Evaluation of a self-regulation based psycho-educational pilot intervention targeting children and adolescents with epilepsy in Greece.

PURPOSE: The purpose of this study is to describe the development and initial evaluation of a minimal structured psycho-educational intervention for children and adolescents with epilepsy. The intervention aimed at increasing the understanding and personal control (self-management) of epilepsy, and at reducing psychological distress, sleep problems and somatic complaints. METHOD: Twelve patients participated in our intervention and another 12, matched on age and gender, served as the control group. Data were obtained at baseline (prior to the intervention) and 3 months later in the context of an interview based on several validated questionnaires. The intervention was limited to one 4-h session using Cognitive Behavioural Therapy techniques, relaxation techniques, video and storytelling. Effects of the intervention on primary and secondary outcomes were examined using 2 (baseline, T1 vs. post-treatment, T2)×2 (intervention vs. control) mixed model repeated measures analysis of covariance (ANCOVA), controlling for epilepsy severity. RESULTS: The analysis revealed that over the three months of the study, significant main effects (group x time) were observed on coherence (F(1,21)=6.12; p=0.02) with important changes in favour of the intervention group. Significant main effects were also observed on psychological distress levels (F(1,21)=10.08; p=0.005) and sleep problems (F(1,21)=11.40; p=0.003). CONCLUSION: The results of this study show that a brief self-regulation-based intervention may have beneficial effects for children and adolescents suffering from epilepsy by inciting improvements in coherence, psychological distress and sleep problems.

How Changes in Psychosocial Job Characteristics Impact Burnout in Nurses: A Longitudinal Analysis.

AIMS: The main aim of this longitudinal study was to test the Job Demand-Control-Support (JDCS) model and to analyze whether changes in psychosocial job characteristics are related to (changes in) burnout. BACKGROUND: Previous studies on the effects of JDCS variables on burnout dimensions have indicated that the iso-strain hypothesis (i.e., high job demands, low control, and low support additively predict high stress reactions) and the buffer hypotheses (i.e., high job control and/or social support is expected to moderate the negative impact of high demands on stress reactions) have hardly been examined concurrently in a longitudinal design; and that the effects of changes of psychosocial job variables on burnout dimensions have hardly been analyzed. DESIGN: This two wave study was carried out over a period of 14 months in a sample of 217 Italian nurses. METHOD: Hierarchical regression analyses were used to test the cross lagged main and interactive effects of JDCS variables, and to analyse the across-time effects of changes in JDCS dimensions on burnout variables. RESULTS: The Time 1 job characteristics explained 2-8% of the variance in the Time 2 burnout dimensions, but no support for the additive, or the buffer hypothesis of the JDCS model was found. Changes in job characteristics explained an additional 3-20% of variance in the Time 2 burnout dimensions. Specifically, high levels of emotional exhaustion at Time 2 were explained by high levels of social support at Time 1, and unfavorable changes in demands, control, and support over time; high depersonalization at Time 2 was explained by high social support at time 1 and by an increase in demands over time; and high personal accomplishment at Time 2 was predicted by high demands, high control, interactive effect demands × control × social support, at Time 1, and by a decrease in demands over time. No reversed effects of burnout on work characteristics have been found. CONCLUSION: Our findings suggest that the work environment is subject to changes: the majority of employees experienced considerable changes in all job conditions over time. These changes impacted employee burnout. Limitations and implications of the study are discussed.

The impact of occupational hazards and traumatic events among Belgian emergency physicians.

