapists' work perceptions were then identified and categorised according to five types of variables (therapist, client, procedural, time and interpersonal). Common features included operator perceptions of painfulness of procedures, complexity of decision-making, interaction with people, stress for the therapist, preventive care for the client, routineness of task and challenge for the therapist. This detailed information gives a better understanding of the complex ways in which therapists view their tasks and therefore make decisions in the clinical setting. It could be conveniently used to develop a questionnaire to assess the empirical relationships between intra-operator factors and clinical outputs.

Adult↗
PubMed2004

Locomotor training with partial body weight support on a treadmill in a nonambulatory child with spastic tetraplegic cerebral palsy: a case report.

PURPOSE: Recent findings by neuroscientists serve as the basis for a new approach to training stepping after neurologic injury. The purpose of this case report was to describe the outcomes for one child with cerebral palsy after locomotor training. CASE DESCRIPTION: The child was a nine-year-old boy diagnosed with spastic tetraplegic cerebral palsy. He could not support his weight upright against gravity and had never experienced walking. METHODS: Forty-four sessions of locomotor training with partial body weight support (BWS) included static step practice, weight shifting, and walk training on a treadmill. The Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) were administered prior to and immediately after training. OUTCOMES: The child demonstrated improvements in all domains of the GMFM and both domains of the PEDI. He was able to complete up to 60 independent steps on the treadmill while supported in the BWS harness. Four months after training, he was able to walk over ground short distances with a rolling walker and minimal assistance. DISCUSSION: This case report is the first to report improvement in stepping on a treadmill with carryover to over-ground walking in a nonambulatory child of this age with spastic tetraplegic cerebral palsy.

Journal Article↗
PubMed1990

Changes in the patient's perception of his therapist in the process of group and individual psychotherapy.

The patient's perception of his therapist seems to be one of the major components of the therapeutic relationship. The different psychotherapeutic setting seem to influence the dynamics of the therapeutic relationship along with some other therapist and patient variables. Two groups of patients treated in the Department of Neurotic Disorders of the Institute of Psychiatry and Neurology (Warsaw) were investigated 2 times during their course of psychotherapies (individual, group). The perception of the therapist was measured by the Adjective Raging Scales constructed for the purpose of this research. These data were correlated with the results of the ACL (Gough) as a measure of personality traits and with the intensity of the clinical symptoms.

Adaptation, Psychological↗
PubMed1991

Effects of an Asian client-therapist language, ethnicity and gender match on utilization and outcome of therapy.

The purpose of this study was to examine the relationship of Asian client-therapist ethnicity, language and gender match on two measures of utilization: number of sessions with primary therapist and dropout from therapy; and one measure of client outcome: admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 1746 Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language, ethnicity, and gender match to the three dependent variables and to eight socio-demographic variables. Either client-therapist language match or ethnic match significantly increased the number of client sessions with the primary therapist. However, only ethnicity match had a significant effect on dropout rate. Gain in GAS admission-discharge score was not affected by either a client-therapist ethnicity or language match. Gender match had no consistent effect on the dependent variables. Of the covariates examined, only therapist discipline (social worker) had a consistent effect on the dependent variables. It was concluded that both client-therapist language and ethnicity match are important variables affecting the utilization of treatment. Further research will be needed to separate the effects of language and ethnicity on therapy utilization.

Adolescent↗
PubMed2000

Validity of the pain anxiety symptoms scale (PASS): prediction of physical capacity variables.

Anxious responses to pain may lead to avoidance of behavior expected to produce pain. McCracken et al. (1992) developed the Pain Anxiety Symptoms Scale (PASS) to assess anxiety related specifically to pain. Efforts to validate the scale, however, have been confined mostly to examining associations between the PASS and other self-report instruments. This study tested whether PASS scores were related to behavioral performance variables recorded by therapists during a physical capacity evaluation. Participants were 98 male patients with persistent pain referred to two industrial rehabilitation centers. PASS scores were correlated negatively with amount of weight lifted and carried, and results of hierarchical regressions showed that PASS scores accounted for additional variance in these variables when measures of trait anxiety, depression and pain severity were controlled. However, we did not replicate the findings of McCracken et al. (1992) that PASS scores accounted for variance in self-reported disability with trait anxiety, depression or pain severity controlled. Results extend the validity of the PASS and are consistent with models of fear of pain: patients with high PASS scores may avoid potentially painful physical exertion to reduce their fear.

