Abstract: Qualitative criteria, such as efficacy, utility and cost-effectiveness are essential for insurance and reimbursement companies to meet the costs for a multidisciplinary treatment (MDT) for persons with chronic low back pain (CLBP).
Abstract: PURPOSE: To reduce the socio-economic burden of persistent low back pain (LBP), factors influencing the progression of acute/subacute LBP to the persistent state must be identified at an early stage. METHODS: Prospective inception cohort study of patients attending a health practitioner for their first episode of acute/subacute or recurrent LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical and demographic/lifestyle factors and followed up over 6Â months. Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains, controlling for age, gender and body mass index. The overall predictive value was calculated for the full regression models of the different domains. Finally, all significant variables from the different domains were combined into a final predictor model. RESULTS: The final four-predictor model predicted 51Â % of variance of persistent LBP and included 'resigned attitude towards the job' (OR 1.73; 95Â % CI 1.16-2.59), 'social support at work' (OR 0.54; 95Â % CI 0.32-0.90), 'functional limitation' (OR 1.05; 95Â % CI 1.01-1.10) and 'duration of LBP' (OR 1.04; 95Â % CI 1.02-1.06). The accuracy of the model was 83Â %, with 92Â % of non-persistent and 67Â % of persistent LBP patients correctly identified. CONCLUSIONS: In this study of patients with acute/subacute LBP, 'resigned attitude towards the job' increased the likelihood of persistent LBP at 6Â month. Addressing this factor with workplace interventions has the potential to modify the outcome. In patients experiencing 'social support at work', the development of persistent LBP was less likely and might therefore be considered as potential resource for prevention of persistent LBP.
Abstract: Global self-esteem was tested to predict quicker cardiovascular adaptation during stressful oral thesis presentation and faster habituation from the first to the second and third thesis presentations. Nineteen graduate students initially rated their global self-esteem and afterwards orally presented their theses proposals in 20-min presentations to their thesis supervisor and peers. A second and third presentation of the revised thesis concepts took place at 4-weeks intervals. Ambulatory blood pressure and heart rate were assessed repeatedly during the presentations. Post-talk self ratings of stressfulness indicated presentations to be a strong public speaking stressor. One hundred and thirty-eight measurements of systolic (SBP), diastolic blood pressure (DBP), and heart rate (HR) showed a significant adaptation (decrease) during presentations. There was an overall mean level decrease from the first to the second, and the second to the third presentations in HR, but not in SBP and DBP. However, habituation in SBP and DBP across three presentations was significantly faster (p < .05) in those participants who initially reported higher levels of global self-esteem. Higher global self-esteem did not foster adaptation within the presentations. Self-esteem is discussed as an important individual resource that allows successful coping with recurring evaluative threats.
Abstract: Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode.
Abstract: Research concerning the association between stress at work and body mass index (BMI) has mainly focused on two models (ie, job demand-control and effort-reward imbalance) as predictors and mostly been cross-sectional. The aim of our study is to extend previous research in two ways. First, social stressors - in the sense of social conflict and animosities at work - were included as an independent variable, arguing that they should be an especially promising predictor as they reflect a "social-evaluative threat". Second, a longitudinal design was employed with a two-year follow-up. In addition, the variables specified by the job demand-control model and the effort-reward imbalance model were assessed as well.
Abstract: Low back pain (LBP) is the most prevalent health problem in Switzerland and a leading cause of reduced work performance and disability. This study estimated the total cost of LBP in Switzerland in 2005 from a societal perspective using a bottom-up prevalence-based cost-of-illness approach. The study considers more cost categories than are typically investigated and includes the costs associated with a multitude of LBP sufferers who are not under medical care. The findings are based on a questionnaire completed by a sample of 2,507 German-speaking respondents, of whom 1,253 suffered from LBP in the last 4Â weeks; 346 of them were receiving medical treatment for their LBP. Direct costs of LBP were estimated at <euro>2.6Â billion and direct medical costs at 6.1% of the total healthcare expenditure in Switzerland. Productivity losses were estimated at <euro>4.1Â billion with the human capital approach and <euro>2.2Â billion with the friction cost approach. Presenteeism was the single most prominent cost category. The total economic burden of LBP to Swiss society was between 1.6 and 2.3% of GDP.
Abstract: There is increasing evidence that the Faces Scale is more sensitive to the emotional component of job satisfaction than other scales. This study investigated underlying processes and tested whether state affect and neuroticism covary with respondents’ evaluations of each face’s meaning. Seventy-five participants repeatedly judged single schematic faces as looking satisfied or unsatisfied. Participants made 11,025 two-alternative, forced-choice judgments about a variety of eleven faces. Results showed that faces appeared more satisfied
to those who reported good mood and lower neuroticism (assimilation effect). In addition, there was a significant range effect of scale composition: In a range including five smiling faces, a face showing a mild smile was more often judged as looking unsatisfied than in a range including five frowning faces. Moreover, a significant interaction between range and neuroticism indicated stronger range effects in those participants who reported higher neuroticism than others. The implications for the use of the Faces Scale in work and organizational psychology are discussed.
Abstract: An association between stress at work and impaired sleep is theoretically plausible and supported by empirical evidence. The current study's main aim was to investigate how the influence of stressors is carried over into the evening and the night. We assume that this relationship is mediated by perseverative cognitions. We tested this assumption in two cross-sectional samples with structural equation modeling, using bootstrapped standard errors to test for significance. Effort-reward imbalance and time pressure were used as stressors, and rumination as a measure for perseverative cognitions. Results show that the stressors are related to perseverative cognitions, and these are related to impaired sleep in both samples. Indirect effects are significant in both samples. With rumination controlled, direct effects of stressors on sleep are only significant in one out of four cases. Thus, there is full mediation in three out of four cases, and partial mediation in the fourth one. Our results underscore the notion that perseverative cognitions are crucial for transferring negative effects of work stressors into private life, including sleep, thus hindering individuals to successfully recover.
Abstract: A literature review of studies analyzing work-family conflict and its consequences was conducted, and 427 effect sizes were analyzed meta-analytically. Work-family conflict was analyzed bidirectionally in terms of work interference with family (WIF) and family interference with work (FIW). We assessed 3 categories of potential outcomes: work-related outcomes, family-related outcomes, and domain-unspecific outcomes. Results show that WIF and FIW are consistently related to all 3 types of outcomes. Both types of interrole conflict showed stronger relationships to same-domain outcomes than to cross-domain outcomes. Thus, WIF was more strongly associated with work-related than with family-related outcomes, and FIW was more strongly associated with family-related than with work-related outcomes. In moderator analyses, parenthood could not explain variability in effect sizes. However, time spent at work did moderate the relationships between WIF and family-related outcomes, as well as FIW and domain-unspecific outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Abstract: Objectives: Stressors in nursing put high demands on cognitive control and, therefore, may increase the risk of cognitive failures that put patients at risk. Task-related stressors were expected to be positively associated with cognitive failure at work and job control was expected to be negatively associated with cognitive failure at work.
