Physical Therapy Use, Costs, and Value for Latent Classes of Good vs Poor Outcome in Patients Who Catastrophize About Their Pain Prior to Knee Arthroplasty.

OBJECTIVE: To examine use, costs, and value of physical therapy (PT) among subgroups. DESIGN: We conducted an observational study of data from a randomized trial of a pain coping skills intervention. Good and poor outcome subgroups were determined based on Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores. The use and costs of PT care as well as changes in WOMAC Pain and Physical Function scores over 4 time periods during a 1-year follow-up were reported. We compared the number of PT visits, total PT costs, and cost per 1-unit improvement in WOMAC scores for the 2 latent subgroups. SETTING: Five academic medical centers. PARTICIPANTS: Patients who catastrophized about their pain prior to knee arthroplasty (N=384). INTERVENTIONS: Pain coping skills training, arthritis education, and usual care. MAIN OUTCOME MEASURES: The WOMAC Pain Scale was the primary outcome. RESULTS: The value of PT was lower and the cost of PT was higher for poor vs good outcome subgroups beginning 2 months after knee arthroplasty. For example, during the 2- to 6-month period, participants in the poor outcome subgroup incurred a PT cost of $5181.22 per 1-unit improvement in WOMAC Pain compared with $437.87 per 1-unit improvement in WOMAC Pain for the good outcome subgroup (P<.001). From the 6- to 12-month period, WOMAC scores worsened for the poor outcome subgroup, indicating no benefit from PT. CONCLUSIONS: Patients in 2 latent classes demonstrated clinically important differences in value of PT. Future research should identify rehabilitation-based interventions that reduce utilization and enhance effectiveness for patients at high risk for poor outcome.

Economic hardship and child intake of foods high in saturated fats and added sugars: the mediating role of parenting stress among high-risk families.

OBJECTIVE: Economic hardship (EH) may link to poorer child diet, however whether this association is due to resource limitations or effects on family functioning is unknown. This study examines whether parenting stress mediates the association between EH and child consumption of foods high in saturated fats and added sugars (SFAS). DESIGN: Data were collected from the Fragile Families and Child Wellbeing study. EH was assessed using eight items collected when children were between 1-9 years old. Mothers reported parenting stress and frequency of child consumption of high SFAS foods when children were 9 years old. Latent growth curve modelling (LGCM) and structural equation modelling tested direct associations between the starting level/rate of change in EH and high SFAS food consumption, and parenting stress as a mediator of the association. SETTING: Twenty US cities. PARTICIPANTS: Mothers/children (n 3846) followed birth through age 9 years, oversampled 'high-risk', unmarried mothers. RESULTS: LGCM indicated a curvilinear trend in EH from ages 1-9, with steeper increases from ages 3-9 years. EH did not directly predict the frequency of high SFAS foods. Average EH at 3 and 5 years and change in EH from ages 1-9 predicted higher parenting stress, which in turn predicted more frequent consumption of high SFAS foods. CONCLUSIONS: Findings suggest it may be important to consider parenting stress in early prevention efforts given potential lasting effects of early life EH on child consumption of high SFAS foods. Future research should explore how supports and resources may buffer effects of EH-related stress on parents and children.

Measuring HIV stigma at the family level: psychometric assessment of the Chinese Courtesy Stigma Scales (CCSSs).

Courtesy stigma is the stigmatization a person perceives or experiences due to their association with a stigmatized individual or group. Most HIV-related stigma scales have been developed for people living with HIV/AIDS (PLWHAs), but not for their HIV-uninfected family members. To date, few measurement scales have been designed to measure the degree of stigma among both PLWHAs and their HIV-uninfected family members at the family level. We developed a set of courtesy stigma scales and estimated their reliability and validity from 256 PLWHAs and 256 of their HIV-uninfected family members. Exploratory and confirmatory factor analyses were performed in two independent samples: a development sample (N = 216) and a validation sample (N = 296), respectively. Two factors ("public stigma" and "self-perceived stigma") had high internal consistency reliability (Cronbach's alpha coefficient between 0.83-0.90) and good construct validity (standardized factor loading range: 0.37-0.95) in both samples. These findings document that the newly developed brief instrument is a psychometrically sound measure of HIV-related stigma among both PLWHAs and their HIV-uninfected family members.

Influences of patient sociodemographics on cancer information received through the first 9 months of treatment.

This study evaluates the amount and change of information cancer patients report receiving related to disease, diagnostic tests, treatments, physical care, and psychosocial resources over 9 months of treatment. Information received by newly diagnosed, stages II-IV cancer patients receiving treatment (N = 139) at baseline, 4, and 9 months is examined through a two-stage latent growth model. Each information-received category was modeled with latent variables of intercept and slope. Random intercept and slope factors are then regressed on multiple sociodemographic covariates. The mean amount of information received does not change over time, but significant inter-individual variability was observed. Age (younger) and marital status (married) are significantly associated with a higher total amount of information received while education (less) and race (African-American) are significantly associated with slower declines of information received over time. While the mean amount of information cancer patients receive is relatively constant over the course of treatment for the first 9 months, the level and rate of information received is somewhat varied based on patient characteristics. Healthcare professionals need to be aware of the varying amounts of information received by patients and ensure that the amount is consistent with the patient's individual needs.

Factors associated with patient reports of positive physician relational communication.