Adult↗
PubMed1993

A survey of workload measurement systems: the occupational therapy manager's perspective.

Interest in measuring workload for budget specific purposes has increased in recent years as health care managers are being forced to cope with the demands of cost containment and fiscal accountability. This paper reports on a survey of senior occupational therapy managers of Ontario facilities accredited by the Canadian Association of Occupational Therapists (CAOT). Respondents were surveyed on their experiences with, and attitudes toward, occupational therapy workload measurement systems and the ability of these systems to assist in management activities. The survey found that most departments were using the National Hospital Productivity Improvement Program (NHPIP) system. Seventy eight percent of managers indicated they were somewhat or very satisfied with the system, but 60% also indicated that it did not adequately meet all of their management needs. In terms of desirable features of a revised workload system, 87% of managers reported wanting a system based on diagnostic or case mix group recording. Client variables (91%), physical and psychosocial aspects of client care (89%) and therapist variables (85%) were also rated as important factors to address in developing new workload systems.

Attitude of Health Personnel↗
PubMed1990

Influence of therapist ethnicity and language on therapy outcomes of Southeast Asian clients.

The purpose of this study was to examine the relationship of Southeast Asian client-therapist ethnicity and language match on three therapy outcomes: number of sessions with primary therapist, dropout from therapy and admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 543 Southeast Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language and ethnicity match to the three outcome variables and to eight sociodemographic variables. Either therapist-client language or ethnicity match significantly increased the number of client sessions with the primary therapist. Dropout from therapy was significantly affected by a language match in the Cambodian sample only but the effect was to increase dropout. Neither ethnicity nor language match was significantly related to GAS score gain. Several possible explanations for these findings and their clinical significance were explored.

Adult↗
PubMed1997

Professional uncertainty and treatment choices by physical therapists.

OBJECTIVE: To determine patient, clinician, and practice setting characteristics associated with physical therapists' treatment choices in patients with knee, lumbar, and cervical impairments. DESIGN: Secondary analysis of data from the Focus on Therapeutic Outcomes (FOTO) database. SETTING: Data from 132 physical therapy practices owned by five United States outpatient rehabilitation companies. PATIENTS: The database contained information on 5,061 patients with knee, lumbar, or cervical impairments seen in these practices in 1993 and 1994 and agreeing to participate in data collection. Our sample consisted of 2,491 patients, treated by 462 physical therapists, who had complete data on the variables of interest. RESULTS: Physical therapists' treatment choices relied on factors other than the patient's clinical status when the impairment was likely to result in professional uncertainty as to diagnosis and consequences of treatments. For patients with spinal impairments, the clinical status of the patient was associated only with the choice of endurance exercises and modalities. Patient's clinical status was associated with every treatment type in patients with knee impairments. Educational level of the physical therapist, patient load, and payer were associated with a variety of treatment choices across the impairment types. CONCLUSION: In conditions of professional uncertainty, physical therapy practice may be influenced by many idiosyncratic factors.

Adolescent↗
PubMed1997

Predictors of success in emotionally focused marital therapy.

This study examined client variables expected to predict success in emotionally focused marital therapy (EFT), now the second most validated form of marital therapy after the behavioral approaches. The relationship of attachment quality, level of emotional self-disclosure, level of interpersonal trust, and traditionality to the therapy outcome variables, marital adjustment, intimacy, and therapist ratings of improvement, was examined. These variables were chosen for their relevance to the theory and practice of EFT and to intimate relationships in general. Overall, therapeutic alliance predicted successful outcome; the task dimension of the alliance in particular predicted couples' satisfaction. More specifically, one dimension of female partners' trust, their faith in their partner, predicted couples' satisfaction at follow-up. Females' faith also significantly predicted males' level of intimacy at follow-up. Males who were most likely to be nondistressed at termination indicated higher levels of proximity seeking on an attachment measure at intake, and older males and males whose partners had higher levels of faith in them were more likely to be nondistressed at follow-up. Traditionality was not found to be significantly related to outcome. Couples who made the most gains at follow-up also indicated lower initial marital satisfaction and included males who indicated lower levels of use of attachment figure on the attachment measure at intake. Males who made the largest gains at termination were older and were rated as less expressive by their partner on self-disclosure measures at intake. Age was the only variable significantly related to males' gains in satisfaction at follow-up. Implications for the practice of marital therapy and future research are delineated.