Methods: Ninety-six registered nurses from 11 Swiss hospitals were investigated (89 women, 7 men, mean age = 36 years, standard deviation = 12 years, 80% supervisors, response rate 48%). A new German version of the Workplace Cognitive Failure Scale (WCFS) was employed to assess failure in memory function, failure in attention regulation, and failure in action exertion. In linear regression analyses, WCFS was related to work characteristics, neuroticism, and conscientiousness.
Results: The German WCFS was valid and reliable. The factorial structure of the original WCF could be replicated. Multilevel regression task-related stressors and conscientiousness were significantly related to attention control and action exertion.
Conclusion: The study sheds light on the association between job characteristics and work-related cognitive failure. These associations were unique, i.e. associations were shown even when individual differences in conscientiousness and neuroticism were controlled for. A job redesign in nursing should address task stressors.
Abstract: AIM: To examined the effects of stochastic resonance whole-body vibration training on musculoskeletal pain in young healthy individuals.
METHODS: Participants were 43 undergraduate students of a Swiss University. The study was designed as a randomized controlled trial (RCT) with randomized group allocation. The RCT consisted of two groups each given 12 training sessions during four weeks with either 5 Hz- Training frequency (training condition) or 1.5 Hz Training frequency (control condition). Outcome was current musculoskeletal pain assessed in the evening on each day during the four week training period.
RESULTS: Multilevel regression analysis showed musculoskeletal pain was significantly decreased in the training condition whereas there was no change in the control condition (B = -0.023, SE = 0.010, P = 0.021). Decrease in current musculoskeletal pain over four weeks was linear.
CONCLUSION: Stochastic resonance whole-body vibration reduced musculoskeletal pain in young healthy individuals. Stochastic resonance vibration and not any other exercise component within training caused pain reduction.
Abstract: This study examines consumer behavior from the perspective of cognitive psychology. It focuses on a set of cognitive psychological determinants of buyer behavior and analyzes how cognitive dissonance, activation and involvement influence consumer behavior. The literature indicates that a deeper insight into the cognitive processes underlying purchase behavior is essential for brand managers to create and communicate interventions that may have a stronger impact on the buyer such that their brand occupies a special position in the consumer’s mind. Up to now, the conflict between presenting a brand in a both favorable light and completely accurately has been rarely addressed in the literature.
Abstract: Psychosocial stress and pain may relate to educational selection. At the end of primary school (International Standard Classification of Education: ISCED level 1) children are recommended for one of three performance-based lower secondary level types of school (ISCED level 2). The study examines the association of educational selection and other risk factors with pain in the upper back (UBP), lower back pain (LBP), peripheral (limb) pain (PP), and abdominal pain (AP). Teacher reports of unsatisfactory grades in mathematics, and official school-type recommendation are included as objective psychosocial risk factors. One hundred and ninety-two schoolchildren, aged between 10 and 13 from 11 classes of 7 schools in Switzerland participated in the cross-sectional study. In logistic regression analysis, predictor variables included age, sex, BMI, participation in sport, physical mobility, weight of satchel, hours of daily TV, video, and computer use, pupils' back pain reported by the mother and father, psychosocial strain, unsatisfactory grade in mathematics, and school-type recommendation. Analysis of pain drawings was highly reliable and revealed high prevalence rates of musculoskeletal pain in the last 4Â weeks (UBP 15.3%, LBP 13:8%, PP 33.9%, AP 20.1%). Psychosocial risk factors were uniquely significant predictors of UBP (psychosocial strain), LBP (psychosocial strain, unsatisfactory grade in mathematics, school-type recommendation), and AP (school-type recommendation). In conclusion, selection in terms of educational school system was uniquely associated with LBP in schoolchildren. Stress caused by educational selection should be addressed in primary prevention of musculoskeletal pain in schoolchildren.
Abstract: In this field study self-confidence was tested to predict the course of galvanic electrodermal stress response prior, during and after public speaking. Ten graduate students initially rated their self-confidence and afterwards presented their thesis proposals orally in a 10-min presentation to their supervisor and peers. Galvanic skin response level was measured throughout and analysed for 10 min prior to, during, and 10 min after the presentation. Two major galvanic electrodermal stress response types were observed. Five students showed a 'healthy response', i.e. an anticipatory increase in electrodermal conductance, followed by a decrease after termination of the presentation. The other five students showed a steady increase of skin conductance during and after their presentation ('prolonged response'). In line with the allostatic load model the 'prolonged response' group reported significantly lower self-confidence before presentation than the 'healthy response' group (p < 0.01). Self-confidence is a resource in novices facing an unfamiliar stressor.
Abstract: Student evaluation of courses is common practice in academic psychology. This study tests
whether overall study satisfaction at the beginning of the lecture predicts evaluation results
of an obligatory lecture on research methods. Using structural equation modelling
judgments from 131 undergraduates resulted in five interrelated scales. Judgments on
teaching skills, teacher social competencies, and quality of course material were unrelated
to overall satisfaction. Moreover, initial satisfaction was unrelated to the judgments whether
the course has increased study motivation. Whether students reported the teacher had
increased their interest in the topic, however, was strongly related to initial overall study
satisfaction (γ = .46, p < .001). The lecture on research methods was less interesting to
students who initially report lower overall satisfaction with their studies. Hence, initial
study satisfaction should be assessed and considered in analysing evaluation data.
Abstract: This study tests psychometrics of the faces scale that is often used in organizational psychology to assess emotions, attitudes, and well-being. In analyzing 10,584 two categorical judgments (‘‘sad’’ versus ‘‘happy’’) of 11 faces from 72 participants, women judged a face with a horizontal line as mouth (‘‘neutral face’’) more often sad than happy and significantly more often sad than men did. Moreover, women adapted their judgments to the range of faces under study in showing a significant contrast effect. In a range of neutral to bright smiling faces a face showing a mild smile was judged to be sad, while in a range of neutral to heavy griming faces a mild grim was judged to be happy. Sex differences in meaning of faces within faces scales and their implications for the use of the faces scale in work and organizational psychology are discussed.
