ABSTRACT
OBJECTIVE: To describe the methodology, challenges, and baseline characteristics of a prevention development trial entitled "Reducing Pain, Preventing Depression." METHODS: A sequential multiple assignment randomized trial (SMART) compared sequences of cognitive behavioral therapy (CBT) and physical therapy for knee pain and prevention of depression and anxiety. Participants were randomized to CBT, physical therapy, or enhanced usual care and followed for 12 months for new-episode depression or anxiety. Participants were age ≥ 60 with knee osteoarthritis and subsyndromal depression, defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥1 (which included the endorsement of one of the cardinal symptoms of depression [low mood or anhedonia]) and no diagnosis of major depressive disorder per the Structured Clinical Interview for DSM-IV. Depression and anxiety severity and characterization of new episodes were assessed with the PHQ-9, Generalized Anxiety Disorder-7, and the PRIME-MD. Knee pain was characterized with the Western Ontario McMaster Arthritis Index. Response was defined as at least "Very Much Better" on a Patient Global Impression of Change. RESULTS: At baseline there were 99 patients with an average age of 71; 61.62% were women and 81.8% white. The average PHQ-9 was 5.6 and average Generalized Anxiety Disorder-7, was 3.2. Most were satisfied with the interventions and study procedures. The challenges and solutions described here will also be used in a confirmatory clinical trial of efficacy. CONCLUSION: A SMART design for depression and anxiety prevention, using both CBT and physical therapy, appears to be feasible and acceptable to participants. The methodologic innovations of this project may advance the field of late-life depression and anxiety prevention.
Subject(s)
Anxiety/prevention & control , Cognitive Behavioral Therapy/methods , Depression/prevention & control , Osteoarthritis, Knee/psychology , Pain/psychology , Aged , Diagnostic and Statistical Manual of Mental Disorders , Emotions , Female , Humans , Male , Middle Aged , Ontario , Patient Satisfaction , Proportional Hazards Models , Psychiatric Status Rating Scales , Severity of Illness Index , Stress, PsychologicalABSTRACT
BACKGROUND: The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS. METHODS: A single group repeated measures design was used. Two pairs of physical therapists participated in data collection. Examiners were blinded to each others' measurements. RESULTS: Thirty patients (age 29 +/- 8; 17 female) with PFPS participated in this study. Inter-tester reliability coefficients were substantial for measures of hamstrings, quadriceps, plantarflexors, and ITB/TFL complex length, hip abductors strength, and foot pronation (ICCs from .85 to .97); moderate for measures of Q-angle, tibial torsion, hip external rotation strength, lateral retinacular tightness, and quality of movement during a step down task (ICCs from .67 to .79); and poor for femoral anteversion (ICC of .45). Standard error of measurement (SEM) for measures of muscle length ranged from 1.6 degrees to 4.3 degrees. SEM for Q-angle, tibial torsion, and femoral anteversion were 2.4 degrees, 2.9 degrees, and 4.5 degrees respectively. SEM for foot pronation was 1 mm. SEM for measures of muscle strength was 1.8 Kg for abduction and 2.4 Kg for external rotation. CONCLUSION: Several of the impairments associated with PFPS had sufficient reliability and low measurement error. Further investigation is needed to test if these impairment measurements are related to physical function and whether or not they are useful for decision-making.
Subject(s)
Arthralgia/diagnosis , Disability Evaluation , Knee Joint/physiopathology , Pain Measurement/standards , Patellofemoral Pain Syndrome/diagnosis , Adolescent , Adult , Ankle Joint/physiology , Arthralgia/physiopathology , Female , Hip Joint/physiology , Humans , Male , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Muscle Weakness/physiopathology , Muscle, Skeletal/physiology , Pain Measurement/methods , Patellofemoral Pain Syndrome/physiopathology , Predictive Value of Tests , Range of Motion, Articular/physiology , Reproducibility of Results , SyndromeABSTRACT
The Clean Air Status and Trends Network (CASTNet) was implemented by the U.S. Environmental Protection Agency (EPA) in 1991 in response to Title IX of the Clean Air Amendments of 1990, which mandated the deployment of a national ambient air monitoring network to track progress of the implementation of emission reduction programs in terms of deposition, air quality, and changes to affected ecosystems. CASTNet evolved from the National Dry Deposition Network (NDDN). CASTNet currently consists of 45 sites in the eastern United States and 28 sites in the West. Each site measures sulfur dioxide (SO2), nitric acid (HNO3), particle sulfate (SO4=), particle nitrate (NO3- ), and ozone. Nineteen sites collect precipitation samples. NDDN/CASTNet uses a uniform set of site-selection criteria which provides the data user with consistent measures to compare each site. These criteria also ensure that, to the extent possible, CASTNet sites are located away from local emission sources. This paper presents an analysis of SO2 and SO4= concentration data collected from 1987 through 1996 at rural NDDN/CASTNet sites. Annual and seasonal variability is examined. Gradients of SO2 and SO4= are discussed. The variability of the atmospheric mix of SO2 and SO4= is explored spatially and seasonally. Data from CASTNet are also compared to SO2 and SO4= data from concurrent monitoring studies in rural areas.