Adult↗
PubMedDate not supplied

Quality of early working alliance in psychotherapy: diagnoses, relationship and intrapsychic variables as predictors.

BACKGROUND: The aim of the study was the prediction of the quality of early working alliance, using possible predictors among patient pretreatment variables: diagnoses, current and past relationships and intrapsychic ones. Data are from the ongoing, naturalistic Norwegian Multisite Project on Process and Outcome of Psychotherapy (NMSPOP). METHODS: The sample, n = 270, is recruited from 15 outpatient clinics; 61.1% of the patients have personality disorders. Alliance was assessed with the Working Alliance Inventory (WAI), and predictors include independent clinicians' evaluations of diagnostic/interpersonal/intrapsychic characteristics and the patients' self-reports on similar and additional variables. RESULTS: Four of 6 hypotheses were supported: Quality of working alliance is difficult to predict, early alliance is better predicted than later, diagnostic variables do not predict quality of working alliance, but quality of both current and past relationships is associated with working alliance. In a hierarchical multiple-regression analysis, 7% variance of working alliance in the 3rd session was explained from current relationship variables, whereas alliance in the 12th session was not predicted by the same model. Intrapsychic variables predicted the therapists' ratings of alliance, but not the patients' ratings. CONCLUSION: The results are in line with previous research, and also with the theoretical model for working alliance.

Adult↗
PubMed1990

Effect of time-limited psychotherapy on patient dropout rates.

The authors conducted an archival study of 149 new clinic patients at a large community mental health center. The dropout rate for patients in brief psychotherapy in which the length of therapy was specified at the outset of treatment (time-limited psychotherapy) (32%) was about one-half the dropout rate for patients in brief (67%) and long-term (61%) individual psychotherapy. The difference in dropout rates could not be explained by patient demographic or diagnostic variables or by therapist characteristics measured in the study. The results suggest that setting a specific time limit on individual psychotherapy at the outset of treatment can reduce the patient dropout rate in a public mental health clinic.

Ambulatory Care↗
PubMed1981

[Consequences of psychotherapeutic research in recent years for general practice].

Psychotherapy research nowadays has become a highly complex field. Its results are presented in 10 hypotheses of which the following are discussed in more details: 1. Indication-stereotype: Variables attractive to the therapist (as "interesting case; nice person; can help him") dominate in a unreflective way those variables characterizing the patient. Those patients called YAVIS (young; attractive; verbal; intelligent; successful) are mostly dealt within uncovering, psychodynamic concepts whereas non-YAVIS-patients are mostly treated with undifferentiated supportive techniques. 2. Of those variables which proofed to be effective, the unspecific factors are superior to the specific, technical factors. 3. Special emphasis is put on side-effects of psychotherapy--long proofed empirically but mostly ignored clinically. 4. Efficacy of psychotherapy as such can no longer be doubted, but its cost-effect-analysis becomes a more and more crucial aspect. The consequences are in favour of short term methods. Strupp has proposed a "Tripartite Model of Psychotherapy", which tries to integrate the needs of the 3 partners involved: patient, therapist and society.

Humans↗
PubMedDate not supplied

Variables affecting the competency maintenance behaviors of occupational therapists.

OBJECTIVE: The purpose of this study was to examine the relationship between work environment and the competency maintenance activities of occupational therapists. METHOD: A survey of 121 occupational therapists in three states and interviews with 8 occupational therapists in Ohio were used. RESULTS: Analysis of survey data indicated that workplace support and the degree of competency monitoring are significant determinants of competency maintenance behavior. State continuing education requirements had no impact on reported levels of competency maintenance. Personal motivation of the therapist emerged as a potentially important moderator of the relationship between environment and competency maintenance. CONCLUSIONS: Although environmental factors enhance competency maintenance activities, active participation in competency maintenance is also related to the personal commitment of the individual therapist. Strategies that reduce barriers to effective competency maintenance and promote a culture of continuing competency in the profession merit further investigation.

Adult↗
PubMed2000

Different perspectives of the therapeutic alliance and therapist technique in 2 forms of dynamically oriented psychotherapy.