Abstract: The development of IT involves major changes in many work settings. Theories of organizational change predict negative consequences of change-related work load on back pain to be less when employees participate in the planning and implementation of change. In a longitudinal field study the effects of participation in the introduction of a new internet service were tested. 29 employees (16 f, 13 m) of a municipal office were studied before, at the end of, and 6 months after implementation of an electronic service. Their participation in the planning and implementation of the project, psychosocial working conditions and back pain were assessed using standardized validated questions. 15 employees said that they had no influence on the project or were only informed of it, while 14 employees said that they could make suggestions, or even take part in decision-making. The two groups did not differ in experience of back pain six months before the project was started, but the group with low participation possibilities had significantly more back pain after the implementation of the project (p=0.021). There was no change in back pain in those employees who had sufficient possibilities of participation. Prevention of work related back pain during phases of technological change should involve employees in planning and implementation.
Abstract: Using latent class analysis (LCA), a previous study on patients attending primary care identified four courses of low back pain (LBP) over the subsequent 6 months. To date, no studies have used longitudinal pain recordings to examine the "natural" course of recurrent and chronic LBP in a population-based sample of individuals. This study examines the course of LBP in the general population and elaborates on the stability and criterion-related validity of the clusters derived. A random sample of 400 individuals reporting LBP in a population-based study was asked to complete a comprehensive questionnaire at the start and end of the year's survey, and 52 weekly pain diaries in between. The latter were analyzed using LCA. 305 individuals returned more than 50% of the diaries. Four clusters were identified (severe persistent, moderate persistent, mild persistent, and fluctuating). The clusters differed significantly with regards to pain and disability. Assessment of cluster stability showed that a considerable proportion of patients in the "fluctuating" group changed their classification over time. Three of the four clusters describing the typical course of pain matched the clusters described previously for patients in primary care. Due to the population-based design, this study achieves, for the first time, a close insight into the "natural" course of chronic and recurrent low back pain, including individuals that did not necessarily visit the general practitioner. The findings will help to understand better the nature of this pain in the general population.
Abstract: In this review, we demonstrate the contribution of ambulatory assessment (AA) research to I/O psychology by reference to
four dynamic phenomena, the investigation of which we judge to benefit most from the application of AA techniques: (a) work strain
and coping with work stressors, (b) the work/nonwork interface, (c) social interactions at the workplace, and (d) job attitudes and
work-related emotions. As we see it, the greatest potential of these studies lies in the analysis of how interindividual differences modulate
intraindividual processes. After demonstrating the value of the method, we outline and discuss ways of tackling a number of methodological
issues raised in the studies reviewed: selective participation and attrition, altered reporting behavior and reactivity, noncompliance
with study instructions, low acceptance, and development of reduced scales or single-item measures. Future studies can pave the way
for the broad acceptance and utilization of AA methods by contributing to the resolution of these issues.
Abstract: Low back pain (LBP) is currently the most prevalent and costly musculoskeletal problem in modern societies. Screening instruments for the identification of prognostic factors in LBP may help to identify patients with an unfavourable outcome. In this systematic review screening instruments published between 1970 and 2007 were identified by a literature search. Nine different instruments were analysed and their different items grouped into ten structures. Finally, the predictive effectiveness of these structures was examined for the dependent variables including "work status", "functional limitation", and "pain". The strongest predictors for "work status" were psychosocial and occupational structures, whereas for "functional limitation" and "pain" psychological structures were dominating. Psychological and occupational factors show a high reliability for the prognosis of patients with LBP. Screening instruments for the identification of prognostic factors in patients with LBP should include these factors as a minimum core set.
Abstract: OBJECTIVES: This study investigated whether work characteristics predict physiological recovery on a rest day. Specifically, we aimed to show that high demands and low control at work would lead to higher cortisol values and thus poor recovery on a rest day. METHODS: A total of 69 individuals participated in this study. In addition to analyzing questionnaire responses, we measured salivary cortisol on two workdays and on a subsequent rest day (a Sunday). We used multiple regression analysis. We controlled for the workday cortisol level; results reflect the relative change in cortisol from workday to rest day. In addition, we controlled for gender, since this relates to cortisol levels at work. RESULTS: We found that control at the workplace predicted cortisol levels on a rest day. Specifically, individuals with less job control had higher cortisol levels, and consequently poorer recovery on the rest day than those with more control. Neither job demands nor the interaction of demands and control predicted a change in cortisol levels from workday to rest day. CONCLUSIONS: The results indicated that a lack of control at work impairs physiological recovery on the weekend, one of the central recuperation periods. In light of the potential importance of incomplete recovery with respect to long-term ill health, it should be considered crucial to ensure job control at the workplace.
Abstract: STUDY DESIGN: Prospective study. OBJECTIVE: The present study compared different theories on the role of expectations in a group of patients undergoing lumbar decompression surgery. SUMMARY OF BACKGROUND DATA: Patients' expectations of treatment are a potentially important predictor of self-rated outcome after surgery. Some studies suggest that high baseline expectations per se yield better outcomes, others maintain that the fulfillment of prior expectations is paramount, and still others assert that it is the actual improvement in symptom status that governs outcome, regardless of prior expectations. METHODS: Hundred patients took part (33 F, 67 M; mean [SD] age, 65 [11] yrs). Before surgery, they completed a booklet containing the Roland-Morris (RM) disability questionnaire, 0-10 pain graphic rating scales (back and leg separately), and Likert-scales about the degree of improvement expected in various domains. Two and 12 months after surgery, questions were answered regarding the perceived improvement for each of these domains, the RM and pain scales were completed again, and the patients rated the global outcome on a 5-point Likert-scale. RESULTS: Compared with the actual improvement recorded at 12 months, prior expectations had been overly optimistic in about 40% patients for the domains leg pain, back pain, walking capacity, social life, mental well-being, and independence, and in 50% patients for everyday activities and sport. There was no significant relationship between baseline expectations and follow-up scores for back pain, leg pain, RM-disability (corrected for baseline values), or global outcome. Hierarchical multiple regression analysis revealed that "expectations being fulfilled" was the most significant predictor of global outcome. CONCLUSION: In this patient group, expectations of surgery were overly optimistic. Having one's expectations fulfilled was most important for a good outcome. The results emphasize the importance of assessing patient-orientated outcome in routine practice, and the factors that might influence it, such that realistic expectations can be established for patients before surgery.
