Predictors for Positive Response to Home Kinematic Training in Chronic Neck Pain.

OBJECTIVES: There is strong evidence for exercise therapy in neck pain, but a wide variety of protocols. Predictors for outcome are unknown and current practice is based on trial and error. The objective of this study was to identify predictors for response to home kinematic training (KT) considering improvement in both self-reported and kinematic measures. METHODS: A continuing analysis of data from the second phase of a randomized controlled trial, which included 4 weeks of KT using laser or virtual reality, with baseline, postintervention, and 3-month follow-up measures. Positive self-reported response was defined as a ≥50% pain reduction, ≥7% reduction in neck disability index (NDI), or a global perceived effect of 3 to 5 of 5. A second model defined improvement by ≥40% increase in cervical velocity. RESULTS: Data were retrieved from 79 participants with chronic neck pain who completed the postintervention evaluation and 52 who completed the 3-month follow-up. Self-reported response was 71% to 73% and kinematic response was 41% to 46%. Prediction models indicated an immediate increase in self-reported measures in men with NDI ≥ 20% slower (≤65°/s), and less accurate (≥16° error) cervical motion at baseline. In the longer term, older patients with higher NDI seemed to benefit more. In the second model, no factors significantly predicted improvement in kinematic measures at either time point. CONCLUSION: A high positive response rate to home KT was found by self-reported criteria. Males with poorer clinical and kinematic presentation at baseline, that is greater disability and slower neck motion, were more likely to respond.

The metabolic syndrome and its components in pediatric survivors of allogeneic hematopoietic stem cell transplantation.

Metabolic syndrome (MetS) is a known complication after hematopoietic stem cell transplantations (HSCT) that contributes to long-term morbidity. We assessed the prevalence of components of the MetS in pediatric survivors of allogeneic HSCT and identified associated risk factors. Thirty-eight patients, median age at HSCT, 8.5 years, were evaluated at a median of 3.9 years post-HSCT. Overweight or obesity was seen in 23.7% of the patients, 15.8% had hypertension, 15.8% had hypertriglyceridemia, and 13% had low high-density lipoprotein cholesterol levels according to age and gender. Four (10.5%) met the criteria of MetS; all were transplanted for malignant disease. Twelve patients (31.6%) had at least one component of the MetS. The 5-year probability of developing components of the MetS revealed that patients with BMI-Z score ≥0 at HSCT were significantly at higher risk than those with lower BMI-Z. Patients who developed components of the MetS had higher levels of insulin, homeostasis model assessment, uric acid, leptin, and lower adiponectin levels. Multivariable regression analysis revealed that BMI-Z-score >1.036 at time of evaluation was associated with 4.3-fold increased risk (P=.050) and adiponectin levels ≤6 µg/mL were associated with 6.7-fold increased risk of develop components of the MetS (P=.007). Overweight and obesity and adiponectin levels may be useful as markers in HSCT survivors.

Predicting Recovery Pathways in Jewish Ultra-Orthodox Intimate Partner Violence Survivors: A Structural Equation Modeling Approach.

Cultural and religious norms, as well as trauma-related cognitions and recovery actions, are known to impact the well-being of survivors of intimate partner violence (IPV). Although acknowledged as a key component, there is scant research on the recovery trajectories of women who have experienced IPV, in particular on survivors from collectivistic societies such as the Jewish Ultra-Orthodox (JUO) community in Israel. A mediation model examined the recovery process of 261 Israeli JUO survivors. In particular, it tested whether the normalization of violence and women's endorsement of Jewish religious norms that justify violence would be directly and negatively associated with women's well-being and positively associated with psychopathology. Additionally, it examined whether women's normalization of violence and support of religious norms would positively predict women's negative trauma-related cognitions. In turn, these cognitions were expected to negatively predict women's engagement in recovery actions, help-seeking behaviors, and faith-based responses but positively predict disengagement responses. The model further posited that women's engagement in steps toward recovery, help-seeking behaviors, and faith-based responses would positively predict women's well-being and negatively predict psychopathology. In contrast, women's disengagement responses would negatively predict women's well-being and positively predict their psychopathology. Bootstrap results indicated that supporting religious norms positively predicted women's trauma-related cognitions, which then negatively predicted women's recovery actions, help-seeking behaviors, and faith-based responses but positively predicted women's disengagement responses. Women's recovery actions and faith-based responses positively predicted women's well-being, while disengagement responses positively predicted women's psychopathology. Contrary to expectations, help-seeking behaviors positively predicted psychopathology.

