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PubMed2006

Physical rehabilitation and burnout: different aspects of the syndrome and comparison between healthcare professionals involved.

AIM: The aim of this study is to investigate burnout syndrome among physical rehabilitation professionals focusing on the differences between 4 categories of healthcare professionals involved. METHODS: The experimental group consisted of 124 physiotherapy workers chosen among physicians, nurses, therapists, and technicians. The variables we chose to measure were: the presence of burnout (emotional exhaustion, depersonalization and lack of personal accomplishment), feelings of depression and anger, symptoms of psychological uneasiness and the level of perceived stress. RESULTS: Overall the level of burnout experienced was medium-low. Emotional exhaustion was more prevalent among physiotherapists, while depersonalization was higher among physicians. Moreover mild feelings of depression emerged among technicians. No differences were found among the 4 categories when feelings of anger were considered, although anger was present at different levels (and more or less expressed) throughout the working environment. CONCLUSIONS: Some considerations on the nature and possible causes of psychological distress emerged from the work carried out with the groups of healthcare professionals and some possible areas of intervention are suggested.

Adult↗
PubMed2006

Timed "Up & Go" test: reliability in older people dependent in activities of daily living--focus on cognitive state.

BACKGROUND AND PURPOSE: It is unknown how cognitive impairment affects the reliability of Timed "Up & Go" Test (TUG) scores. The aim of the present study was to investigate the expected variability of TUG scores in older subjects dependent in activities of daily living (ADL) and with different levels of cognitive state. The hypothesis was that cognitive impairment would increase the variability of TUG scores. SUBJECTS: Seventy-eight subjects with multiple impairments, dependent in ADL, and living in residential care facilities were included in this study. The subjects were 84.8+/-5.7 (mean+/-SD) years of age, and their Mini-Mental State Examination score was 18.7+/-5.6. METHODS: The TUG assessments were performed on 3 different days. Intrarater and interrater analyses were carried out. RESULTS: Cognitive impairment was not related to the size of the variability of TUG scores. There was a significant relationship between the variability and the time taken to perform the TUG. The intraclass correlations were greater than .90 and were similar within and between raters. In repeated measurements at the individual level, an observed value of 10 seconds was expected to vary from 7 to 15 seconds and an observed value of 40 seconds was expected to vary from 26 to 61 seconds for 95% of the observations. DISCUSSION AND CONCLUSION: The measurement error of a TUG assessment is substantial for a frail older person dependent in ADL, regardless of the level of cognitive function, when verbal cuing is permitted during testing. The variability increases with the time to perform the TUG. Despite high intraclass correlation coefficients, the ranges of expected variability can be wide and are similar within and between raters. Physical therapists should be aware of this variability before they interpret the TUG score for a particular individual.

Activities of Daily Living↗
PubMed1988

[Computerized analysis of the verbal behavior of patients and therapists in the 1st diagnostic interview].

From 282 psychoanalysis-oriented First Interview existing in the Computarized Text-Bank of the University of Ulm, Germany, a 68-sample was selected in order to assess and evaluate the following points: (a) Describing the talking behavior of both patients and therapists, according to specific variables; (b) Constructing a sample for the future development of a "Computarized First-Interview Archive", and (c) Testing some hypotheses connected to the verbal style of psychosomatic patients, compared with psychoneurotic patients; female patients compared with male patients; and older patients compared with younger patients. Using computarized dictionaries and the Electronic-Verbal-Analysis System (EVA) already stored and programmed at Ulm, formal, grammatical, and content analysis were performed. As a result, the determinant influence of diagnosis, and the heavy influence of age and sex on verbal style were shown. As regards the text measurements discriminating capacity, it was found out that grammatical analysis, with its high reliability, and validity, proved to be the best discriminative tool.

Adult↗
PubMed2004

[Success of treatment, experience of treatment, and satisfaction with treatment from the perspective of patients, parents, and therapists--results of an evaluative study on inpatient treatment in child and adolescent psychiatry].