Abstract: OBJECTIVES: This study examined the course of low-back pain over 52 weeks following current pain at baseline. Initial beliefs about the inevitability of the pain's negative consequences and fear avoidance beliefs were examined as potential risk factors for persistent low-back pain. METHODS: On a weekly basis over a period of one year, 264 participants reported both the intensity and frequency of their low-back pain and the degree to which it impaired their work performance. In a multilevel regression analysis, predictor variables included initial low-back pain intensity, age, gender, body mass index, anxiety/depression, participation in sport, heavy workload, time (1-52 weeks), and scores on the "back beliefs" and "fear-avoidance beliefs" questionnaires. RESULTS: The group mean values for both the intensity and frequency of weekly low-back pain, and the impairment of work performance due to such pain showed a recovery within the first 12 weeks. In a multilevel regression of 9497 weekly measurements, greater weekly low-back pain and impairment were predicted by higher levels of work-related fear avoidance beliefs. A significant interaction between time and the scores on both the work-related fear-avoidance and back beliefs questionnaires indicated faster recovery and pain relief over time in those who reported less fear-avoidance and fewer negative beliefs. CONCLUSIONS: Negative beliefs about the inevitability of adverse consequences of low-back pain and work-related, fear-avoidance beliefs are independent risk factors for poor recovery from low-back pain.
Abstract: OBJECTIVE:: To examine the influence of beliefs about low back pain (LBP) on reduced productivity at work ("presenteeism") caused by LBP. METHODS:: Two thousand five hundred seven individuals completed the Back Beliefs Questionnaire, the Fear Avoidance Beliefs questionnaire (FABQ), and questions about LBP-related work-absence, reduced work-productivity, pain, comorbidity, and demographics. RESULTS:: Six hundred seventy (25%) individuals were of working age, employed and reported current LBP. Univariate models showed beliefs were more "negative" in individuals with work-absence and reduced productivity (P = 0.0001). In multivariable analysis, controlling for confounders, "FABQwork" was a unique predictor of both absenteeism and presenteeism (each, P = 0.0001), though with small effect sizes. CONCLUSIONS:: Negative beliefs about LBP are associated with both work absence and reduced work-productivity. Further investigations should examine their potential as a target for educational interventions when considering initiatives to reduce the socioeconomic costs of LBP.
Abstract: ABSTRACT: BACKGROUND: Low back pain (LBP) is by far the most prevalent and costly musculoskeletal problem in our society today. Following the recommendations of the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement, our study aims to define outcome assessment tools for patients with acute LBP and the time point at which chronic LBP becomes manifest and to identify patient characteristics which increase the risk of chronicity. METHODS: Patients with acute LBP will be recruited from clinics of general practitioners (GPs) in New Zealand (NZ) and Switzerland (CH). They will be assessed by postal survey at baseline and at 3, 6, 12 weeks and 6 months follow-up. Primary outcome will be disability as measured by the Oswestry Disability Index (ODI); key secondary endpoints will be general health as measured by the acute SF-12 and pain as measured on the Visual Analogue Scale (VAS). A subgroup analysis of different assessment instruments and baseline characteristics will be performed using multiple linear regression models. This study aims to examine 1. Which biomedical, psychological, social, and occupational outcome assessment tools are identifiers for the transition from acute to chronic LBP and at which time point this transition becomes manifest 2. Which psychosocial and occupational baseline characteristics like work status and period of work absenteeism influence the course from acute to chronic LBP 3. Differences in outcome assessment tools and baseline characteristics of patients in NZ compared with CH. DISCUSSION: This study will develop a screening tool for patients with acute LBP to be used in GP clinics to access the risk of developing chronic LBP. In addition, biomedical, psychological, social, and occupational patient characteristics which influence the course from acute to chronic LBP will be identified. Furthermore, an appropriate time point for follow-ups will be given to detect this transition. The generalizability of our findings will be enhanced by the international perspective of this study. [Clinical Trial Registration Number, ACTRN12608000520336].
Abstract: OBJECTIVES: Prolonged activation of the sympathetic-adrenal medullary system during work and the lack of recovery after work may indicate a risk for musculoskeletal pain (ie, neck, shoulder, or low-back pain). This field study tested whether a high level of work stressors are associated with musculoskeletal pain and higher urinary norepinephrine excretion rates at work, after work, and on Sundays. METHODS: Altogether 32 male employees working in adult education took part in a three-phase repeated-measures field study including workplace observation, self-report of musculoskeletal pain, and measurement of urinary catecholamine at work, in the evening after work, and at corresponding times on Sundays. RESULTS: In univariate analyses, work stressors and workday levels of norepinephrine were significantly higher in the participants with high levels of musculoskeletal pain. Moreover, regressing workday norepinephrine excretion rates on predictor variables in the multilevel regression analysis showed a significant interaction between work stressors and musculoskeletal pain (P=0.011) with elevated excretion rates of norepinephrine in those exposed to a high level of work stressors and, at the same time, reporting higher levels of musculoskeletal pain. CONCLUSIONS: High work stressors turned out to be associated with musculoskeletal pain and norepinephrine concentration in male employees. Increased activity of the sympathetic-adrenal medullary system seems to play an important role in work-related musculoskeletal pain.
