Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation.

OBJECTIVE: To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle-foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and transmetatarsal amputation (TMA). RESEARCH DESIGN AND METHODS: Thirty patients with diabetes and TMA participated (mean age 62 +/- 4 years). In-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare treatments. RESULTS: All five types of therapeutic footwear reduced plantar pressures compared with regular shoes with a toe-filler (P < 0.05). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regular shoe and toe-filler. Footwear with an AFO showed reduced PPP on the residuum, but most patients complained of reduced ankle motion during walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regarding cosmesis of the shoe. CONCLUSIONS: The full-length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.

Small sample failure of random assignment: a further examination.

The purpose of random assignment is to produce equivalence on nuisance variables across experimental groups, even when the nuisance variables are unmeasured or of uncertain number. The effectiveness of random assignment, however, depends on sample size; as sample size increases, the likelihood of equivalence also increases. This article demonstrates that, although nonequivalence on a nuisance variable may be quite likely for small samples, the probability is quite low that nonequivalence will produce erroneous inferences. In fact, the probability of an erroneous inference in the absence of a true treatment effect is generally no greater than the nominal Type I error rate. Accordingly, it is unlikely that small samples have biased inferences drawn from past psychotherapy outcome research. However, small samples cause other problems that argue against their routine use.

Differential effects of hypnotic suggestion on multiple dimensions of pain.

Within the framework of multidimensional pain assessment, this study extended an earlier finding that hypnotic analgesia and relaxation suggestions have differential effects on pain reduction by evaluating these strategies in subjects undergoing a cold pressor protocol. Thirty-two highly susceptible subjects were randomly assigned to an analgesia or a relaxation suggestion treatment group. Six pain reports were taken at 10-sec intervals for each experimental condition. The baseline measures served as covariates. A 2 x 2 x 2 x 6 repeated-measures analysis of covariance (ANCOVA) revealed a significant group (analgesia, relaxation) by pain dimension (intensity, unpleasantness), by condition (suggestion alone, hypnotic induction plus suggestion) interaction. Analysis of the simple-simple main effects, holding both group and condition constant, revealed that application of hypnotic analgesia reduced report of pain intensity significantly more than report of pain unpleasantness. Conversely, hypnotic relaxation reduced pain unpleasantness more than intensity. The clinical implications of the study are discussed.

Attributional style and the type A coronary-prone behavior pattern.

The present two studies examined the attributional styles of Type A and B individuals. Past research suggests that Type A's exhibit greater performance deficits than Type B's following exposure to extended, salient uncontrollable stimuli. The reformulated learned helplessness model suggests that individuals most prone to such performance deficits should exhibit an attributional style characterized by internal, stable, and global attributions for negative outcomes, but external, unstable, and specific attributions for positive outcomes. However, a self-esteem protection explanation of learned helplessness findings predicts an opposite, self-serving attributional style. Results from both studies indicated that Type A's are more self-serving than Type B's in their attributions for positive and negative outcomes.

Type A behavior pattern and the judgment of noncontingency: mediating roles of mood and perspective.

Past research indicates that Type A's and B's differ in their behavioral responses to lack of control. The present study examined perceptual judgments of noncontingency in an attempt to clarify further the role of a control dynamic in Type A-B differences. Type A's and B's assumed the role of either an actor or an observer on a standard contingency judgment task. Consistent with previous research, both Type A's and B's exhibited an illusion of control when in the role of actor. Only Type B's exhibited an illusion of control when observing another person perform the task. Additional analyses indicated that the absence of an illusion of control by Type A observers reflected accuracy rather than a motivational distortion. Mood was also found to mediate control judgments, but only for actors. The plausibility of a memory-based interpretation for the mood effects is discussed.

Self-enhancement, self-assessment, and self-evaluative task choice.

Past research on self-evaluation indicates that there are two contrasting viewpoints concerning the acquisition of self-knowledge. According to the self-assessment view, accurate information is sought, regardless of its implications for self-esteem. According to the self-enhancement view, accurate information is desirable, but only if it also has positive implications for the self. We examined the conditions under which each view provides an adequate description of self-evaluative task choice. We predicted that both individuals with high self-esteem and individuals with low self-esteem but no tendency to use self-protective strategies would choose maximally informative tasks. By contrast, individuals with low self-esteem and a tendency to use self-protective strategies were expected to choose tasks that were maximally self-enhancing. Subjects chose among four forms of a cognitive abilities test that varied in diagnosticity of success and diagnosticity of failure. As expected, subjects with ego-protective tendencies and low self-esteem preferred the test form that was high in diagnosticity of success but low in diagnosticity of failure, whereas subjects with low self-protective tendencies (both high and low self-esteem) preferred the test form high in diagnosticity of both success and failure. Subjects with both high self-esteem and high self-protective tendencies did not exhibit a clear preference between test forms allowing maximal self-assessment and those allowing self-enhancement. The results suggest the importance of considering both diagnosticity and self-esteem protection in the study of self-evaluation.

