The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain.
The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain.
Filed under: Rehab Centers
Phys Ther. 2012 Nov 8;
Ferreira PH, Ferreira ML, Maher CG, Refshauge KM, Latimer J, Adams RD
BACKGROUND: The impact of the relationship (therapeutic alliance) between patients and physical therapists on treatment outcome in the rehabilitation of chronic low back pain (LBP) has not been previously investigated. OBJECTIVE: To investigate whether the therapeutic alliance between physical therapists and chronic LBP patients predicts clinical outcomes. DESIGN: Retrospective observational study nested within a randomized controlled trial. METHODS: 182 patients with chronic LBP who volunteered for a randomized controlled trial that compared the efficacy of exercises and spinal manipulative therapy rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session. The primary outcomes of function, global perceived effect of treatment, pain, and disability were assessed before and after 8 weeks of treatment. Linear regression models were used to investigate if the alliance was a predictor of outcome or moderated the effect of treatment. RESULTS: The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome. The therapeutic alliance moderated the effect of treatment on global perceived effect for two of three treatment contrasts (general exercise vs motor control exercise, spinal manipulative therapy vs motor control exercise). There was no treatment effect modification when outcome was measured with function, pain and disability measures. LIMITATIONS: Therapeutic alliance was measured at the second treatment session and it is likely to bias the interaction during initial stages of treatment. Data analysis was restricted to primary outcomes at 8 weeks. CONCLUSIONS: Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.
HubMed – rehab
Reliability and Responsiveness of the Gross Motor Function Measure-88 in Children With Cerebral Palsy.
Filed under: Rehab Centers
Phys Ther. 2012 Nov 8;
Ko J, Kim M
BACKGROUND: The “Gross Motor Function Measure” (GMFM-88) is a commonly used measure for evaluating gross motor function in children with cerebral palsy (CP). The relative reliability of GMFM-88 has been assessed in children with CP. However, little information is available about the absolute reliability or responsiveness of GMFM-88. OBJECTIVE: The objective of this research was to determine the absolute and relative reliability and responsiveness of the GMFM-88 in evaluating gross motor function in children with CP. DESIGN: A clinical measurement design. METHODS: Ten raters scored GMFM-88 of 84 children from video records across all GMFCS levels to establish inter-rater reliability. Two raters participated to assess intra-rater reliability. Responsiveness was determined from three additional assessments after the baseline assessment. The inter- and intra-rater intraclass correlation coefficient (ICC) with 95% confidence intervals, standard error of measurement (SEM), smallest real difference (SRD), effect size (ES), and standardized response mean (SRM) were calculated. RESULTS: The relative reliabilities of the GMFM were excellent (ICCs = 0.986-1.000). The SEM and SRD for total score of the GMFM were acceptable (1.60 and 3.14, respectively). Additionally, the goal total scores of the ES and SRM increased gradually in the three follow-up assessments (GMFCS level I-II: ES = 0.5, 0.6, and 0.8, SRM = 1.3, 1.8, and 2.0; GMFCS III-V: ES = 0.4, 0.7, and 0.9, SRM = 1.5, 1.7, and 2.0). LIMITATIONS: Children over 10 years of age with CP were not included in this study, so the results should not be generalized to all children with CP. CONCLUSIONS: This study indicates that both reliability and responsiveness of the GMFM-88 are reasonable for measuring gross motor function in children with CP.
HubMed – rehab
Accuracy of Physical Therapists’ Early Predictions of Upper-Limb Function in Hospital Stroke Units: The Early Prediction of Functional Outcome After Stroke (EPOS) Study.
Filed under: Rehab Centers
Phys Ther. 2012 Nov 8;
Nijland RH, van Wegen EE, Harmeling-van der Wel BC, Kwakkel G,
BACKGROUND: Early prediction of outcome after stroke is becoming increasingly important, since most patients are discharged from hospital stroke units within several days after stroke. OBJECTIVE: 1) To determine the accuracy of physical therapists (PTs) prediction at hospital stroke unit regarding upper limb (UL) function; 2) to develop a Computational Prediction Model (CPM) and 3) to compare the accuracy of PTs’ and CPMs’ prediction. Secondary objectives were to explore the impact of timing on the accuracy of PTs and CPMs’ predictions and to investigate the direction of the difference between predicted and observed outcome. Finally, we investigated if the accuracy of PTs’ prediction was affected by their experience in stroke rehabilitation. DESIGN: Prospective cohort study. METHODS: PTs made predictions at T(72h) and T(discharge) about UL function after 6 months in 3 categories, derived from the Action Research Arm Test. At the same time, clinical variables were measured to derive a CPM. The accuracy of PTs and CPMs’ predictions was evaluated by calculating Spearman rank correlation coefficients (r(s)) between predicted and observed outcome. RESULTS: 131 patients and 20 PTs participated. For T(72h), r(s) between predicted and observed outcome was 0.63 for PTs’ predictions, and 0.75 for the CPM, which is significantly higher (P<0.01). For T(discharge), r(s) for PTs' predictions significantly (P<0.01) improved to 0.75, the r(s) for CPMs' predictions improved slightly, although not significantly, to 0.76. LIMITATIONS: PTs administered a test battery every 3 days, which might enhance accuracy of prediction. CONCLUSIONS: Accuracy of PTs' predictions at T(72h) is lower than that of the CPM. At T(discharge), PTs and CPMs' predictions are about equally accurate. HubMed – rehab
Out of control: accelerated aging in uremia.
Filed under: Rehab Centers
Nephrol Dial Transplant. 2012 Nov 8;
Kooman JP, Broers NJ, Usvyat L, Thijssen S, van der Sande FM, Cornelis T, Levin NW, Leunissen KM, Kotanko P
Next to a high morbidity, patients with end-stage renal failure (ESRD) suffer from a complex spectrum of clinical manifestations. Both the phenotype of patients with ESRD as well as the pathophysiology of uremia show interesting parallels with the general aging process. Phenotypically, patients with ESRD have an increased susceptibility for both cardiovascular as well as infectious disease and show a reduction in functional capacity as well as muscular mass (sarcopenia), translating into a high prevalence of frailty also in younger patients. Pathophysiologically, the immune dysfunction, telomere attrition and the presence of low-grade inflammation in uremic patients also show parallels with the aging process. System models of aging, such as the homeodynamic model and reliability theory of Gavrilov may also have relevance for ESRD. The reduction in the redundancy of compensatory mechanisms and the multisystem impairment in ESRD explain the rapid loss of homeodynamic/homeostatic balance and the increased susceptibility to external stressors in these patients. System theories may also explain the relative lack of success of interventions focusing on single aspects of renal disease. The concept of accelerated aging, which also shares similarities with other organ diseases, may be of relevance both for a better understanding of the uremic process, as well as for the design of multidimensional interventions in ESRD patients, including an important role for early rehabilitation. Research into processes akin to both aging and uremia may result in novel therapeutic approaches.
HubMed – rehab
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