Abstract: Functional social support can be described as emotional (i.e., caring, esteem, etc.) or instrumental (i.e., informational, tangible) support. Hypothesizing that instrumental support often is interpreted as helpful because of its emotional meaning (signalling caring, understanding, esteem), we asked hospital patients (N = 67) to describe situations (N = 109) during which they were supported, and to indicate why this support was helpful. Both the description of the supportive behaviors and the meaning attributed to them were coded with regard to their instrumental versus emotional quality. As expected, many situations that were instrumental in descriptive terms were emotional in terms of meaning; the reverse occurred very seldom. This effect was confined to "private" interactions (i.e. interactions involving family and friends), whereas instrumental behaviors of medical professionals were largely instrumental in meaning as well. Results underscore the importance of giving instrumental support in a way that communicates care and esteem. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract)
Abstract: Objectives: To carry out a pilot study to demonstrate the feasibility of the contingent valuation (CV) approach to identify net benefits gained from spinal interventions; and to conduct a formal cost-benefit analysis (CBA) using a retrospective study design. The study design is a CBA feasibility study using a CV survey with ex post willingness-to-pay/willingness-to-accept (WTP/WTA) questions. The CBA study was carried out in the specialty of spinal surgery. Summary of Background Data: Although increasing data are gathered on the societal costs of low back pain, little information is available on how patients "value" the benefits of surgery or whether interventions in this area are indeed cost-beneficial. CV surveys are used in CBA to elicit the consumer's monetary valuations for program benefits. Materials and Methods: A total of 115 patients after lumbar fusion, discectomy, or decompression were asked to respond to an ex post questionnaire on their WTP/WTA for their respective intervention. Additional questions addressed socio-demographics, household income, and clinical outcome. WTP/WTA was related to the actual intervention costs and clinical outcome. The WTP and cost data were then combined within a formal CBA framework with associated 95% confidence intervals generated using bootstrapping methods. Results: The response rate was 91.3% (n = 105). 89.5% were satisfied/very satisfied with the treatment. 76.2% found the result of the operation was good/excellent and 75.7% would choose the operation for a given hypothetical intervention cost. Mean stated WTP was 20% lower than the actual operation costs (not known to respondents) for spinal fusion, although it was 37% higher for discectomy and 10% higher for decompression. The individuals' financial situation was the strongest predictor for WTP. Pain improvement, present pain, duration of hospitalization, and estimated intervention costs were significant independent predictors in the expected direction for the WTP, having controlled for socio-demographic and financial confounding variables. Conclusion: This study explored the feasibility of the CV approach for spinal interventions. The approach produced results suggesting positive net benefits with their associated levels of variability for discectomy and decompression, indicating that such surgery is cost-beneficial within a CBA framework, but this conclusion is not supported in the case of spinal fusion. Nevertheless, to improve reliability of the net-benefit estimates for these interventions, we recommend further studies comparing in particular ex ante and ex post WTP methods.
Abstract: Standardized and validated self-administered outcome-instruments are broadly used in spinal surgery. Despite a plethora of articles on outcome research, no systematic evaluation is available on what actually comprises a good outcome in spinal surgery from the patients' and surgeons' perspective, respectively. However, this is a prerequisite for improving outcome instruments. In performing a cross-sectional survey among spine patients from different European regions and spine surgeons of the SSE, the study attempted (1) to identify the most important domains determining a good outcome from a patients' as well as a surgeon's perspective, and (2) to explore regional differences in the identified domains. For this purpose, a structured interview was performed among 30 spine surgeons of the SSE and 353 spine surgery patients (representing Northern, Central and Southern Europe) to investigate their criteria for a good outcome. A qualitative and descriptive approach was used to evaluate the data. Results revealed a high agreement on what comprises a good outcome among surgeons and patients, respectively. The main parameters determining good outcome were achieving the patients' expectations/satisfaction, pain relief, improvement of disability and social reintegration. Younger patients more often expected a complete pain relief, an improved work capacity, and better social life participation. Patients in southern Europe more often wanted to improve work capacity compared to those from central and northern European countries. No substantial differences were found when patients' and surgeons' perspective were compared. However, age and differences in national social security and health care system ("black flags") have an impact on what is considered a good outcome in spinal surgery.
Abstract: BACKGROUND: There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. METHODS: This study aims to examine if1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP.This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study.Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data. CONCLUSION: This study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP.
Abstract: The Job Demand-Control model postulates that job control attenuates the effects of job demands on health and well-being. Support for this interactive effect is rather weak. Conceivably, it holds only when there is a match between job control and individual characteristics that relate to exercising control options, such as locus of control, or self-efficacy. This three-way interaction was tested in a sample of 96 service employees, with affective strain and musculoskeletal pain as dependent variables. As hypothesized, job control attenuated the effects of stressors only for people with an internal locus of control. For people with an external locus of control, job control actually predicted poorer well-being and health as stressors increased. For self-efficacy, the corresponding three-way interaction was significant with regard to affective strain.
Abstract: A sample of 423 Swiss job entrants reported major change in general, as well as positive and negative work experiences one, two, and four years after finishing vocational training. Qualitative data analysis showed change in responsibility, increase in decision latitude, acquisition of new status (professional work status, full team member status), increased salary, and change in work rhythm to be characteristic for the transition from apprenticeship into "real work". In terms of costs and benefits participants reported transition-specific combinations of work experiences, with responsibility and social recognition as positive experiences combined with high demands as negative experiences. Reports of increasing demands and task intensity were frequent throughout the first four years of job experience. Cooperation and social exchange always were of major concern, both as positive and negative experiences. The number of positive and negative experiences reported predicted job satisfaction over and above previous job satisfaction, background variables, stressors, and resources. Results point to a rather smooth transition, in which negative experiences are embedded in, and outweighed by, positive ones. (c) 2006 Elsevier Inc. All rights reserved.
Abstract: Judgments are context bound. Moreover, in most situations, context is changing; hence judgments often reflect a dynamic adaptation to these changes. This study is on working memory load as a factor that potentially moderates speed of adaptation to new context. Two specific stimulus formats used in generalization tests, simultaneous vs successive presentation, were intended to reflect substantial differences in memory load. Conditions that place a higher memory load on the respondent (successive presentation) should show slower changing effects than do conditions that entail a lower memory load (simultaneous presentation). Sixty participants were trained in two stimulus two forced-choice visual discriminations of size. Later generalization tests included more extreme visual stimuli. The stimulus that was seen as neither "small" nor "large" (50% ratings each) changed in the direction of the central stimuli within the stimulus series, with both successive and simultaneous stimulus presentation (adaptation). Multilevel regression analyses showed that change increased gradually in successive stimulus presentation, whereas change was immediate in simultaneous presentation. A significant three-way interaction indicated that generalization was faster with simultaneous presentation of generalization test stimuli than with successive presentation. The results showed that the speed of Point of Subjective Indifference (PSI) shift depends on the mental representation of experience that is strongly related to working memory. The study therefore makes a contribution to the understanding the speed of behavioural change during transition, e.g., the transition from school to work. On a macro-level, model application may assist rapid learning and behavioural adaptation, for instance when individuals change from one cultural context to another.