BACKGROUND: Emergency Physicians (EPs) are regularly confronted with work related traumatic events and hectic work conditions. Several studies mention a high incidence of post-traumatic stress disorder (PTSD) and psychosomatic complaints in EP. The main objective of this study is to examine the contribution of demographics, traumatic events, life events, the occurrence of occupational hazards and social support to post-traumatic stress symptoms (PTSS), psychological distress, fatigue, somatic complaints and job satisfaction in Emergency Physicians. METHODS: For this study questionnaires were distributed to Belgian Emergency Physicians, These include, as determinants socio-demographic characteristics, traumatic events, life events, the occurrence of physical hazards, occurrences of violence, occurrence of situations that increase the risk of burnout and social support by supervisors and colleagues (LQWQ-Med), and as outcomes PTSS (IES), psychological distress (BSI), somatic complaints (PHQ 15), perceived fatigue (CIS20 R) and job satisfaction (LQWQ-MD). The response rate was 52.3 %. Hierarchical multiple regression analysis was performed to examine the association between the determinants and each of the outcomes. RESULTS: Emergency Physicians are particularly vulnerable to post-traumatic and chronic stress consequences due to repetitive exposure to work related traumatic incidents such as serious injuries or death of a child/adolescent. One out of three Emergency Physicians met sub-clinical levels of anxiety and 14.5 % met a clinical level of PTSD, short for Post-Traumatic Stress Disorder. Levels of fatigue were high but not directly related to traumatic events and occupational hazards. Social support from colleagues was found to have a beneficial effect on these complaints. Job satisfaction seems to have a protective factor. All of these not only affect the Emergency Physicians themselves, but can also have an adverse impact on patient care. DISCUSSION: EPs are, according to our and other studies, confronted on a regular basis with significant, potentially traumatizing work related events. There is a higher perception of traumatic events in older Eps. We find out that 36 % of the EPs find dealing with sudden death of a young person and traumatic accident/disease involving a young person the most traumatic experience during their work activity. Three quarter of these EPs have children of their own. The results of the study show that frequency of exposure to traumatic (work) events contributes next to occurrence of situations that increase the risk of burnout to the explanation of variance in posttraumatic stress and psychological distress. The novelty of this study is that it explores the effect of specific determinants of PTSS, psychological distress, fatigue, somatic complaints and job satisfaction in Emergency Physicians. Especially occurrence of situations that increase the risk of burnout seems to have a major impact on all outcomes including job satisfaction, while occurrence of violence contributes especially to psychological distress and perceived fatigue. Lack of social support is a well-known predictor of occupational stress in emergency care workers. In contrast however, good social support of colleagues at work, as we found in our study, can facilitate the recovery process after confrontation with traumatic events and occupational hazards. CONCLUSION: Emergency Physicians are particularly vulnerable to post-traumatic stress and chronic stress consequences due to repetitive exposure to work related traumatic events. Training in dealing with violence and situations that can increase the risk of burnout can reduce detrimental consequences in emergency physicians. In addition, it is suggested that emergency units are screened systematically on determinants of burnout, in view of interventions. Finally, creating a supportive work environment and training the medical staff in supportive skills with backup by experts may also reduce adverse consequences of confrontation with traumatic work events.

Differences in Physical and Psychosocial Characteristics Between CFS and Fatigued Non-CFS Patients, a Case-Control Study.

PURPOSE: The main research question is: "Do CFS patients differ from fatigued non-CFS patients with respect to physical, cognitive, behavioral, social, and emotional determinants?" In addition, group differences in relevant outcomes were explored. METHOD: Patients who met the Centers for Disease Control (CDC) criteria for CFS were categorized as CFS; these patients were mainly recruited via a large Dutch patient organization. Primary care patients who were fatigued for at least 1 month and up to 2 years but did not meet the CDC criteria were classified as fatigued non-CFS patients. Both groups were matched by age and gender (N = 192 for each group). RESULTS: CFS patients attributed their fatigue more frequently to external causes, reported a worse physical functioning, more medical visits, and a lower employment rate. The results of a multiple logistic regression analysis showed that patients who believe that their fatigue is associated with more severe consequences, that their fatigue will last longer and is responsible for more additional symptoms are more likely to be classified as CFS, while patients who are more physically active and have higher levels of "all or nothing behavior" are less likely to be classified as having CFS. CONCLUSION: A longitudinal study should explore the predictive value of the above factors for the transition from medically unexplained fatigue to CFS in order to develop targeted interventions for primary care patients with short-term fatigue complaints.

Determinants of methotrexate adherence in rheumatoid arthritis patients.