OBJECTIVE: To evaluate the patient, physician, and visit-related factors associated with patient ratings of positive physician relational communication. METHODS: Pre- and post-visit surveys were conducted with 485 patients attending a routine periodic health exam with one of 64 participating physicians. The audio-recorded visits were coded for elements of patient-physician communication including assertive responses, partnership building, question asking, supportive talk, and expressions of concern. RESULTS: Patient reports of positive physician relational communication were associated with patient perceptions of how well the physician understood the patient's health care preferences and values, a patient-physician interaction outside of the exam room, and physician-prompted patient expressions of concern. CONCLUSION: In addition to a patient's perception of their relationship with their physician going into the visit, relatively simple acts like extending the interaction beyond the exam room and ensuring that patients feel invited to express concerns they may have during the visit may influence patient perceptions of physician relational communication. PRACTICE IMPLICATIONS: This study offers preliminary support for the idea that relational communication and its associated benefits may be fostered through simple physician-driven acts such as interacting with patients outside of the exam room and encouraging patients to express concerns within the visit.

Incremental validity of test session and classroom observations in a multimethod assessment of attention deficit/hyperactivity disorder.

This study tested the incremental validity of behavioral observations, over and above parent and teacher reports, for assessing symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in children ages 6 to 12, using the Test Observation Form (TOF) and Direct Observation Form (DOF) from the Achenbach System of Empirically Based Assessment. The TOF Attention Problems and DOF Intrusive scales contributed significant unique variance, over and above parent and teacher ratings, to predicting parent and teacher ratings of hyperactivity and impulsivity and predicting categorical diagnoses of ADHD-Combined type versus Non-ADHD and ADHD-Combined type versus ADHD-Predominantly Inattentive type. The TOF Oppositional and Attention Deficit/Hyperactivity Problems scales contributed unique variance to predicting parent ratings of hyperactivity and impulsivity and the DOF Oppositional and Attention Deficit/Hyperactivity Problems scales contributed unique variance to predicting teacher ratings of hyperactivity and impulsivity.

Broad spectrum assessment of psychopathology and adaptive functioning with the Older Adult Behavior Checklist: a validation and diagnostic discrimination study.

OBJECTIVE: Self-administered by spouses and other collateral informants, the nationally normed Older Adult Behavior Checklist (OABCL) provides standardized data on diverse aspects of older adult psychopathology and adaptive functioning. We tested the validity of the Older Adult Behavior Checklist (OABCL) scale scores in terms of associations with diagnoses of dementia of the Alzheimer's type (DAT) and mood disorders (MD) and with nine measures of psychopathology, cognitive performance, and adaptive functioning. METHOD: Informants completed OABCLs for 727 60-97-year-olds recruited from a memory disorders clinic, geriatric psychiatry clinic, and community-dwelling seniors. OABCL scale scores were tested for associations with DAT and MD diagnoses, as well as with scores on the Neuropsychiatric Inventory, Mini-Mental State Exam (MMSE), Clock Drawing Test, Alzheimer's Disease Assessment Scale, Geriatric Depression Scale, Clinical Dementia Rating, Dementia Severity Rating Scale, Trail Making Test Part A, and Instrumental Activities of Daily Living. RESULTS: OABCL scales had medium to large correlations with the nine other indices of functioning and significantly augmented MMSE discrimination between patients with DAT versus MD. OABCL scales also discriminated significantly between patients diagnosed with DAT versus MD and both these groups versus nonclinical subjects. CONCLUSIONS: Multiple OABCL scales had medium to large associations with diverse indices of functioning based on other kinds of data. The nationally normed OABCL provides new ways to integrate informant and self-report data to improve assessment of older adults. Specifically, the OABCL can provide discrimination between those who qualify for diagnoses of DAT versus MD versus neither diagnosis.

Standardized Observational Assessment of Attention Deficit Hyperactivity Disorder Combined and Predominantly Inattentive Subtypes. II. Classroom Observations.

Trained classroom observers used the Direct Observation Form (DOF; McConaughy & Achenbach, 2009) to rate observations of 163 6- to 11-year-old children in their school classrooms. Participants were assigned to four groups based on a parent diagnostic interview and parent and teacher rating scales: Attention Deficit Hyperactivity Disorder (ADHD)-Combined type (n = 64); ADHD-Inattentive type (n = 22); clinically referred without ADHD (n = 51); and nonreferred control children (n = 26). The ADHD-Combined group scored significantly higher than the referred without ADHD group and controls on the DOF Intrusive and Oppositional syndromes, Attention Deficit Hyperactivity Problems scale, Hyperactivity-Impulsivity subscale, and Total Problems; and significantly lower on the DOF On-Task score. The ADHD-Inattentive group scored significantly higher than controls on the DOF Sluggish Cognitive Tempo and Attention Problems syndromes, Inattention subscale, and Total Problems; and significantly lower on the DOF On-Task score. Implications are discussed regarding the discriminative validity of standardized classroom observations for identifying children with ADHD and differentiating between the two ADHD subtypes.

Assessment of adult psychopathology: meta-analyses and implications of cross-informant correlations.

Assessment of adult psychopathology relies heavily on self-reports. To determine how well self-reports agree with reports by "informants" who know the person being assessed, the authors examined 51,000 articles published over 10 years in 52 peer-reviewed journals for correlations between self-reports and "informants" reports. Qualifying correlations were found in 108 (0.2%) of the articles. When self-reports and informant reports were obtained with parallel instruments, mean cross-informant correlations were .681 for substance use, .428 for internalizing, and .438 for externalizing problems. When based on different instruments, the mean cross-informant correlation was .304. The moderate sizes of the correlations argue for systematically obtaining multi-informant data. National survey findings were used to illustrate practical ways to obtain and use such data.