OBJECTIVE: This study addresses several issues concerning patients' and therapists' perceptions of key therapy process variables. This includes examining whether patients and therapists differ in their perceptions of the therapeutic alliance and therapist technique, what the relation is between perceptions of the alliance and technique, and whether these perceptions are predictive of treatment outcome. METHOD: Patient and therapist perceptions of the therapy process were provided in a comparative trial of 2 forms of short-term individual dynamic psychotherapy. Patients (n = 144) were randomly assigned to each condition. Treatment outcome was assessed using a large, comprehensive battery of reliable measures. RESULTS: The findings revealed several differences in the patients' and therapists' ratings of the alliance and technique in the 2 forms of therapy. Patient ratings of the alliance and technique were predictive of treatment outcome. CONCLUSION: The findings contribute to understanding the extent to which therapy participants share views of therapy processes and highlight the importance of the therapist's attending to the patient's perception of therapy.

Adolescent↗
PubMed2006

Initial development of a device for controlling manually applied forces.

UNLABELLED: In both simulation and manual therapy studies, substantial variability has been shown when therapists attempt to replicate an applied force. Knowledge about the forces employed during treatment could reduce this variability. In the current project, a prototype for a mobilizing device incorporating a dynamometer was constructed. The prototype device was built around a conventional "hand-grip" dynamometer to give dial visibility during application of mobilizing forces and a moulded handle was used to increase the hand contact surface during force application. The variability of the mobilization forces produced was measured, and ratings of comfort during a simulated spinal mobilization technique were obtained from therapists. METHOD: Thirty physiotherapists were randomly allocated to apply either: (i) their own estimate of a grade III mobilization force using their hands in a pisiform grip or (ii) a 100N force with the manual therapy dynamometer, and to rate comfort during the performance of both techniques on a 100mm visual analogue scale. RESULTS: Variance in dynamometer-dial-guided force application was always significantly less than the variance in therapist-concept-guided force application. Repeated-measures tests showed that the mean force produced at grade III was not significantly different from 100N, but physiotherapist comfort ratings were found to be significantly greater (P<0.01) when the manual therapy dynamometer was used. CONCLUSION: Manually applied force variability was significantly less and therapist comfort greater when using a device with visual access to a dial giving immediate force readout.

Adult↗
PubMed2001

Variability of erythrocyte and serum lithium levels correlates with therapist treatment adherence efforts and maintenance treatment outcome.

This study investigated the relationship between psychotherapeutic interventions and pharmacologic measures of pharmacotherapy treatment adherence in patients with bipolar I disorder, as well as the relationship between these measures and treatment outcome. Subjects were participating in an ongoing maintenance treatment study. Audiotaped therapy sessions were rated for frequency of psychotherapeutic interventions related to pharmacotherapy treatment adherence. Pharmacologic measures of medication adherence were compared to the tape ratings as well as to treatment outcome. Variability in log erythrocyte (RBC) lithium-a marker of probable nonadherence to the pharmacotherapy regimen-for individual patients correlated significantly with treatment adherence interventions scale ratings. This marker of nonadherence was significantly related to maintenance treatment outcome, as was variability of the serum lithium level/dose (L/D) ratio; however, no relationship was found between treatment adherence interventions scale ratings and outcome.

Adult↗
PubMed1981

Social class and perceived improvement in therapy: the effects of therapist discipline and therapy type.

The present study approached the question of differential perception of improvement across social classes by various disciplines and therapeutic orientations. Records of 4,257 psychiatric patients were examined for type of therapy, discipline of therapist, rated improvement, and social class. For variables "type of therapy" and "discipline of therapist," the interaction term of analysis of variance was significant, indicating that some therapists (i.e., with a given therapeutic orientation) show greater differential among the social classes with regard to perceived improvement than others. Psychiatrists were found more reluctant to rate patients as improved, and responded less differentially among the classes than social workers and psychologists. With regard to therapeutic orientation used, therapists using family therapy or medication rated a higher percentage of patients improved in Class IV than in Class III. The results suggest that therapists with differential training backgrounds (either discipline or therapeutic orientation) have different perceptions of change in psychiatric patients, which may be due to their differential training.

Humans↗
PubMed2002

Controlling is not enough: the importance of measuring the process and specific effectiveness of psychotherapy treatment and control conditions.

The major argument of this article is that failing to measure what is taking place in treatment and control conditions can lead to scientifically invalid conclusions. It is argued that researchers are ethically responsible for being aware that variables related to the therapist, client, and the therapeutic relationship (as well as their interaction) might play a confounding role when treatment and control conditions are compared. As a consequence, they should either measure those variables or be tentative in their interpretation of their findings.

Behavioral Research↗