In rheumatoid arthritis (RA) patients, weekly intake of methotrexate (MTX) is the basic drug treatment. This observational study aims to investigate how many RA patients are adherent in terms of MTX intake and to identify determinants of non-adherence. Intake of MTX (orally or via injection) was recorded in 129 RA patients with an electronic monitoring system (MEMS(®)) during 16 weeks. In addition, two adherence questionnaires, the Medication Adherence Report Scale (MARS-5) and the Compliance-Questionnaire-Rheumatology (CQR) as well as a visual analogue scale (VAS) measuring MTX adherence, were administered to these patients. As possible determinants of adherence, data on demographics, disease and treatment characteristics, depression, illness cognitions, motivation, and social support were collected. Of all participants, 58 % were fully adherent and 75 % skipped at most one dose during 16 weeks. A better mental health status and suffering from comorbidities had a positive effect on adherence, while living alone had a negative effect. These three predictors explained 30 % of the variance in MTX adherence. Of the three self-report medication adherence measures, the VAS correlated the highest with the results of the electronic monitoring system (r = 0.552, p = 0.01). A relatively high adherence rate was observed in RA patients treated with MTX. The determinants identified by this study could be used to screen patients at risk for non-adherence. A simple VAS scale seems to be an acceptable way for a preliminary screening of MTX adherence.

Psychosocial job characteristics and psychological distress / well-being: the mediating role of personal goal facilitation.

OBJECTIVE: This study examined the mediating role of personal goal facilitation through work (PGFW), defined as perceptions of the extent to which one's job facilitates the attainment of one's personal goals, in the association between psychosocial job characteristics and psychological distress and job-related well-being. MATERIAL AND METHODS: Questionnaire data from 217 nurses (84% female, with a mean age of 42.7 years, SD=7.2) were analyzed. Participants completed the following measures: the Leiden Quality of Work Questionnaire for Nurses, Workplace Goal Facilitation Inventory, Maslach Burnout Inventory-Human Services Survey, and Utrecht Work Engagement Scale (short version). A cross-sectional study design was applied. Hierarchical multiple regression analyses were conducted. RESULTS: The results indicated that unfavorable psychosocial job characteristics (high demands, low control, and low social support) were associated with lower PGFW. Furthermore, personal goal facilitation through work explained significant additional variance (from 2 to 11%) in psychological distress (somatic complaints and emotional exhaustion) and job-related well-being (personal accomplishment, job satisfaction, and work engagement), controlling for demographic indicators and psychosocial job characteristics. Finally, the results provided support for the mediating effects of PGFW between all psychosocial job characteristics and all outcomes, except in the case of depersonalization. CONCLUSIONS: This study suggests that hindered personal goal facilitation may be a mechanism through which psychosocial job characteristics have a negative impact on employees' well-being.

The contribution of illness perceptions to fatigue and sleep problems in youngsters with epilepsy.

PURPOSE: The present study aims to explore the extent to which gender, epilepsy severity and illness perceptions predict fatigue and sleep problems in youngsters with epilepsy. METHOD: Structured interviews were conducted in 100 young patients (Mage = 13,9, SD = 2.21; 41% girls) and data were analyzed by means of multiple hierarchical regression analyses. RESULTS: Most patients (91%) were well controlled by anti-epileptics; 3% had infrequent seizures and 6% were pharmacoresistant. At a multivariate level it appeared that youngsters with epilepsy who believe that they have less personal control over their illness and who feel that the illness has a high emotional impact on their lives reported higher levels of fatigue. In addition, more sleep problems were reported by youngsters who think they have less personal control over the disease, who believe that treatment controls epilepsy and report that the disease has a high emotional impact on their lives. CONCLUSION: Given the importance of illness perceptions, it is suggested that they are targets for future interventions that aim to reduce fatigue and sleep problems in youngsters with epilepsy.

Explaining Physical Activity Maintenance After a Theory-Based Intervention Among Patients With Rheumatoid Arthritis: Process Evaluation of a Randomized Controlled Trial.