Abstract: The variables identified as predictors of surgical outcome often differ depending on the specific outcome variable chosen to designate "success". A short set of multidimensional core outcome measures was recently developed, in which each of the following domains was addressed with a single question and then combined in an index: pain, function, symptom-specific well-being, general well-being (quality of life), disability (work and social). The present study examined the factors that predicted surgical outcome as measured using the multidimensional core measures. 163 spinal surgery patients (mixed indications) completed questionnaires before and 6 months after surgery enquiring about demographics, medical/clinical history, fear-avoidance beliefs (FABQ), depression (Zung self-rated depression), and the core measures domains. Multiple regression analyses were used to identify predictor variables for each core domain and for the multidimensional combined core-set index. The combination of baseline symptoms, medical variables (pain duration, previous spine operations, number of levels treated, operative procedure) and psychosocial factors (FABQ and Zung depression) explained 34% of the variance in the core measures index (P < 0.001). With regard to the individual domain items, the medical variables were better in predicting the items "pain" and "symptom-specific well-being" (R (2) = 6-7%) than in predicting "function", "general well-being" or "disability" (each R (2) < 4%). The inverse pattern was shown for the psychosocial predictors, which accounted for in each case approximately 20% variance in "function", "general well-being" and "disability" but only 12-14% variance in "pain" and "symptom-specific well-being". Further to previous studies establishing the sensitivity to change of the core-set, we have shown that a large proportion of the variance in its scores after surgery could be predicted by "well-known" medical and psychosocial predictor variables. This substantiates the recommendation for its further use in registry systems, quality management projects, and clinical trials.
Abstract: STUDY DESIGN: Retrospective study on patients 10 to 60 years of age after nonoperative treatment for adolescent idiopathic scoliosis (AIS). OBJECTIVES: To investigate long-term outcome with regard to pain, disability, psychological disturbance, and health-related quality of life (HRQOL) in nonoperatively treated patients with AIS. SUMMARY OF BACKGROUND DATA: Only little is known on the long-term quality of life and disability in patients nonoperatively treated for AIS. A detailed knowledge of the nonoperative treatment results is important when advising patients for surgery. METHODS: A total of 135 nonoperatively treated AIS patients with a minimum follow-up of 10 years were included in this investigation, 121 of whom responded to a questionnaire containing questions on pain, disability (Oswestry Disability Index [ODI], Hannover Functional Ability Questionnaire [HFAQ], psychological general well-being [PGWB], and health-related quality of life [WHOQOLBREF]). Eighty-one patients participated in a clinical/radiologic follow-up examination. Nonoperative treatment consisted of bracing (n = 60), physiotherapy (n = 59), and electrical stimulation (n = 2). The overall follow-up rate was 89.6%. The mean age at follow-up was 38.0 years (range, 20-73 years.). RESULTS: In general, patients achieved a satisfactory outcome 10 to 60 years (mean, 23 years) after nonoperative treatment with regard to pain, disability, and HRQOL. The average curve at first diagnosis measured 29.5 degrees (range, 15 degrees -59 degrees ) for the thoracic spine, 21.3 degrees (range, 15 degrees -28 degrees ) for the thoracolumbar spine, and 26.8 degrees (10 degrees -44 degrees ) for the lumbar spine. Thirteen patients showed a substantial change in curve size (+/-10 degrees ) between first diagnosis and end of growth: 11 curves progressed more than 10 degrees showing an average increase of 19.0 degrees (range, 12 degrees -30 degrees ) and 2 patients presented with less severe curves at follow-up (-10 degrees and -13 degrees ). After end of growth, 7 patients showed a substantial average increase of 16.3 degrees (range, 10 degrees -31 degrees ). Five of eight patients with thoracic curves greater than 80 degrees had restrictive pulmonary disease. Patients with curves greater than 45 degrees reported significantly higher pain levels than those with smaller curves. Patients only showed a minimal absolute disability (Oswestry and HFAQ), and no significant correlation was found between curve size and curve type, respectively. Compared with a healthy control group that was matched for age and gender, no significant differences were found in terms of HRQOL as assessed by the WHOQOLBREF questionnaire. No significant differences in pain, disability, or HRQOL were found between patients with and without brace treatment. CONCLUSIONS: Although pain, disability, HRQOL, and psychological general well-being are quite satisfactory on an absolute level, curve size was found to be a significant predictor for pain in a long-term follow-up.
Abstract: Prevention of work disability is a primary goal within treatment of spinal disorders. Work-related outcome measures therefore are essential indices within evidence-based medicine. So far many measures suffer, however, from standardized measurement, standardized terminology, and a lack of theoretical background. This review addresses traditional indicators like work status and sickness absence, and discusses more theory-bound concepts, i.e. work ability, occupational risk factors for recurrence of symptoms and re-injury, work-related attitudes that may become obstacles to recovery, and individual reactions to occupational stressors that increase the risk of maintenance and recurrence of symptoms. The review includes methodological and theoretical considerations and recommendations for the use of work-related outcome measures in future outcome research.
Abstract: Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery. Pain intensity, pain-related disability, pain duration and pain affect are the aspects that define pain and its effects. For each of these aspects, different assessment instruments exist and are discussed in terms of advantages and disadvantages. Risk factors for the development of chronic pain have been a major topic in pain research in the past two decades. Now, it has been realised that psychological and psychosocial factors may substantially influence pain perception in patients with chronic pain and thus may influence the surgical outcome. With this background, pain acceptance, pain tolerance and pain-related anxiety as factors influencing coping strategies are discussed. Finally, a recommendation for a minimum as well as for a more comprehensive pain assessment is given.
Abstract: Debate continues on the effect of disc degeneration and aging on disc volume and shape. So far, no quantitative in vivo MRI data is available on the factors influencing disc volume and shape. The objective of this MRI study was to quantitatively investigate changes in disc height, volume, and shape as a result of aging and/or degeneration omitting pathologic (i.e., painful) disc alterations. Seventy asymptomatic volunteers (20-78 years) were investigated with sagittal T1- and T2-weighted MR-images encompassing the whole lumbar spine. Disc height was determined by the Dabbs method and the Farfan index. Disc volume was calculated by the Cavalieri method. For the disc shape the "disc convexity index" was calculated by the ratio of central disc height and mean anterior/posterior disc height. Disc height, disc volume, and the disc convexity index measurements were corrected for disc level and the individuals age, weight, height, and sex in a multilevel regression analysis. Multilevel regression analysis showed that disc volume was negatively influenced by disc degeneration (p < 0.001) and positively correlated with body height (p < 0.001) and age (p < 0.01). Mean disc height and the disc convexity index were negatively influenced by disc degeneration but not by gender, weight, and height. Disc height was positively correlated with age (p < 0.01). From the results of this study, it can be concluded that disc degeneration generally results in a decrease of disc height and volume as well as a less convex disc shape. In the absence of disc degeneration, however, age tends to result in an inverse relationship on disc height, volume, and shape.
