Health locus of control and self-efficacy predict back pain rehabilitation outcomes.

INTRODUCTION: Chronic back pain treatments have generally been costly and/or ineffective despite advances in medical technology. Patient selection and factors intrinsic to patients, including beliefs and behaviors, have been increasingly looked upon as possible predictive factors for success following multidisciplinary intervention for chronic back pain. The current study investigated the value of using patients' perceived control over health changes (health locus of control) and their perceived ability to engage in pain management behaviors (pain-related self-efficacy) to predict physical and mental health outcomes. METHODS: We retrospectively analyzed 61 patients who completed a two-week multidisciplinary chronic back pain rehabilitation program at our institution between 2007 and 2009. Patient demographics were identified and categorized. Pre- and post-intervention functional surveys, including the Multidimensional Health Locus of Control Form C, Chronic Pain Self-Efficacy Scale, Medical Outcomes Study Short Form-36 Version 2, Beck Depression Inventory-II, and Oswestry Disability Index Version 2, were used to evaluate benefit from back pain intervention and to examine patient factors that may predict physical and mental health outcomes. RESULTS: Participants included 28 males and 33 females, ages 28 to 72, completing chronic back pain rehabilitation. Locus of control, self-efficacy, and physical and mental health demonstrated treatment-related changes, with notable improvements in physical and mental health. Regression analyses examined the value of pre-treatment health locus of control and pain-related self-efficacy as predictors of physical and mental health one month following treatment. Higher internal and lower doctor health locus of control, and higher self-efficacy at baseline predicted higher lift scores one month after treatment (p <. 05; p <. 01; p <. 01, respectively). Higher baseline self-efficacy also predicted better physical functioning (p <. 01) and lower disability (p <. 01) at one month. CONCLUSIONS: In addition to supporting the multiple benefits of multidisciplinary rehabilitation, this study suggests that pain-related self-efficacy and health locus of control may be valuable predictors of treatment benefit for chronic back pain patients. These results provide direction in screening for factors that may maximize the potential to benefit from multidisciplinary intervention for chronic back pain.

Anticipating posttraumatic growth from cancer: patients' and collaterals' experiences.

Posttraumatic growth has been demonstrated to occur following the diagnosis and treatment of cancer. Still unknown is whether patients expect such growth, how growth is perceived at early points in time that follow the cancer experience, and whether patient reports of growth are corroborated by others. Participants were 87 patients and 55 collaterals who reported their anticipation of growth pretreatment and their perceived growth at a 9-month follow-up. Patients' expectations for their own growth were significantly higher than collaterals' expectations for theirs. When anticipated growth was compared to later reported growth, patients overanticipated growth across all domains and collaterals underanticipated growth.

Thought intrusion among adults living with complex regional pain syndrome.

PURPOSE: This study investigated the presence and influence of intrusive thoughts among adults previously diagnosed with complex regional pain syndrome. METHOD: The present study used an Internet-based survey completed by a sample (N = 326) from two national organizations. RESULTS: After controlling for age, gender, and pain level, intrusive thoughts were significantly related to disability and health-related quality of life. CONCLUSIONS/IMPLICATIONS: Intrusive thoughts about the inciting event that caused CRPS uniquely influenced pain and quality of life, suggesting a potential mechanism to target for intervention. Understanding factors that relate to maintenance of CRPS and its resulting disability will help in the development of treatments to improve quality of life.

Spiritual growth and decline among patients with cancer.

PURPOSE/OBJECTIVES: To investigate spiritual transformation among patients with cancer. DESIGN: Longitudinal. SETTING: A university medical center in the midwestern United States. SAMPLE: 47 adult cancer survivors. METHODS: Patients were asked about spirituality, religious and spiritual importance, religious coping, and spiritual gain and decline at baseline as well as nine months post-treatment. MAIN RESEARCH VARIABLES: Religious importance, religious coping, and spiritual gain or decline. FINDINGS: Positive religious coping at baseline predicted spiritual growth at the nine-month follow-up point. Spiritual decline was predicted by negative religious importance. A bivariate relationship existed between increased levels of negative religious coping and increased spiritual growth. CONCLUSIONS: Positive religious coping strategies may influence spiritual transformation. IMPLICATIONS FOR NURSING: Healthcare providers who support a strengths-based perspective on human functioning may be equipped to perform research on spiritual or religious interventions for patients with cancer. KNOWLEDGE TRANSLATION: Greater use of spiritual resources, even if conceptualized as negative religious coping mechanisms or initial spiritual decline, may contribute to increased levels of spiritual growth later. When acting as expert companions, healthcare providers may facilitate spiritual growth by addressing spiritual transformation, creating safe environments for exploring spirituality, becoming familiar with different religious faiths, and seeking appropriate consultation and referrals for patients.

