Subjective experiences of men with and without spinal cord injury: tolerability of the juvent and WAVE whole body vibration plates.

BACKGROUND: Device tolerability is an important determinant of subject adherence and intervention effectiveness. Although popular in rehabilitation settings, the tolerability of whole-body vibration (WBV) among patients with spinal cord injury (SCI) is unknown. OBJECTIVE: To assess feedback from SCI and non-SCI subjects on the usability of passive standing and WBV devices (Juvent [Juvent Medical, Somerset, NJ] and WAVE [WAVE Manufacturing, Windsor, Ontario, Canada]) using a priori specified knee postures, plate amplitudes, and frequencies. DESIGN: A matched groups design with repeated measures. SETTING: A tertiary SCI rehabilitation center. SUBJECTS: Eight men with chronic SCI (C4-L2, American Spinal Injury Association Impairment Scale A-D) and 10 men without SCI of similar height, weight, and body mass index. INTERVENTION: Subjects (N = 18; 8 with SCI) underwent intermittent WBV during passive standing (EasyStand 5000 [Altimate Medical, Morton, MN]) for 45 minutes using the optimized WAVE and Juvent plates. WBV parameters were sequentially altered every 2 minutes and included parameter combinations of (1) postures of 140°, 160°, and 180° knee extension (180° with Juvent only); (2) amplitudes of 0.7 mm and 1.1 mm (WAVE only); and (3) frequencies of 25 Hz, 35 Hz, and 45 Hz. Outcome assessments were completed at 4-minute intervals throughout WBV exposure. MAIN OUTCOME MEASURES: Qualitative, semistructured interviews were used to generate neutral, positive, and negative descriptors of the subjects' overall experience and device preference. RESULTS: SCI subjects reported a greater frequency of positive descriptors than non-SCI subjects during WBV, regardless of plate, posture, amplitude, or frequency, with the exception of 1 combination of parameters (WAVE plate at 140°, 1.1 mm, and 25 Hz). Non-SCI subjects reported the highest frequency of negative effects with the WAVE plate at 160°, 1.1 mm, 25 Hz, and 35 Hz. Non-SCI subjects preferred the Juvent, whereas SCI subjects preferred the WAVE plate. CONCLUSIONS: SCI and non-SCI subjects reported differing frequencies of positive and negative descriptors and indicated divergent device preferences. SCI subjects preferred the WAVE plate and vibration at high frequency. Future research will determine the therapeutic potential and adverse events associated with the device and WBV parameters tolerable for persons with SCI.

Continued success of the rapid response radiotherapy program: a review of 2004-2008.

PURPOSE: To update the clinical activity of the Rapid Response Radiotherapy Program (RRRP). MATERIALS AND METHODS: We conducted a retrospective review of our clinic database from January 2004 until July 2008. The number of patients referred to the RRRP, relevant demographic data, diagnosis and treatment dispositions were recorded. Time interval between referral to consultation and consultation to simulation were also calculated. RESULTS: During the study period, 3,267 patients were seen in the RRRP. Forty-five percent (1,494) of the patients were new to the clinic. Of the 3,267 patients seen, 1,548 (47.4%) were female and 1,719 (52.6%) were male. The median age was 69.2 years (range, 22-101 years). The most common primary sites were lung (34.2%), breast (21.2%) and prostate (17.0%). The majority of patients were referred for palliative treatment of bone metastases (52.4%) or treatment for brain metastases (20.7%). Of the patients referred, 2,311 (70.5%) patients received palliative radiotherapy. The median duration from referral to consultation was 4 days. The majority (82.3%) of patients were simulated and treated within the first 7 days following consultation. CONCLUSION: The number of patients referred to the RRRP from January 2004-July 2008 remains comparable to our previous report (1996-2003). The overall median interval from referral to consultation for the analysed time period was 4 days. Therefore, we are continuing to meet our goal of providing rapid access to palliative radiation treatment for symptomatic cancer patients. Further information relating to progression and advancements within the clinic aimed at improving our patients' quality of life are explored.

Symptom clusters in patients with cancer with metastatic bone pain.

PURPOSE: The primary objective was to explore how patients' worst pain clustered together with functional interference items. Secondary objectives were to determine whether symptom clusters change with palliative radiotherapy (RT) and to compare the difference between responders and nonresponders to radiation. MATERIALS/METHODS: Worst pain at the site of treatment and functional interference scores were assessed using the Brief Pain Inventory (BPI). Patients provided their scores at baseline, 4, 8, and 12 weeks post-RT. A principal component analysis was performed on the 8 items (worst pain and 7 functional interference items) at all time points to determine interrelationships between symptoms. Principal components with an eigenvalue higher than 0.90 and explaining more than 10% of the variance were selected. The Cronbach alpha statistic was used to estimate the internal consistency and reliability of the derived clusters at baseline and at subsequent follow-ups. Robust relationship and correlation among symptoms were displayed with a biplot graphic. RESULTS: From May 2003 to January 2007, 348 patients with bone metastases that were referred for palliative RT were accrued into the study. There were 206 males (59%) and 142 females (41%), with a median age of 68 years (range, 30-91). Lung (26%), breast (25%) and prostate (24%) were the most common primary cancer sites. Treatment ranged from single to multiple fractions, with the majority of patients receiving a single 8 Gy (58%) and 20 Gy/5 (35%). The most prevalent sites of RT were spine (31%), pelvis (16%), and hips (15%). Two symptom clusters were identified. Cluster 1 included walking ability, general activity, normal work, enjoyment of life and worst pain. Cluster 2 included relations with others, mood and sleep. The two clusters at baseline accounted for 67% of the total variance with a Cronbach alpha of 0.87 and 0.70, respectively. In responders to radiation treatment, the two symptom clusters disintegrated at 4, 8, and 12 weeks post-RT. All symptom severity items improved over time (p < 0.0001). In nonresponders, two clusters had disappeared at week 4, reemerged at week 8, and disintegrated at week 12. CONCLUSION: Symptom clustering has proved to be therapeutically important because treatment of one symptom may affect others within the same cluster. The significant correlations between worst pain and the functional interference items reaffirm the importance of pain reduction as a treatment goal for palliative radiotherapy. By treating a patient's symptom of worst pain, it would subsequently ease their response burden on their daily functional activities by decreasing symptom severity, increasing function, and improving overall quality of life.