Postperformance attributions and task persistence among type A and B individuals: a clarification.

We examined task persistence and postperformance attributions by Type As and Bs on tasks that varied in level of difficulty. On the basis of past research, we hypothesized that Type As would be more self-serving than Type Bs in their attributions for success and failure. We also hypothesized that task persistence would differ among Type As and Bs and would be dependent on task difficulty and perceived task diagnosticity. Type As and Bs attempted multiple sets of anagrams that were either easy or difficult. We measured persistence by the number of anagram sets attempted, and, after task performance, we assessed attributions for success and failure. Results supported both hypotheses. Type As took more credit for success than for failure, whereas Type Bs did not provide reliably different attributions for success and failure. Furthermore, Type As persisted longer at the task when it was difficult and when it was viewed as relatively low in information value. Type Bs persisted longer at the task when it was difficult but viewed as relatively high in information value. Results are discussed in the context of current debates regarding the responses of Type As and Bs to performance settings.

Relinquishment of control and the type A behavior pattern: the role of performance evaluation.

We investigated the role of information processing in the control relinquishment decisions of Type As and Bs. Pairs of subjects worked independently on a task and received feedback indicating that their partner had performed at a comparable or superior level. On a second task, subjects combined their efforts and made decisions concerning who would work on different parts of that task. One third of the subjects made this decision before completing an evaluation of the initial performances. Another third completed the evaluation without knowing that they would subsequently make a control decision. The final third of the subjects completed their evaluations knowing that a control decision would follow. Results indicated that when the evaluations were completed last, or when the evaluations were completed first but without knowledge of the impending decision, Type As relinquished less control to a superior partner than did Type Bs. When the evaluations were completed with knowledge of an impending control decision, Type As and Bs did not differ in their decisions. These results suggest that under certain conditions, Type As use an automatic or mindless decision style with potentially maladaptive consequences.

Type A behavior, age, and psychological well-being.

We investigated psychological well-being among Type A and B individuals across the age span. We hypothesized that the hard-driving, achievement-oriented lifestyle exhibited by Type As would be adaptive in younger age groups, but would lead to lower well-being in later life because of increased limitations on the range and level of one's activities. By contrast, the more relaxed, easygoing style of the Type B matches better the slower pace of old age, but is not as conducive to success in younger age groups. Thus we expected older Type Bs more than younger Type Bs to exhibit greater well-being. Results confirmed these hypotheses, but indicated that psychological differences may be mediated in part by differences in physical well-being. Furthermore, experience with life events, and the structure and function of social networks, may contribute to the differences in well-being.

Type A behavior pattern and the judgment of control.

We investigated the control judgments of Type A and B actors and observers after five tasks in which actual response-outcome contingency and success were varied systematically. Results indicated that, overall, actors provided higher control judgments than did observers, and both actual contingency and success influenced judged control. Type A and B actors did not differ in their self-perceptions of control but observers judged the Type A actors to have exerted more control than the Type B actors, primarily on positive contingency tasks. These findings suggest that Type As, because of their more active, dynamic style, may be credited by observers with more control or competence than is warranted. By contrast, the more relaxed style of the Type B may lead to lower than warranted evaluations of control or competence. Lastly, Type As were found to learn the contingencies better than Type Bs with important implications for the actual exercise of control.

Type A and type B attentional responses to aesthetic stimuli: effects on mood and performance.

Recent investigations of the Type A coronary-prone behavior pattern have found that Type A's focus their attention on a central task and actively inhibit attention to peripheral distracting stimuli. This attentional difference has resulted in greater performance for Type A's than for Type B's. However, research on aesthetic stimuli suggests that the focused attention of Type A's may not always be adaptive for solving frustrating cognitive tasks, particularly when paying attention to a peripheral stimulus could enhance performance by reducing negative emotions. Simple, predictable, aesthetic stimuli can have a soothing effect, which reduces negative emotions and enhances performance. The present study found that Type B's had improved affect and performance from attending to a soothing peripheral stimulus (simplex melodies) while working on a frustrating cognitive task. Neither the performance nor the affect of Type A's was influenced by the simplex music, because they apparently suppressed paying attention to these melodies.