OBJECTIVE: Regular physical activity (PA) benefits patients with rheumatoid arthritis (RA), particularly when maintained over time. Research in this area has largely focused on factors associated with initiating PA, while factors contributing to PA maintenance, particularly after lifestyle interventions, have received less attention. This study examined whether higher levels of autonomous motivation, self-efficacy for PA, and greater use of self-regulation skills mediated PA initiation and maintenance 6 months after a theory-based motivational interviewing and self-regulation coaching intervention. METHODS: Seventy-eight individuals with RA were randomized to receive either a patient-education session (control group), or the patient-education session plus 1 motivational interview and 2 self-regulation coaching sessions (treatment group). Mediation analyses examined the effects of this intervention on PA initiation and maintenance through the intermediate variables autonomous motivation, self-efficacy for PA, and use of self-regulation skills. Analyses were controlled for age, sex, and previous levels of PA. RESULTS: The treatment group reported significantly higher autonomous motivation and greater use of self-regulation skills than controls at posttreatment. Increases in PA from baseline to posttreatment were not mediated by any intermediate variables. However, maintenance of PA from posttreatment to followup (6 months later) was mediated by greater autonomous motivation and use of self-regulation skills. CONCLUSION: Greater autonomous motivation and use of self-regulation skills predict maintenance of PA following a motivational interviewing and self-regulation coaching intervention. In promoting PA among patients with RA, supporting patient autonomy and teaching self-regulation skills, which focus attention on achieving PA goals, may improve long-term maintenance of PA.

Occupational coping self-efficacy explains distress and well-being in nurses beyond psychosocial job characteristics.

AIM: The main purpose of the present study was to extend the Job Demand Control Support (JDCS) model analyzing the direct and interactive role of occupational coping self-efficacy (OCSE) beliefs. BACKGROUND: OCSE refers to an individual's beliefs about their ability to cope with occupational stressors. The interplay between occupational stressors, job resources, and self-efficacy beliefs is poorly investigated. The present research attempts to address this gap. DESIGN: Cross-sectional survey. METHOD: Questionnaire data from 1479 nurses (65% response) were analyzed. Hierarchical regression analyses were used to test the direct and moderating role of OCSE in conjunction with job demands (i.e., time pressure), and two job resources: job control (i.e., decision latitude and skill discretion) and social support (i.e., supervisor support and coworker support) in predicting psychological distress and well-being. RESULTS: Our findings indicated that high demands, low job control, and low social support additively predicted the distress/well-being outcomes (job satisfaction, emotional exhaustion, depersonalization, psychological distress, and somatic complaints). Beyond the main effects, no significant interactive effects of demands, control, and support were found. OCSE accounted for an additional 1-4% of the variance in the outcomes, after controlling for the JDCS variables. In addition, the results indicate that OCSE buffers the association between low job control and the distress dimensions emotional exhaustion, depersonalization, and psychological distress. Low control was detrimental only for nurses with low OCSE. CONCLUSION: Our results suggest expanding the JDCS model incorporating individual characteristics such as OCSE beliefs, for predicting psychological distress and well-being. Limitations of the study and practical implications are discussed.

Illness perceptions determine psychological distress and quality of life in youngsters with epilepsy.

The aim of this cross-sectional study was to explore the extent to which gender, epilepsy severity, and self-regulation concepts (illness perceptions, autonomous treatment regulation, perceived autonomy support by parents) predict psychological distress and quality of life (QoL) in young patients with epilepsy. Structured interviews were conducted in 100 patients (Mage=13.9, SD=2.21, 41% girls), and data were analyzed by means of multiple hierarchical regression analyses. Seizures of most patients (91%) were well controlled by antiepileptics, 3% of the patients had infrequent seizures, and seizures in 6% were pharmacoresistant. At a multivariate level, it appeared that youngsters with epilepsy who expect that their disease will last for a long time, who believe that they have less personal control over their illness, and who expect the illness to have a high emotional impact reported higher levels of distress. In addition, a better QoL was reported by youngsters who believed that treatment did not control their illness and who thought that their epilepsy would not affect them emotionally. Findings indicate the importance of illness perceptions, and it is suggested that they should be targeted in future interventions in youngsters with epilepsy.

Association of goal orientation with work engagement and burnout in emergency nurses.