In spite of the high importance of subjective opinions as essential evaluation criteria there are hardly any studies available, dealing with the research of subjective judgements made by children and adolescent patients in relation to their inpatient treatment, and comparison with the evaluation of their parents. The evaluative study on an age-group random sample survey (n=95) of patients and parents at the Department of Child and Adolescent Psychiatry at the University of Heidelberg includes success of treatment, experience of treatment and satisfaction with treatment by means of specially constructed and parallelized questionnaires for patients, parents and therapists. Apart from the extent of subjectively experienced changes in precisely defined success variables, not only agreements and differences were studied, but also connections between success of treatment, experience of treatment and satisfaction with treatment as well as influences of success variables and experience variables on treatment satisfaction. Parents', patients' and therapists' evaluations of the treatment in regard of most success variables were all positive. At the end of treatment a perspective convergence was noticeable in some variables. The pressure on the parents requires special therapeutic attention. In the sense of therapy evaluation the change in the way the problem was viewed proved to be a worthwile success criterium. From the patients' and parents' point of view the change in the problem "as a whole" is mainly characterized by a positive change in emotional disposition. The therapeutic atmosphere and organisation of therapeutic relationships were highly appreciated by patients and parents. All in all patients, parents and therapists were highly satisfied with inpatient treatment. The correlations found between the grade of success, experience of treatment and satisfaction with treatment were clearly positive. On the patients' side treatment satisfaction was dictated more by their experiences during the treatment, whereas on the parents' side the success of treatment proved to be the stronger factor.

Adolescent↗
PubMed1980

Treatment of heroin addicts: is the client--therapist relationship important?

The purpose of this paper is to examine one variable in the treatment of heroin addiction, ther therapist-client relationship. Eighty-six individuals who were discharged from the Tulane NARA Drug Abuse Program were examined on 20 social and personality variables. The variable of the counselor--patient relationship was found important in the final outcome of treatment. Clients who had a single counselor throughout the entire course of treatment did significantly better (p less than .002) than their peers who were transferred from one counselor to another, suggesting that a stable client--therapist relationship greatly enhances the chances of the patient reaching drug abstinence and being rehabilitated.

Adolescent↗
PubMed1983

Therapists' and chronic pain patients' perceptions of treatment outcome.

Pain is a complex phenomenon which is influenced by multiple factors; likewise, assessment of chronic pain patients' response to treatment is influenced by many variables. A physician, psychologist, physical therapist, and occupational therapist rated the extent of recovery of 40 chronic pain patients who had spent 4 to 6 weeks in an inpatient chronic pain treatment program. Each patient also rated his/her own degree of improvement. In addition, therapists and patients reported which factors were the primary determinants of their outcome ratings. Although therapists rated the patients as significantly more improved than the patients rated themselves, there was still a high degree of similarity between therapists' and patients' view of recovery. Therapists and patients were in high agreement concerning which patients were classified as treatment successes or failures. Furthermore, activity level and ability to cope with pain were frequently endorsed by therapists and patients as important determinants of recovery rating. Contrary to a previous report, the results of this study suggest that pain patients are not necessarily poor judges of (their own) treatment results. Perhaps more importantly, this study supports the use of a broad-based multidimensional approach to assessing treatment outcome for chronic pain patients.

Adult↗
PubMed1998

Using feedback on patient progress to predict the outcome of psychotherapy.

The Dose-Response and Phase Models are useful for informing quality assurance research on the expected patterns for separate categories of outcomes in psychotherapy. Moreover, these models predict the sequence of change for outcomes that may be differentially valued by patients, therapists, stakeholders, and cost managers. Valid feedback on the progress of treatment is critical because patients, therapists, and cost managers make decisions about continuation and focus of treatment while psychotherapy is in progress. In this study, the focus is on the validity of feedback data for therapist appraisal of patient progress. Feedback at patient intake, in early sessions of psychotherapy, and at later sessions of psychotherapy is considered. Among the variables examined are patient and therapist agreement on severity, level of severity, evidence of remoralization, and evidence of symptomatic remission. Data are drawn from archived records of 243 psychotherapy cases conducted in several managed care service delivery settings. The implications of a therapist's use of feedback to adjust the therapeutic process in an individual case are discussed.

Adult↗
PubMed1980

Therapists' recognition of psychopathology: a model for quality review of psychotherapy.

In this study 32 randomly selected psychiatric emergency room patients, who were in concurrent psychotherapy, completed the SCL-90 and a clinically oriented questionnaire. Their therapists independently rated the patients' degree of psychopathology on the nine SCL-90 symptom scales. Therapists were highly efficient in recognizing depression (94% of the cases) and anxiety (89%) but not psychotic (35%) and obsessive-complusive (16%) pathology. Variables significantly associated with the therapists' nonrecognition of psychopathology were the diagnosis of borderline, the patient's expression of inadequacy in comparison to the therapist, the patient's fear of offending the therapist, and the patient wanting but not receiving empathy from the therapist. The authors discuss the implications of these findings for peer review and further research.