A review of psychosocial factors in complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a disabling pain condition poorly understood by medical professionals. Because CRPS is particularly enigmatic, and has significant impact on patient function, researchers have examined psychological processes present among patients with this diagnosis. This systematic review examines psychosocial factors associated with CRPS, both predictors and sequelae. Our conclusions are that CRPS is associated with negative outcomes, both psychological (e.g., increased depression and anxiety) and psychosocial (e.g., reduced quality of life, impaired occupational function) in nature. However, research does not reveal support for specific personality or psychopathology predictors of the condition.

Influence of coping style on symptom interference among adult recipients of hematopoietic stem cell transplantation.

PURPOSE/OBJECTIVES: To investigate the influence of coping style on interference caused by a variety of common post-treatment symptoms after hematopoietic stem cell transplantation. DESIGN: Longitudinal; secondary analysis of data from the original study that examined health-related quality-of-life variables (e.g., depression, well-being) in adult patients treated with conventional bone marrow transplantation or depleted T-cell bone marrow transplantation. SETTING: Fifteen university medical centers in the United States. SAMPLE: 105 adult recipients of hematopoietic stem cell transplantation. METHODS: Patients were assessed via telephone-based interviews for coping style at baseline and for symptom interference in daily living six months post-treatment. MAIN RESEARCH VARIABLES: Coping style and symptom interference. FINDINGS: Neither age nor gender predicted symptom interference, with the exception of chronic graft-versus-host disease, where older patients experienced more interference at six months, and breathing symptoms, for which women experienced more interference than men at six months. Avoidant coping style at baseline predicted increased interference from symptoms, but emotion-focused and instrumental coping styles did not predict decreased interference. CONCLUSIONS: A generalized avoidant coping style before treatment increased interference from common cancer symptoms six months after hematopoietic stem cell transplantation. IMPLICATIONS FOR NURSING: An intervention to teach alternate coping strategies should be implemented prior to treatment and tested for prevention of symptom-related life interference.

Specialized summer camp for children with cancer: social support and adjustment.

The purpose of this study was to assess the types of social support received by children attending a week-long residential summer camp for children with cancer. Following the camp, families were sent a social support questionnaire (for the child to complete) and the Child Behavior Checklist (for parents to complete). Analyses evaluated children's adjustment rated by parents, support reported by children, and the relationship between adjustment and support. Girls reported receiving more support than boys, and both genders reported receiving more support at camp than children in the general population. Ratings of adjustment were not different from normative data for boys or girls. No relationship was found between adjustment and support. The camp environment is very supportive and may offer forms of support not available in other environments. Research is needed to further understand how camp can be supportive, what factors may affect that support, and how the experience enhances children's quality of life.

Neurocognitive deficits related to poor decision making in people behind bars.

Using a novel quantitative model of repeated choice behavior, we investigated the cognitive processes of criminal offenders incarcerated for various crimes. Eighty-one criminals, including violent offenders, drug and sex offenders, drivers operating a vehicle while impaired, and 18 matched controls were tested. The results were also contrasted with those obtained from neurological patients with focal brain lesions in the orbitofrontal cortex and from drug abusers. Participants performed the computerized version of the Iowa gambling task (Bechara, Damasio, Damasio, & Anderson, 1994), and the results were decomposed into specific component processes, using the expectancy valence model (Busemeyer & Stout, 2002). The findings indicated that whereas all the criminal groups tended to select disadvantageously, the cognitive profiles exhibited by different groups were considerably different. Certain subpopulations--most significantly, drug and sex offenders--overweighted potential gains as compared with losses, similar to chronic cocaine abusers. In contrast, assault/murder criminals tended to make less consistent choices and to focus on immediate outcomes and, in these respects, weremore similar to patients with orbitofrontal damage. The present cognitive model provides a novel way for building a bridge between cognitive neuroscience and complex human behaviors.

Social support and depression among bone marrow transplant patients.

This study considered the role of social support in mitigating depression among bone marrow transplant (BMT) patients. Eighty-six BMT patients completed the Medical Outcomes Study Social Support Scale (MOS-SSS) and the Centers for Epidemiological Studies of Depression Scale (CES-D) before transplant and again at one year posttransplant. Results showed moderate levels of depressive symptoms in BMT patients, with 29.1 percent and 27.6 percent meeting the suggested criterion for clinical depression at pre-BMT and one year post-BMT, respectively. Overall, patients experienced a reduced level of depression post-BMT, although females reported more depression than males. Social support pre-BMT predicted depression levels post-BMT controlling for initial levels of depression. Clinical implications for health care providers working with cancer patients and their families are discussed.