OBJECTIVES: Goal orientation is a mindset towards the achievement of work-related goals, and it has been found to be related to occupational well-being. This study explored to what extent the 4-dimensional model of goal orientation adds additional variance to the explanation of burnout and work engagement in emergency nurses, after controlling for demographics, job characteristics and organizational variables. METHODS: Self-report questionnaires including the Leiden Quality of Work Questionnaire for Nurses, Goal Orientation Questionnaire, Maslach Burnout Inventory and Utrecht Work Engagement Scale were completed by 170 out of 274 emergency nurses from 13 secondary Belgian hospitals (response rate 62%). Hierarchical multiple regression analyses were conducted. RESULTS: Goal orientation explained 14 and 13% of the variance in burnout and work engagement respectively. Job control was predictive of both outcomes. Job demands was a predictor of burnout, and social support predicted work engagement. Reward was related to work engagement. The mastery-approach goal orientation was strongly related to an increase in work engagement and to a decrease in burnout. The performance-avoidance goal orientation was strongly related to a decrease in work engagement and to an increase in burnout. The performance-approach and mastery-avoidance goal orientations were not predictive for the two outcome variables. CONCLUSIONS: Goal orientation explains additional variance in burnout and work engagement over and above work characteristics and organizational variables. A mastery-approach goal orientation appears to be beneficial while a performance-avoidance goal orientation is not. Hospital management should therefore invest in personal involvement and growth of ER-nurses and in a rewarding organizational culture.

Identifying effective techniques within psychological treatments for irritable bowel syndrome: a meta-analysis.

OBJECTIVES: Psychological interventions can alleviate the symptoms of irritable bowel syndrome (IBS) and psychological distress commonly reported among IBS sufferers. However, the theoretical underpinnings and intervention techniques used by such interventions vary considerably. This study aimed to identify which theoretical approaches and techniques lead to greater improvements in IBS symptoms and psychological well-being within psychological interventions for IBS. METHODS: Outcome data were extracted from 48 randomized controlled trials testing psychological treatments for IBS. Theoretical intervention targets and intervention techniques of each study were identified. Cumulative effect sizes were calculated for pain, bowel dysfunction, composite symptom scores, psychological distress, and health-related quality of life. Comparative analyses contrasted the effect sizes of studies which included each intervention technique to those which did not. RESULTS: Cumulatively, interventions significantly improved all outcomes, with effect sizes (Hedges' g) ranging from 0.32 to 0.64. Interventions which stated a theoretical intervention target, prompted self-monitoring of symptoms and cognitions, provided tailored feedback linking symptoms and cognitions, utilized problem solving or assertiveness training and provided general support had greater effects upon symptom and well-being outcomes than interventions which did not (all P<.05). Across all studies, improvements in psychological distress were associated with improvements in composite symptom scores (P<.01). CONCLUSIONS: This study identifies a set of techniques associated with improvements in IBS symptoms and psychological well-being in existing interventions, and provides initial evidence for the link between improvements in psychological distress and IBS composite symptom scores. These findings can aid the development and refinement of psychological treatments for IBS.

Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research.

BACKGROUND: Burnout is an important problem in health care professionals and is associated with a decrease in occupational well-being and an increase in absenteeism, turnover and illness. Nurses are found to be vulnerable to burnout, but emergency nurses are even more so, since emergency nursing is characterized by unpredictability, overcrowding and continuous confrontation with a broad range of diseases, injuries and traumatic events. OBJECTIVES: This systematic review aims (1) to explore the prevalence of burnout in emergency nurses and (2) to identify specific (individual and work related) determinants of burnout in this population. METHOD: A systematic review of empirical quantitative studies on burnout in emergency nurses, published in English between 1989 and 2014. DATA SOURCES: The databases NCBI PubMed, Embase, ISI Web of Knowledge, Informa HealthCare, Picarta, Cinahl and Scielo were searched. RESULTS: Seventeen studies were included in this review. On average 26% of the emergency nurses suffered from burnout. Individual factors such as demographic variables, personality characteristics and coping strategies were predictive of burnout. Work related factors such as exposure to traumatic events, job characteristics and organizational variables were also found to be determinants of burnout in this population. CONCLUSIONS: Burnout rates in emergency nurses are high. Job demands, job control, social support and exposure to traumatic events are determinants of burnout, as well as several organizational variables. As a consequence specific action targets for hospital management are formulated to prevent turnover and burnout in emergency nurses.