Abstract: OBJECTIVE: The objective of our study was to investigate outcome predictors of short- and medium-term therapeutic efficacy of facet joint blocks. MATERIALS AND METHODS: Forty-two patients with chronic lower back pain who were undergoing facet joint blocks at one (n = 29) or two (n = 13) levels were analyzed. All patients underwent MRI or CT of the lumbar spine within 5 months before the facet joint blocks. The facet joint blocks were performed under fluoroscopic guidance. A small amount (< 0.3 mL) of iodinated contrast agent, 0.5 mL of local anesthetics and 0.5 mL of steroids, were injected. The initial pain response was prospectively assessed using a visual analogue scale. Additional data, including short-term effect (> 1 week) and medium-term effect (> 3 months), were collected by a structured telephone interview. CT and MRI were reviewed with regard to the extent of facet joint abnormalities. Multiple logistic regression analyses were conducted to identify outcome predictor for efficacy of facet joint blocks. RESULTS: A positive immediate effect was seen in 31 patients (74%). A positive medium-term effect was found in 14 patients (33%). Pain alleviated by motion (p = 0.035) and the absence of joint-blocking sensation (p = 0.042) predicted pain relief. However, the extent of facet joint osteoarthritis on MRI and CT was not a significant predictor for outcome (p = 0.57-0.95). CONCLUSION: Facet joint blocks appear to have a beneficial medium-term effect in one third of patients with chronic lower back pain and may therefore be a reasonable adjunct to nonoperative treatment. However, outcome appears to depend on clinical, not on morphologic, imaging findings.
Abstract: PURPOSE: To prospectively evaluate the fat content of paraspinal muscles by using proton magnetic resonance (MR) spectroscopy in patients with chronic low back pain (LBP) and in asymptomatic volunteers matched with regard to age, sex, and body mass index. MATERIALS AND METHODS: The study was approved by the responsible institutional review board. Informed consent was obtained from each patient and each volunteer. Single-voxel proton MR spectroscopy was used to measure the fat content of the lumbar multifidus and longissimus muscles in 25 patients (13 women, 12 men; mean age, 40.5 years) with chronic LBP and in 25 matched asymptomatic volunteers (13 women, 12 men; mean age, 39.8 years). The fat content was also graded semiquantitatively (grades 0-4). The relationship between fat content and LBP duration, LBP intensity, and self-rated disability was assessed (Pearson correlation). RESULTS: The mean percentage fat content of the multifidus muscle was 23.6% (95% confidence interval [CI]: 17.5%, 29.7%) in patients with chronic LBP and 14.5% (95% CI: 10.8%, 18.3%) in the volunteers (P = .014). The corresponding values for the longissimus muscle were 29.3% (95% CI: 23.4%, 35.3%) in patients with LBP and 26.0% (95% CI: 21.9%, 30.0%) in the volunteers (P = .66). The semiquantitative grading of the fat content of the multifidus muscle was 0 in 12 (48%) of 25 patients and in 14 (56%) of 25 volunteers, 1 in 11 (44%) patients and in eight (32%) volunteers, and 2 in two (8%) patients and three (12%) volunteers. The semiquantitative grading of the fat content of the longissimus muscle was 0 in nine (36%) of 25 patients and 15 (60%) of 25 volunteers, 1 in 13 (52%) patients and nine (36%) volunteers, and 2 in three (12%) patients and one (4%) volunteer. Neither grade 3 nor grade 4 was assigned to any muscle. The grading differences were not significant between patients and volunteers. No significant correlation was found between fat content and pain intensity, pain duration, or self-rated disability. CONCLUSION: Proton MR spectroscopy demonstrates a significantly higher fat content in the multifidus muscle in patients with chronic LBP than in asymptomatic volunteers. No difference was detected with a semiquantitative grading system.
Abstract: This paper reports effects of short-term memory and context stimuli on recognition of visual stimuli. After presentation of a square as the target stimulus, participants had to store the target during a variable delay, until they had to identify the target within a sample of seven squares that differed systematically in size (context variation). Marked context effects ("shifts") that occurred as responses to the test series were obtained when sets of comparison stimuli were arranged asymmetrically with respect to targets. Participants overestimated the size of the target in a set of larger comparison stimuli by choosing a larger stimulus to match the target, and vice versa (Experiment 1). This assimilation effect increased with longer delays between target offset and the onset of comparison stimuli (Experiment 2). Briefer target exposure also induced stronger assimilation (Experiment 3). The results indicated that visual short-term memory modulates (contextual) stimulus integration in delayed matching to sample. A working model of memory and contextual effects in matching is discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Abstract: This study investigates the link between workplace stress and the 'non-singularity' of patient safety-related incidents in the hospital setting. Over a period of 2 working weeks 23 young nurses from 19 hospitals in Switzerland documented 314 daily stressful events using a self-observation method (pocket diaries); 62 events were related to patient safety. Familiarity of safety-related events and probability of recurrence, as indicators of non-singularity, were the dependent variables in multilevel regression analyses. Predictor variables were both situational (self-reported situational control, safety compliance) and chronic variables (job stressors such as time pressure, or concentration demands and job control). Chronic work characteristics were rated by trained observers. The most frequent safety-related stressful events included incomplete or incorrect documentation (40.3%), medication errors (near misses 21%), delays in delivery of patient care (9.7%), and violent patients (9.7%). Familiarity of events and probability of recurrence were significantly predicted by chronic job stressors and low job control in multilevel regression analyses. Job stressors and low job control were shown to be risk factors for patient safety. The results suggest that job redesign to enhance job control and decrease job stressors may be an important intervention to increase patient safety.
Abstract: The relatively high rate of failed back surgery has prompted the search for "risk factors" to predict the result of spinal surgery in a given individual. However, the literature reveals few unequivocal predictors and they often explain a relatively low proportion of variance in outcome. This suggests that we have a long way to go before being able to rest easily, having refused someone surgery on the basis of unfavourable baseline characteristics. The best recommendation is to ensure, firstly, that the indication for surgery is absolutely clear-cut (i.e. that surgically remediable pathology exists) and then to consider the various factors that may influence the "typical" outcome. Consistent risk factors for a poor outcome regarding return-to-work include long-term sick leave/receipt of disability benefit. Hence, every effort should be made to keep the individual in the workforce, despite the ongoing symptoms and plans for surgery. In patients with a particularly heavy job, consultation with occupational physicians might later ease the patient's way back into the workplace. Patients with degenerative disorders and/or comorbidity should be counselled that few of them will have complete/lasting pain relief or a complete return to pre-morbid function. Patients with a high level of distress may benefit from psychological treatment, before and/or accompanying the surgical treatment. The opportunity (time), encouragement (education and positive messages), and resources (referral to appropriate support services) to modify risk factors that are indeed modifiable should be offered, and realistic expectations should be discussed with the patient before the decision to operate is made.
