Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomised controlled trial in healthy respondents.

OBJECTIVE: This study aimed to determine the effect of physiotherapists' negative language use on nocebo effects of state anxiety and illness beliefs. METHODS: A web-based randomised controlled trial included adults without recent musculoskeletal pain. The intervention was a short educational video about low back pain using negative language (nocebo condition: n = 87) versus a video using neutral or positive language (control condition: n = 82). State anxiety was assessed using the State-Trait Anxiety Inventory. Illness beliefs were assessed using the Illness Perception Questionnaire. RESULTS: Nocebo and control groups differed in outcome measures (MANOVA Pillai's trace = 0.22, F = 4.98; df = (9,159), p < 0.001). Post-hoc analyses showed a medium to large effect for the nocebo condition on anxiety (d = 0.71, 95% CI 0.4 -1.0). The nocebo group also had higher scores in three illness beliefs: beliefs on timeline (d = 0.45, 95% CI 0.14 - 0.75), treatment control (d = 0.43, 95% CI 0.12 - 0.74) and concern (d = 0.47, 95% CI 0.16 - 0.78). CONCLUSION: Physiotherapists' use of negative language contributes directly to a higher state anxiety and illness beliefs that can trigger the nocebo effects in the recipient PRACTICE IMPLICATIONS: Negative language use should be avoided.

[The health status and health care use of elderly living in sheltered residences. A comparison with independently living elderly]. / Gezondheidstoestand en zorggebruik van bewoners van service-ouderenwoningen. Een vergelijking met zelfstandig wonenden.

A sheltered residence for older persons is a living arrangement in between independent living and a residential institution. There is little knowledge about the health of elderly living in these residences. We studied the physical, functional and psychosocial health of 401 persons living in a sheltered residence for elderly in Zwolle through a standardised interview. We compared the health of these elderly to the health of independently living elderly in the same region studied in the Longitudinal Aging Study Amsterdam and adjusted for sex, age and married state. We found an impaired functional health and more chronic illnesses among elderly living in a sheltered residence. In addition, more medication was used (OR = 2.4). The studied elderly felt more often depressed (OR = 1.9) or lonely (OR = 1.7). Their mental state was more frequently impaired (OR = 1.7), they visited health professionals more often and received more help for personal care (OR = 2.0) and housekeeping (OR = 1.6). We conclude that people living in sheltered residences form a distinct group of elderly, characterised by impaired physical, functional and psychosocial health. Planners of future care must be aware of this vulnerable group.

Subjective ordering, short-term memory, and the frontal lobes.

Four tasks relying on short-term retention, i.e. digit span, missing scan, randomization span, and pointing span were presented to patients with frontal-lobe lesions and normal controls. Digit span was considered a measure of passive short-term memory, the other three tasks additionally reflect comparing processes, and two of these, the randomization and pointing spans, also measure active ordering by the subject. The results confirmed Petrides and Milner's (Neuropsychologia 20, 249-262, 1982) hypothesis that frontal-lobe patients are typically deficient in subject-ordered tasks. It is also suggested that they are deficient in a spontaneous generation, rather than comparison component of subjective ordering.