Causes and consequences of occupational stress in emergency nurses, a longitudinal study.

AIM: This longitudinal study examines the influence of changes over time in work and organisational characteristics on job satisfaction, work engagement, emotional exhaustion, turnover intention and psychosomatic distress in emergency room nurses. BACKGROUND: Organisational and job characteristics of nurses are important predictors of stress-health outcomes. Emergency room nurses are particularly exposed to stressful work-related events and unpredictable work conditions. METHOD: The study was carried out in 15 emergency departments of Belgian general hospitals in 2008 (T1) and 18 months later (T2) (n = 170). RESULTS: Turnover rates between T1 and T2 were high. Important changes over time were found in predictors and outcomes. Changes in job demand, control and social support predicted job satisfaction, work engagement and emotional exhaustion. In addition, changes in reward, social harassment and work agreements predicted work engagement, emotional exhaustion and intention to leave, respectively. CONCLUSIONS: Work-related interventions are important to improve occupational health in emergency room nurses and should focus on lowering job demands, increasing job control, improving social support and a well-balanced reward system. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should be aware of the causes and consequences of occupational stress in emergency room nurses in order to enable preventive interventions.

Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial.

The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity (PA) among patients with rheumatoid arthritis (RA) not meeting current PA recommendations. In a randomised controlled trial, a control group­which received a group-based patient education session led by a physical therapist­was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse. Outcomes included leisure-time PA, days per week with at least 30 min of moderate-intensity PA, self-efficacy and autonomous motivation (cognitions which predict PA initiation and maintenance), disease activity, functional status, depressive symptoms and fatigue. Effects were assessed using mixed models repeated measures. Of the 78 patients randomised, 76 and 67 completed the post-treatment and follow-up assessments, respectively. Significant treatment effects were found for leisure-time PA (p = 0.022), active days/week (p = 0.016), self-efficacy (p = 0.008) and autonomous motivation (p = 0.001). At post-treatment and 6-months follow-up, significantly more treated patients than controls met current PA recommendations. No significant effects were found for disease activity, functional status, depressive symptoms or fatigue. Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA. However, further research is necessary to identify ways of helping patients with RA transition to­and maintain­more intensive forms of PA which are more likely to improve disease activity and functional status.

A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence.

As maintenance of lifestyle change and risk factor modification following completion of cardiac rehabilitation has been shown to be notoriously difficult, we developed a brief self-regulation lifestyle program for post-cardiac rehabilitation patients. Randomized-controlled trial. Following completion of cardiac rehabilitation 210 patients were randomized to receive either a lifestyle maintenance program (n = 112) or standard care (n = 98). The program was based on self-regulation principles and consisted of a motivational interview, 7 group sessions and home assignments. Risk factors and health behaviors were assessed at baseline (end of cardiac rehabilitation), and 6 and 15 months thereafter. ANCOVAs showed a significant effect of the lifestyle program on exercise behavior at 15-month follow-up. Mediation analysis demonstrated that the treatment effect on exercise behavior could be explained by self-regulation skills. Chi squared tests showed that patients in the intervention group had significantly fewer uncontrolled risk factors as compared to the control group. Finally, the lifestyle intervention program was associated with a 12 % reduction in self-reported cardiac hospital admission rates. This trial indicates that a relatively brief, theory-based lifestyle program is capable of inciting and maintaining improvements in exercise adherence. It is suggested that patients may need ongoing attention and guidance, for example in the form of (internet-based) booster sessions, as long-term consolidation of changes is arduous.

Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Lifestyle modification programmes for coronary heart disease patients have been shown to effectively improve risk factors and related health behaviours, quality of life, reincidence, and mortality. However, improvements in routine cardiac care over the recent years may offset the incremental benefit associated with older programmes. PURPOSE: To determine the efficacy of lifestyle modification programmes for coronary heart disease patients developed over the last decade (1999-2009) by means of a systematic review and meta-analysis. RESULTS: The study included 23 trials (involving 11,085 randomized patients). Lifestyle modification programmes were associated with reduced all-cause mortality (summary OR 1.34, 95% CI 1.10-1.64), cardiac mortality (summary OR 1.48, 95% CI 1.17-1.88), and cardiac readmissions and non-fatal reinfarctions (summary OR 1.35, 95% CI 1.17-1.55). Furthermore, lifestyle modification programmes positively affected risk factors and related lifestyle behaviours at posttreatment (M = 10.2 months), and some of these benefits were maintained at long-term follow up (M = 33.7 months). Improvements in dietary and exercise behaviour were greater for programmes incorporating all four self-regulation techniques (i.e. goal setting, self-monitoring, planning, and feedback techniques) compared to interventions that included none of these techniques. CONCLUSION: The evidence summarized in this meta-analysis confirms the benefits of lifestyle modification programmes - over and above benefits achieved by routine clinical care alone.

Changes in illness perceptions and quality of life during participation in cardiac rehabilitation.

BACKGROUND: The beliefs patients hold about their disease and corresponding treatment have been shown to predict recovery in cardiac patients. PURPOSE: However, it is not known to what extent these beliefs change during participation in cardiac rehabilitation and whether this is related to psychological indicators of outcome. METHOD: Illness perceptions and health-related quality of life (HRQOL) were measured upon entry to (T0) and completion of (T1) a 3-month outpatient cardiac rehabilitation program in 158 cardiac patients. RESULTS: Repeated-measures ANOVA revealed that all illness perceptions other than timeline and personal control changed significantly over the course of cardiac rehabilitation. Overall, cardiac rehabilitation patients came to view their illness as more benign. Further analysis revealed that perceiving fewer emotional consequences of the illness, gaining a better understanding, and attributing fewer symptoms to the illness at the end of cardiac rehabilitation, was related to better HRQOL. CONCLUSION: Illness perceptions change during cardiac rehabilitation and these changes are associated with enhanced quality of life. Clinical trials have shown illness beliefs in cardiac patients to be modifiable during hospital admission; our results suggest that cardiac rehabilitation may provide a second window of opportunity during which illness perceptions can be actively monitored and modified if maladaptive.

Beyond resolutions? A randomized controlled trial of a self-regulation lifestyle programme for post-cardiac rehabilitation patients.

BACKGROUND: As lifestyle adherence and risk factor management following completion of cardiac rehabilitation (CR) have been shown to be problematic, we developed a brief self-regulation lifestyle programme for post-CR patients. DESIGN: Randomized-controlled trial. METHODS: Following completion of CR 210 patients were randomized to receive either a lifestyle maintenance programme (n = 112) or standard care (n = 98). The programme was based on self-regulation principles and consisted of a motivational interview, seven group sessions, and home assignments. Risk factors and health behaviours were assessed at baseline (end of CR) and 6 months thereafter. RESULTS: ANCOVAs showed a significant effect of the lifestyle programme after 6 months on blood pressure, waist circumference, and exercise behaviour. CONCLUSION: This trial indicates that a relatively brief intervention based on self-regulation theory is capable of instigating and maintaining beneficial changes in lifestyle and risk factors after CR.

Lifestyle- and behaviour-change interventions in musculoskeletal conditions.

This review discusses several health behaviours associated with the progression and impact of osteoarthritis (OA) and rheumatoid arthritis (RA), including weight management, physical activity, medication adherence and smoking. An overview of current theories of behaviour-change is provided in terms of principles that can guide medical practice. Finally, evaluation studies of interventions targeting weight loss, physical activity and medication adherence in patients with OA or RA are presented and discussed. Of existing behaviour-change interventions in this population, few have taken a comprehensive theory-based approach to behaviour-change. Practitioners who provide lifestyle or behavioural advice to patients would do well to adopt a less prescriptive and more patient-centred approach in which they, or other health professionals to whom they refer the patient, assist the patient in formulating personal change goals, in translating good intentions into specific action plans and in closely monitoring their progress towards self-chosen goals.