Type A behavior pattern and self-evaluation of abilities: empirical tests of the self-appraisal model.

The self-appraisal model proposes that Type A behavior reflects active attempts to generate diagnostic information about abilities, particularly in situations that evoke high uncertainty. In Study 1, subjects were provided feedback indicating high or low uncertainty about underlying abilities in two domains. When subjects were more uncertain of their ability in one domain than in the other, Jenkins-Activity-Survey-defined Type As (but not Type Bs) subsequently constructed tests that were biased to assess the more uncertain domain. Study 2 examined postfailure performance. The model holds that Type As perform poorly because they suspend information gathering when faced with evidence that requisite abilities are absent. Results indicated that deficits emerged only if Type As believed that a second task assessed the same abilities as the initial task on which they failed. A final study examined social comparison among Type As and Bs. Results indicated that Type As engaged in social comparison to obtain diagnostic information, primarily when they were uncertain of their ability levels.

Interpersonal aggression and the type A coronary-prone behavior pattern: a theoretical distinction and practical implications.

Past research suggests that Type As are more aggressive than Type Bs. However, little is known about the nature of that aggression. The present two studies investigated the theoretical distinction between hostile aggression and instrumental aggression and examined the practical implications of this distinction. Study 1 used a modified version of the Buss teacher-learner procedure that allowed the isolation of hostile from instrumental acts. Results indicated that a prior task frustration produced greater aggression by Type As than Type Bs but only under conditions where the aggressive act could not affect a confederate's immediate performance (i.e., hostile aggression). Study 2 examined the representation of Type As and Type Bs among perpetrators of intrafamily violence. Results indicated that Type As were more likely than Type Bs to exhibit the extreme hostility found in child abuse. Both studies suggest that a lack of control may underlie the greater aggression displayed by Type As than Type Bs.

Cardiovascular correlates of type A behavior components during social interaction.

This study examined the cardiovascular (CV) correlates of the primary Type A behavior components during social interactions. Brief dialogues were created to role-play (RP) stereotypic Type A and Type B ways of responding to three common social situations designed to elicit hostility (H), time-urgency (T), and competition (C). Situations and dialogues were validated by independent raters. Thirty undergraduate students were identified as Type A and 30 as Type B, with 15 males and 15 females in each group. Subjects were provided scripts for each of the six experimental RPs and rehearsed them prior to the CV assessment. Measures of systolic and diastolic blood pressure (SBP, DBP) and heart-rate (HR) were obtained during an adaptation period and during each RP. Analyses of the "A" (i.e. H, T, C) versus "B" (i.e. non-H, non-T, non-C) RPs indicated that DBP (p less than 0.03) and HR (p less than 0.002) were higher during the H as compared with non-H RP. Significantly higher SBP was observed in the T as compared with the non-T RP (p less than 0.04). No CV differences were observed in the comparison of the C and non-C RPs. Analyses comparing the three "Type A" RPs revealed higher SBP during H and T RPs, as compared with the C RP (p less than 0.003). Effects of subject Type (i.e. A/B) were not obtained in any analysis. These findings indicate that hostile and time-urgent social interactions are associated with significant increases in CV arousal which are independent of overall Type status.

Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait.

The purposes of this study were to determine the effects of tendon Achilles lengthening (TAL) on ambulatory plantar pressures and ankle range of motion, moment, and power, and to determine whether changes in forefoot pressure after treatment of a neuropathic ulcer are related to changes in ankle dorsiflexion range of motion (DFROM) or plantar flexor (PF) power during gait. Pressure and gait tests were performed before treatment, and at 3 weeks and 8 months after treatment in two randomly assigned groups of subjects with diabetes, equinus deformity, and a neuropathic forefoot ulcer treated with TAL and total contact casting (TAL group, n=14), or total contact casting alone (TCC group, n=14). The TAL group had an initial decrease in forefoot peak pressure (PP) (27%), forefoot pressure-time integral (PTI) (42%), PF moment (53%), and PF power (65%), along with an initial increase in rear foot PP (34%), rear foot PTI (48%), and DFROM (74%). Post-surgical changes in rear foot pressure and DFROM were maintained up to 8 months after treatment with TAL, whereas forefoot pressure and PF moment and power increased significantly. Changes in forefoot pressure after treatment in either group were correlated with changes in PF power (r=0.45-0.60), but not with changes in DFROM during gait (r=-0.02-0.08). Results suggest TAL causes a temporary reduction in forefoot pressure primarily by reducing PF power during gait. The initial decrease in forefoot pressure, followed by progressive reloading of forefoot tissues as PF muscles regain strength after TAL, may help reduce the risk of ulcer recurrence in patients with diabetes.