Social support, optimism, and self-efficacy predict physical and emotional well-being after bone marrow transplantation.

This study examined whether three psychosocial variables (social support, self-efficacy, and optimism) assessed prior to bone marrow transplantation (BMT) predicted physical and emotional wellbeing one year post-BMT. Data were gathered on 87 participants enrolled in a multicenter, randomized trial examining the impact of ex-vivo T-cell depletion on disease-free survival in leukemia patients receiving allogeneic BMT. Social support, optimism, and self-efficacy significantly predicted emotional and physical well-being one year post-BMT, controlling for age, gender, maximum grade of acute GVHD, and treatment arm. Attention to psychosocial factors prior to BMT and during recovery appears critical for physical and mental well-being, especially considering the influence of psychosocial variables independent of medical risk factors.

The effect of unrelated donor marrow transplantation on health-related quality of life: a report of the unrelated donor marrow transplantation trial (T-cell depletion trial).

The primary objective of this study was to compare health-related quality of life (HRQL) in adult patients undergoing either ex vivo T cell-depleted bone marrow transplantation or conventional marrow transplantation. Data on patients' HRQL were gathered as part of a multicenter randomized trial comparing the effect of ex vivo T-cell depletion versus methotrexate and cyclosporine immunosuppression on disease-free survival. HRQL assessments were conducted at baseline, day +100, 6 months, 1 year, and 3 years. There were no treatment arm differences 1 year after transplantation on the Functional Assessment of Cancer Therapy, Bone Marrow Transplantation, the Medical Outcomes Study Short-Form 36, and the Centers for Epidemiological Studies of Depression. The lack of treatment differences was robust across types of data analyses that took baseline functioning into account and that recognized the sensitivity of outcome measures to assumptions concerning missing data. The trajectory of recovery revealed an initial decrease in function and then a recovery to pretreatment levels that were similar for both treatment arms. Furthermore, the patients in both treatment groups returned to a functional level that approximated general US population norms. Even though the incidence of acute graft-versus-host disease was slightly higher in the conventional treatment arm, T-cell depletion did not differentially affect HRQL at 1 year after transplantation.

The relationship between religion/spirituality and physical health, mental health, and pain in a chronic pain population.

This study sought to better understand the relationship between religion/spirituality and physical health and mental health in 122 patients with chronic musculoskeletal pain. The current study conceptualized religion/spirituality as a multidimensional factor, and measured it with a new measure of religion/spirituality for research on health outcomes (Brief Multidimensional Measure of Religion/Spirituality). Pain patients' religious and spiritual beliefs appear different than the general population (e.g. pain patients feel less desire to reduce pain in the world and feel more abandoned by God). Hierarchical multiple regression analyses revealed significant associations between components of religion/spirituality and physical and mental health. Private religious practice (e.g. prayer, meditation, consumption of religious media) was inversely related to physical health outcomes, indicating that those who were experiencing worse physical health were more likely to engage in private religious activities, perhaps as a way to cope with their poor health. Forgiveness, negative religious coping, daily spiritual experiences, religious support, and self-rankings of religious/spiritual intensity significantly predicted mental health status. Religion/spirituality was unrelated to pain intensity and life interference due to pain. This study establishes relationships between religion/spirituality and health in a chronic pain population, and emphasizes that religion/spirituality may have both costs and benefits for the health of those with chronic pain.

Development of a Medical School Admissions Interview Phase 2: Predictive Validity of Cognitive and Non-Cognitive Attributes.

BACKGROUND: Interest in improving medical school admissions processes led to the development of a structured admissions interview to eliminate potential bias and provide valid information for selection. This article reports on the degree to which this interview, along with other admissions variables, predicted later student performance during medical school. METHODS: All applicants considered for admission participated in the new interview. Interview scores and regular admissions data were compiled. Measures of performance in cognitive (e.g., written test scores) and non-cognitive (e.g., ratings of listening skills) domains were gathered during participants' enrollment in medical school and correlated with measures gathered during the admissions process. RESULTS: Cognitive predictors predicted later performance in cognitive domains but did not predict non-cognitive performance. Both written and interview-based measures of non-cognitive abilities predicted performance in non-cognitive domains. Both cognitive and non-cognitive predictors predicted grades in clinical rotations, which presumably reflect a mixture of cognitive and non-cognitive abilities. CONCLUSIONS: Our results do not support the predictive validity of our interview-based measure above other cognitive and non-cognitive admissions variables more easily gathered. However, in some domains, interview-based variables did incrementally predict medical school performance.

Long-term outcomes in multidisciplinary treatment of chronic low back pain: results of a 13-year follow-up.