High-vs. low-tech cervical movement sense measurement in individuals with neck pain.

OBJECTIVES: To compare diagnostic ability of the clinical cervical movement sense (CCMS) test to the neck virtual reality (VR) system accuracy module. BACKGROUND: Altered cervical proprioception is common in patients with persistent neck pain (NP). Recently a simple CCMS has been found to be feasible and reliable. However, it is not known how this compares to a valid method. METHODS: Twenty participants with persistent NP and 20 healthy controls were videoed while performing the CCMS using a laser pointer and traced a zigzag pattern and then assessed using the VR accuracy module which consisted of following 8 segments in four directions. Diagnostic ability using a model from potential variables from the video analysis of number of errors and task performance time was compared to a model provided from VR data. RESULTS: Subjects with NP had significantly greater horizontal errors in the CCMS and VR accuracy. Both CCMS and VR measurement models utilising measurements of horizontal movement error demonstrated good diagnostic ability (AUC = 0.88, 0.91 respectively) and there was no statistical difference between the models' AUC (p = 0.7). CONCLUSION: The simple clinical testing tool appears to provide a measure of cervical movement sense, similar to the established Neck VR accuracy measure. Both tools differentiated individuals with NP from controls with similar sensitivity and specificity, with some advantage to the VR. The rotational motion measures seem most suitable in the assessment of motion accuracy. CCMS has potential to be used as a simple clinical measure and warrants further research.

Patients' Evaluation of Intervention by a Medical Clown Visit or by Viewing a Humorous Film Following In Vitro Fertilization and Embryo Transfer.

This study compared responses to an in-person clown visit and a humorous film following in vitro fertilization and embryo transfer. Intervention was a 10-minute clown visit (n = 101) or 10-minute humorous video clip (n = 99). Demographic and fertility-related data and preintervention anxiety scores were collected. Participants completed an Evaluation of Intervention form postintervention. There were no group differences on demographic or fertility-related data or anxiety scores. Findings indicate while participants viewed the intervention positively, the clown visit offered a higher degree of satisfaction in more patients than did the film. Median evaluation scores were significantly higher for the clown visit, specifically reducing anxiety level and being more distracting. Both groups reported that the exposure made the clinic experience more pleasant and did not bother them, and most would recommend incorporating the intervention in routine treatment. However, free-text comments clearly expressed greater enthusiasm to the in-person clown intervention than to the film.

Overweight and obese midlife women in Israel: cultural differences in perceived weight status.

OBJECTIVES: To examine cultural differences in Weight status misperception (WSMP) and identify associations between weight perception and weight control efforts among overweight/obese midlife women in Israel. METHODS: Data from the nationally representative Women's-Health-in-Midlife-National-Study were used. Participants included overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30) midlife women (45-64 years) from three cultural groups: Long-Term Jewish Residents (LTJR), Immigrants from the former USSR, and Arabs. Interviews included measures of BMI, weight perception, lifestyle, and socio-demographics. RESULTS: Most overweight/obese women (88 %) perceived their weight status correctly. No significant differences were found in overall WSMP rates across cultural groups. Overweight women of Arab origin were significantly more likely (p < 0.001) to perceive their weight as "about right" relative to LTJR and Immigrants. WSMP was associated with several unhealthy eating patterns [eating red meat (OR = 2.1, 95 % CI = 1.13-3.97), white bread (OR = 2.4, 95 % CI = 1.26-4.58)] and with more perceived barriers to exercising (OR = 1.8, 95 % CI = 1.00-3.42). CONCLUSIONS: Health care providers are encouraged to pay attention to overweight/obese women who misperceive their weight status. These women are more likely to consume unhealthy foods and to be at higher risks of suffering from medical complications associated with obesity.