Adult↗
PubMed2005

Early intensive behavioral intervention for children with autism: therapists' perspectives on achieving procedural fidelity.

The variability in outcomes observed in home-based early intensive behavioral intervention for children with autism is likely in part to be the result of the quality of therapist performance. Therapist behavior in this context, however, is poorly understood. To achieve such an understanding, it will be necessary to specify how factors such as therapist, child and intervention program characteristics, as well as supervision and training provision, influence therapists' interactions with children. This study identified facilitating factors and barriers that therapists considered to influence their capacity to deliver early intensive behavioral intervention to young children with autism. Nineteen therapists associated with various service providers in the South of England were interviewed. In general, responses represented opposite poles of the same construct. For example, child factors such as compliance and competence were considered to facilitate instruction, whereas challenging behavior and lack of progress were perceived to hinder it. These issues are considered in the light of previous research on staff behavior in related contexts. The factors identified suggest specific avenues for questionnaire and experimental research to validate these findings, have implications for routine service provision and may help improve the outcomes of children receiving early intensive behavioral intervention.

Adult↗
PubMed1985

Empathy and outcome in brief focal dynamic therapy.

In an attempt to test the hypothesis that therapist empathy is an important variable in successful dynamic therapy, the authors collected outcome measures and empathy ratings in the brief focal dynamic therapy of 59 patients. There was no significant agreement among patients, therapists, and clinical supervisors when they used the same scale to rate therapist empathy for the same sessions. Only the patients' ratings correlated significantly with some of the outcome measures, and they added modest but statistically significant predictive variance on multiple regression analysis. The authors discuss the implications of these findings for the traditional mode of supervision of dynamic therapy.

Adult↗
PubMed2001

Training brain injury rehabilitation therapists to use generalized teaching and interaction skills.

Persons sustaining a brain injury often exhibit aberrant response patterns and skill deficits that require remediation. To promote recovery, rehabilitation staff must be competent in use of therapeutic teaching and interaction skills. This study focused on teaching 13 direct-care rehabilitation therapists these skills in a multiple baseline design across skill dimensions. Performance-based approaches were used to promote acquisition of therapist skills, and the 'general case' strategy was used to enhance generalization. The general case approach involved use of multiple examples of teaching and interaction situations selected to sample the range of variability in the rehabilitation setting. Therapists were videotaped in simulations of various teaching and interaction situations before and after staff training. These observations were coded for correct use of teaching and interaction skills. Therapists demonstrated mean increases of approximately 30 percentage points in correct skill use after training. The present training format appears to provide an efficient strategy for training staff to promote rehabilitation efforts.

Adult↗
PubMed1981

California physician's professional image of therapists.

The purpose of this study was to identify the attitudes of California physicians toward the professional image of physical therapists and to determine the influence of several independent variables on that image. A three-part questionnaire was used to survey the sample of physicians. The first two sections contained attitudinal statements based on criteria representing degrees of professionalism; the third section contained questions on demographic variables. The results indicated that, although the majority of responding physicians viewed physical therapists as possessing all of the criteria denoting professionalism, there was relatively less agreement with the two criteria representing the highest degrees of professionalism-evaluative skills and autonomy of judgment. None of the independent variables influenced physicians' professional image of physical therapists except physician specialty area, in which family practitioners held a significantly higher professional image of physical therapists than did neurosurgeons and orthopedists. The authors suggest further study of other factors that may affect physicians' professional image of physical therapists as well as recommend steps that may be taken to improve the professional image of physical therapists.

Attitude of Health Personnel↗
PubMed1990

Developing a variable budget for occupational therapy contract work.

Contract occupational therapists need to develop a financial plan for improved control of their business. The variable budget allows financial planning according to actual performance volume. This paper describes a step-by-step method for the development of a variable budget through the illustration of a case example.

Budgets↗
PubMed1983

Continuing education and the geographically isolated therapist.

The relationship between therapists' geographic location and three program planning variables in continuing education was studied using the descriptive survey method. The findings suggested that learning needs were high in evaluation related competencies and that family responsibility and lack of appropriate programs were major barriers to participation. The overwhelming preference in delivery systems was the one or two day workshop. The study concluded that there were few significant differences between urban and rural therapists in relation to the variables studied indicating restraint rather than innovation in programming for the geographically isolated therapist.

Analysis of Variance↗
PubMedDate not supplied

Early intensive behavioral intervention for children with autism: parental therapeutic self-efficacy.