STUDY DESIGN: Patients completing a multidisciplinary pain treatment were contacted to obtain 13-year follow-up information on pain, mood, employment, and general health. OBJECTIVES: Study objectives were to determine if post-treatment improvements were maintained over a lengthy follow-up period and to compare patients' general health to norms of comparably aged persons. SUMMARY OF BACKGROUND DATA: Although many studies have demonstrated the short-term effectiveness of multidisciplinary pain treatment programs for chronic low back pain, few studies have documented that these treatment gains are maintained over time. Only two studies have reported patient outcomes on a long-term basis (10+ years). Those studies have documented that patient gains during treatment are generally maintained during follow-up. METHODS: An attempt was made to contact all patients completing an inpatient chronic back pain rehabilitation program at the University of Iowa's Spine Diagnostic and Treatment Center. Of the 45 participants, 28 were located and 26 agreed to participate in a telephone interview. Analyses of pretreatment and posttreatment data revealed these follow-up participants did not differ from the larger study sample. RESULTS: Patients maintained their treatment gains in all areas (pain intensity and interference, negative mood). Additionally, patients showed levels of general health comparable to similarly aged peers with the exceptions of pain (more pain) and physical functioning (lower functioning, more pain interference). More than half the sample was employed; of those not employed, few reported this was due to pain. CONCLUSIONS: The data lend support to the long-term effectiveness of multidisciplinary treatment programs for chronic low back pain.

A Content Analysis of Interviewee Reports of Medical School Admissions Interviews.

INTRODUCTION: Prospective medical school applicants use Internet websites to gain information about medical school interviews as well as to offer their experience in such interviews. This study examined applicants' reported experiences of interviews and compared them to the purposes of the interview as purported by medical schools. METHOD: Content analysis of student feedback regarding medical school interviews at 161 medical schools was conducted for entries of over 4600 students applying to medical school who anonymously and voluntarily completed an online questionnaire. RESULTS: Across all medical schools, nearly one half of all cited interview questions addressed noncognitive characteristics of the applicants. Top ranked medical schools were reported to ask significantly more interpersonal and illegal questions and fewer academic/general knowledge questions than other medical schools. Lower ranked schools did not differ significantly in the types of questions reportedly asked applicants compared to other medical schools. DISCUSSION: Medical school interviews are generally gathering types of information about applicants that admissions personnel identify as important in the admission decision. In addition to measuring interpersonal characteristics, medical school admissions interviews are assessing cognitive abilities and ethical decision-making. Sources on the Internet provide actual medical school interview questions to prospective students. This practice can help them gain an undue advantage in interviewing. Admissions committees and faculty who interview students may want to consider how best to obtain accurate and valid responses from applicants.

The effects of perceived versus enacted social support on the discriminative cue function of spouses for pain behaviors.

This study examined the effects of spouse social support on patient displays of pain behaviors. A standardized behavioral observation method was used to record pain behaviors in 110 chronic pain patients while the spouse was present and while the spouse was absent. Patients and their spouses also completed paper and pencil measures of spouse-provided social support as well as a demographic questionnaire. Results indicated that pain behaviors varied as a function of spouse presence and the type, or dimension, of support considered. Patients reporting higher levels of enacted support displayed a greater number of pain behaviors irrespective of spouse presence, consistent with the operant theory. When a measure of perceived support was used, the pain behaviors displayed differed, depending upon the level of support and spouse presence. Results are consistent with support-seeking and cognitive-behavioral models of the effects of social support on outcome. We discuss our findings within the context of a multidimensional model of support and pain and we caution against strict application of the operant model in treatment programs. Additional research is warranted to better understand the impact of support on the rehabilitation of patients with chronic pain.

The effectiveness of psychological interventions for the rehabilitation of low back pain: a randomized controlled trial evaluation.

Forty-five low back pain patients were randomly assigned to either a standard inpatient rehabilitation program or the standard program with additional psychological components. The standard program emphasized education, support, and physical reconditioning through exercise. Patients receiving the psychological program were given additional training in relaxation and other coping skills and received contingent reinforcement for exercise. Both programs included reduction of medication intake and an emphasis on family involvement after discharge. Measures of functional status were taken prior to the program, at discharge from the 3-week inpatient program, and at a 6-month follow-up appointment. These data revealed that patients improved their overall functioning at discharge and maintained these gains at the follow-up assessment. A similar pattern of findings was obtained for self-reported pain and interference. Furthermore, 81% of the patients had returned to work or were engaged in active job retraining by the follow-up. Using a conservative measure of full-time return to the same or an equivalent job, 57% were employed by the follow-up. Patient improvement, however, was not differentially affected by treatment group assignment, suggesting that the psychological treatment failed to add to the effectiveness obtained by the standard rehabilitation program. Results are discussed in the context of improving patient outcomes from rehabilitation for low back pain.