What should be the optimal cut points for mild, moderate, and severe pain?

PURPOSE: Grouping patients' rating of pain intensity from 0 to 10 into categories of mild, moderate, and severe pain is useful for informing treatment decisions, interpreting study outcomes, as well as aiding policy or clinical practice guidelines development. In 1995, Serlin and colleagues developed a technique to establish the cut points for mild, moderate, and severe pain by grading pain intensity with functional interference. Since then, a number of studies attempted to confirm these findings in similar or different populations but had different results. Such inconsistencies in the literature prompt for more research to establish the definition of mild, moderate and severe pain. Thus, the purpose of the current study was to identify optimal cut points (CP) of the three pain severity categories for worst, average, and current pain. PATIENTS AND METHODS: The study population (n = 199) was patients with symptomatic bone metastases referred to a palliative radiotherapy clinic. Using the Brief Pain Inventory (BPI), patients reported their worst, average, and current pain intensity, as well as the degree of functional interference due to pain. All possible combinations for the CPs, between 2 and 8, were created and related to the set of 7 interference items from the BPI using the multivariate analysis of variance (MANOVA). The criteria used to determine the optimal set of cut points for mild, moderate and severe pain was a MANOVA among pain severity categories that yielded the largest F ratio for the between-category effect on the 7 interference items as indicated by Pillai's trace, Wilk's lambda, and Hotelling's trace F statistics. RESULTS: Results confirmed a non-linear relationship between cancer pain severity and functional interference. The optimal CP for worst and average pain was CP4, 6 (mild = 1-4, moderate = 5-6, and severe = 7-10), confirming Serlin and colleagues's findings. CONCLUSION: These findings are pivotal in further understanding the meaning of pain intensity levels and the assessment of pain in patients with metastatic cancer. However, further research in alternative methods of defining the optimal CP and clinically important change should be considered.

Symptom clusters in cancer patients with bone metastases.

PURPOSE: The purpose of this study is to explore whether bone pain "clusters" with other symptoms in patients with bone metastases. MATERIALS AND METHODS: Patients with bone metastases referred to a palliative radiotherapy clinic were asked to rate their symptom distress using the Edmonton Symptom Assessment Scale (ESAS). Analgesic consumption during the previous 24 h was captured at initial consultation. To determine interrelationships between symptoms, a principal component analysis (PCA) with "varimax rotation" was performed on the nine ESAS symptoms. This study defined a "symptom cluster" as two or more symptoms that occur together, are stable, and are relatively independent of other clusters. Patients were followed 1, 2, 4, 8, and 12 weeks post-radiation treatment by telephone. Statistical analysis was performed at each time point for both responders and nonresponders to radiation (response was defined in accordance to the International Bone Metastases Consensus Working Party). RESULTS: Five hundred eighteen patients with bone metastases provided complete baseline data using the ESAS. The four most prevalent symptoms were poor sense of well-being (93.5%), fatigue (92.3%), pain (84.1%), and drowsiness (81.8%). Three clusters were identified and accounted for 66% of the total variance at baseline. Cronbach's alpha coefficient demonstrated high internal reliability in the clusters, with a coefficient ranging from 0.61 to 0.81. It was observed that the clusters changed post-radiation in both responders and nonresponders and that pain clustered with different symptoms (or remained a separate symptom in responders). In nonresponders, three symptom clusters were consistently present, except in week 8. CONCLUSION: Radiotherapy influenced the structure of symptom clusters in both responders and nonresponders. There was evidence that pain clustered out in responders of radiation to pain. It was found that pain clustered with fatigue, drowsiness, and poor sense of well-being at baseline. However, these findings must be heeded with caution, as more work is needed to clearly define symptom clusters and to understand the effects of radiation in the symptom experience of patients with bone metastases.

Symptom clusters in patients with advanced-stage cancer referred for palliative radiation therapy in an outpatient setting.

PURPOSE: The aim of this study was to explore the presence of symptom clusters in patients with advanced cancer. PATIENTS AND METHODS: Patients with metastatic cancer referred to an outpatient palliative radiation therapy clinic were asked to rate their symptom distress using the Edmonton Symptom Assessment Scale (ESAS). Baseline demographic data were obtained. To determine interrelationships between symptoms, a principal component analysis with "varimax rotation" was performed on the 9 ESAS symptoms. RESULTS: Between January 1999 and January 2002, a total of 1296 patients with metastases provided complete baseline data on the ESAS. The most common primary cancer sites were lung, breast, and prostate. Fatigue was the highest scored symptom, followed by poor sense of well-being, pain, lack of appetite, and drowsiness. The 4 most prevalent symptoms were poor sense of well-being (92.7%), fatigue (92.2%), drowsiness (79.7%), and anxiety (78.7%). Three symptom clusters were found. Cluster 1 included lack of appetite, nausea, poor sense of well-being, and pain. Cluster 2 included fatigue, drowsiness, and shortness of breath. Cluster 3 included anxiety and depression. CONCLUSION: More work needs to be done on symptom cluster research, especially in setting a consensus in methodology.