Several authors have suggested that the quality of therapist performance accounts for some of the variability in outcomes observed in early intensive behavioral intervention for children with autism. However, there is a distinct lack of theoretical and empirical work addressing therapist performance in this context. In the present study, we explored predictors of one variable, beliefs about one's efficacy in the therapeutic role, that may be related to therapist performance. Eighty-five UK mothers who were acting as therapists for their child's program completed a questionnaire survey. Results showed that program variables (e.g., number of hours of therapy each week, time since program started) were unrelated to maternal therapeutic self-efficacy. However, support received from the program, the severity of the child's autism, and maternal stress were significant predictors. Regression analysis also showed that maternal stress mediated the impact of support from the program and autism severity on maternal therapeutic self-efficacy. Limitations of the study, suggestions for future research, and practical implications are briefly discussed. In particular, we advocate a role for supervisors in analyzing and developing interventions for therapist behavior.

Adult↗
PubMed1995

Sleep compression and sleep education for older insomniacs: self-help versus therapist guidance.

A treatment package consisting of a bed-time restriction strategy and education was administered to 50 insomniacs and 50 noninsomniacs 60 years or older. Half of the insomniacs and noninsomniacs received treatment through a self-help video only, whereas the remaining treated participants received therapist guidance to supplement the video. A waiting-list control group of 25 senior insomniacs was also included. Sleep knowledge was equivalent for senior insomniacs and noninsomniacs. The self-help insomniac group exhibited improvement on multiple sleep variables, but the addition of therapist guidance appeared to enhance treatment outcome for sleep latency, wake time after sleep onset, and sleep satisfaction. Control participants also improved across time but were generally outperformed by treated insomniacs.

Aged↗
PubMed2005

Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: a study of process and outcome.

The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome variable. There were no significant therapist or Therapist x Treatment effects on outcome. Although results showed high levels of alliance and adherence across treatments, CBT was associated with greater adherence. Across treatments and time points, better adherence was associated with enhanced alliance. Treatment condition and baseline purging frequency, but not adherence, predicted outcome. Early alliance predicted posttreatment purging frequency. In temporal analyses, prior symptom change assessed early in treatment was significantly related to subsequent adherence at midtreatment.

Adult↗
PubMed1997

One-year experience with an inpatient asthma clinical pathway.

OBJECTIVE: To study the effects of an inpatient asthma clinical pathway on the processes and outcomes for children who were admitted to a hospital for the treatment of asthma. DESIGN: Before-and-after study. SETTING: A private nonprofit academic children's hospital in Seattle, Wash. PATIENTS AND METHODS: Three hundred forty-two admissions of 297 patients in the first year of the asthma clinical pathway were compared with 353 admissions of 292 similar patients in the previous year. Patients who required intensive care, were younger than 2 years, or had a major chronic disease were excluded. INTERVENTION: Asthma was chosen for the development of a clinical pathway because of its large number of admissions, involvement of multiple health care providers (nurses, physicians, and respiratory therapists), predictable hospital course, and variable lengths of hospital stay. The pathway was a consensus-based guideline for patient management that was intended to be adapted to the care of an individual patient. Prior to the implementation of the clinical pathway, nurses, attending physicians, house staff, and respiratory therapists were trained in its use. The main hospital chart of each patient who was admitted to the pathway had a flowchart that outlined day-to-day guidelines for monitoring and care. Nursing staff were responsible for documenting when a patient's care varied from the pathway, and these variances were entered into a computer database. OUTCOME MEASURES: Use of peak flowmeters, steroids, laboratory studies, radiological studies, and respiratory therapy was assessed by analyzing the patients' electronic billing records. For patients enrolled in the pathway, additional data on process of care were obtained by analyzing the variance database. For both groups, the total charges, length of stay, and rate of readmission to the hospital were measured by use of the billing records. RESULTS: There were no significant differences in the use of steroids or peak flowmeters, average lengths of stay, or total charges between the 2 groups. However, patients in the "pathway group" had significantly lower average charges for laboratory ($26 vs $39; P < .05) and radiology ($32 vs $55; P < .001) services. Variances from the pathway guidelines were most often related to the patients' responses to therapy. CONCLUSIONS: The asthma clinical pathway had no effect on clinical outcomes and small effects on the use of resources. Further development, including physician and nurse training, computer and administrative support, and clinical severity scales, are needed to develop the potential utility of the clinical pathway as a research and quality assurance tool.

Adolescent↗