Reliability of isokinetic measurements of trunk muscle performance.

The purpose of this investigation was to assess the reliability of isokinetic trunk muscle performance. Sixty-one volunteers participated (29 men, 32 women; age range, 20-60 years). All subjects were without low-back symptoms at the time of testing. All testing was performed with the subject initially standing, using speeds of 60, 120, and 180 degrees per second. Ten repetitions of flexion and extension were performed reciprocally at each speed, with a 3-minute rest period between speeds. Test-retest intervals were 1 and 3 weeks from the initial test. Peak torque-to-body-weight ratios, extension-to-flexion ratios, and average work per repetition were calculated for each speed for flexion and extension. Data were analyzed with analysis of variance, intraclass correlation coefficients, and Pearson correlation coefficients. Intraclass correlation coefficient values ranged from .74 to .88 for measurements derived from peak torque, and from .88-.93 for measurements derived from work (with the exception of .69 for men at 180 degrees/sec). Standard error of measurements ranged from 8 to 32 ft-lb, with a tendency to increase with increasing speeds. It was concluded that, when using this protocol, isokinetic measurements of muscle function offer the clinician sensitive and reliable measurements of trunk muscle performance and that incorporating increased practice with women and longer rest periods with men may further decrease error associated with these isokinetic trunk strength measurements.

Development of a distance-based interval throwing program for Little League-aged athletes.

We developed a distance-based interval throwing program for Little League-aged athletes (9 to 12 years) to be used in training and rehabilitation. The timing and repetition parameters were developed from data collected during 400 innings of organized baseball during a single season, and short toss distance from Little League rules for field dimensions. There were 1022 boys from organized baseball teams in the four studies. Maximal distance and speed measurements were recorded for 853 boys. We developed a mathematical model from these data to predict maximal throwing distance from maximal throwing speed. This model was then tested on a second sample of 114 players. We compared the predicted distance with the actual maximal throwing distance; the correlation coefficient was 0.92. Forty players aged 9 to 12 participated in a study to assess degradation of speed and distance. The average variability of the speed was small (< 5 mph), but the variability in distance was large (22.4 feet). Fifteen boys then threw the entire throwing program as designed. These results show that healthy young athletes can be expected to be able to throw the predicted value of this practical progressive interval throwing program for Little League-aged athletes. The appropriate program can be assigned from age and known preinjury pitch speed.

Some cautionary comments on the use of retrospective designs to evaluate treatment efficacy.

This article contrasts the true experimental approach with nonexperimental alternatives, such as retrospective designs, for research on treatment efficacy. The potential problems and limitations of the nonexperimental approach are highlighted so that when deviations from the more desirable experimental methodology are necessary, they can be undertaken with full knowledge of the hazards to be expected. Important issues are illustrated through discussion of a specific type of retrospective design, the case-control design.

Guide for the interpretation of one-way analysis of variance.

In summary, one-way ANOVA for independent groups is used to test whether the group means for a specific dependent variable differ significantly after exposing each group to a unique level of a single factor or independent variable. You may recognize the preceding sentence. We hope it makes more sense to you now than when you first read it at the beginning of this article.

The influence of experience with a set of simulated patients on diagnosis of simulated patients not previously diagnosed.

BACKGROUND AND PURPOSE: Diagnoses, to be useful, should be accurate. The purpose of this study using fictitious patients and student judges was to test the theory that diagnostic errors would occur when students saw simulated patients who were similar to previously seen simulated patients. SUBJECTS: Sixty physical therapist (PT) students and 60 non-physical therapist (NPT) students were studied. Subjects were assigned randomly to one of three groups. METHODS: Instructions to the three groups differed in terms of rules provided for diagnoses and instructions to remember the patients. Students first diagnosed the same eight fictitious patients five times. The students then diagnosed eight new patients with similar characteristics interspersed with the original eight patients. Half of the new patients had a diagnosis different from that of the most similar old patient. RESULTS: Students who were given a rule for diagnosis made fewer errors than students who were not given a rule. Students in the PT group took longer but made fewer errors on the critical opposite-diagnosis new cases than did students in the NPT group. CONCLUSION AND DISCUSSION: The results do not provide support for the theory that diagnostic errors would occur when students saw patients who were similar to previously seen patients. Students in the PT group appeared to emphasize accuracy at the expense of speed in making their diagnoses. Given the nature of the simulated patient information and the mode of presentation used in the experiment, however, the conclusion that therapists in actual practice do not make errors because of the similarity between new and previously seen patients is not yet warranted.