Abstract: OBJECTIVES: This study examines recognition performance to depend on image context and time order error. Recognition of standard images is a basic process in medical image analysis. METHODS: After the presentation of a standard square, 20 subjects identified the standard within a variety of 7 squares. The choice was between the standard and either 3 smaller and 3 larger squares, 5 smaller and 1 larger square, or 5 larger and 1 smaller square (context conditions). RESULTS: Multilevel regression analysis showed large individual differences in judgments (P < .001). Context induced assimilation of judgments to the medium-sized square within response options (P < .001). Negative time order error in rapid judgments caused an underestimation of the standard (P < .001). CONCLUSIONS: Assimilation of judgments and time order error might be a threat to the reliability of medical image analysis. Some procedural recommendations are derived to reduce bias and increase patient safety in radiology.
Abstract: The mean of self-report and observer ratings of working conditions was used to predict 3 types of well-being in 52 young workers: general well-being, job-related well-being, and spillover from work to nonwork domains. Longitudinally, job control predicted spillover. There was no strong evidence for reverse causation. Synchronously, Time 2 job stressors predicted all types of well-being, and job control predicted general well-being. Because dependent variables at Time 1 are controlled for, this indicates short-term effects. Results for stressors are in line with a stress reaction model, indicating a rather quick symptom development but reversibility. The effect of control on spillover, however, suggests a sleeper effect model, with symptoms appearing with delay.
Abstract: The present study examined the psychometric characteristics of a "core-set" of six individual questions (on pain, function, symptom-specific well-being, work disability, social disability and satisfaction) for use in low back pain (LBP) outcome assessment. A questionnaire booklet was administered to 277 German-speaking LBP patients with a range of common diagnoses, before and 6 months after surgical (N=187) or conservative (N=90) treatment. The core-set items were embedded in the booklet alongside validated 'reference' questionnaires: Likert scales for back/leg pain; Roland and Morris disability scale; WHO Quality of Life scale; Psychological General Well-Being Index. A further 45 patients with chronic LBP completed the booklet twice in 1-2 weeks. The minimal reliability (similar to Cronbach's alpha) for each core item was 0.42-0.78, increasing to 0.84 for a composite index score comprising all items plus an additional question on general well-being ('quality of life'). Floor or ceiling effects of 20-50% were observed for some items before surgery (function, symptom-specific well-being) and some items after it (disability, function). The intraclass correlation coefficient (ICC) ("test-retest reliability") was moderate to excellent (ICC, 0.67-0.95) for the individual core items and excellent (ICC, 0.91) for the composite index score. With the exception of "symptom-specific well-being", the correlations between each core item and its corresponding reference questionnaire ("validity") were between 0.61 and 0.79. Both the composite index and the individual items differentiated (P<0.001) between the severity of the back problem in surgical and conservative patients (validity). The composite index score had an effect size (sensitivity to change) of 0.95, which was larger than most of the reference questionnaires (0.47-1.01); for individual core items, the effect sizes were 0.52-0.87. The core items provide a simple, practical, reliable, valid and sensitive assessment of outcome in LBP patients. We recommend the widespread and consistent use of the core-set items and their composite score index to promote standardisation of outcome measurements in clinical trials, multicentre studies, routine quality management and surgical registry systems.
Abstract: The present study investigates how chronic work characteristics relate to situational work characteristics, and their effect on outcomes such as well-being, problem solving, and calming down. It also examines how the relationship between situational work characteristics and coping strategies affect these outcomes. Based on an event-sampling approach, 23 employees of a counselling agency reported 120 stressful events over 7 days, yielding 92 work-related and 28 private events. Multi-level analyses revealed that with regard to chronic conditions, job control was positively associated with successful calming down and problem solving in stressful situations, whereas job stressors were negatively related to immediate well-being. Chronic stressors and job control can be seen as 'background' variables that influence the response to stressful events. For situational factors, stressfulness was negatively associated and controllability was positively associated with immediate well-being and problem solving. In addition, problem-focused coping predicted positively situation-related success in calming down and problem solving. An effect on well-being was found when situational controllability was high, confirming the active coping rule of Perrez and Reicherts (1992). Palliative coping was positively related to successful calming down.
Abstract: PURPOSE: To retrospectively evaluate if the degree of disk degeneration and disk herniation volume at magnetic resonance (MR) imaging are risk factors for recurrent disk herniation. MATERIALS AND METHODS: The institutional review board permits such retrospective studies, and individual informed consent was not required. MR imaging findings obtained before initial diskectomy in 30 patients (mean age, 42.8 years; 10 women, 20 men) with recurrent disk herniation (study group) and 30 patients (mean age, 42.2 years; nine women, 21 men) without recurrence for at least 2 years after surgery (control group) were compared. Disk degeneration was assessed on T2-weighted sagittal MR images with a five-point grading system (grade I indicated no degeneration; grade II, horizontal hypointense bands within disk; grade III, inhomogeneous disk with intermediate signal intensity; grade IV, no distinction between inner and outer parts of disk; and grade V, collapsed hypointense disk). Disk herniation was classified as representing protrusion, extrusion, or sequestration. The volume of both the affected intervertebral disk and the herniated disk material was measured. Qualitative and quantitative analyses were performed by two readers. The chi(2) test was used for comparison of categorical variables. For comparison of disk degeneration and volumes between patients with and those without recurrence, a paired two-tailed t test was used. Odds ratios based on the extent of disk degeneration were calculated for the entire sample. RESULTS: Advanced disk degeneration (grades IV and V) was significantly less frequent in the study group than in the control group (P < .006). The risk of recurrent disk herniation decreased by a factor of 3.4 for each increase in grade of disk degeneration (odds ratio: 3.58; 95% confidence interval: 1.3, 9.6; P = .011). Mean disk herniation volume as a percentage of intervertebral disk volume was 10.59% +/- 3.41 in the study group and 11.56% +/- 3.84 in the control group. This difference was not significant (P = .31). CONCLUSION: Minor disk degeneration but not herniation volume represents a risk factor for the recurrence of disk herniation after diskectomy.
Abstract: Work and activity-specific fear-avoidance beliefs have been identified as important predictor variables in relation to the development of, and treatment outcome for, chronic low back pain. The objective of this study was to provide a cross-cultural German adaptation of the Fear-Avoidance Beliefs Questionnaire (FABQ) and to investigate its psychometric properties (reliability, validity) and predictive power in a sample of Swiss-German low back pain patients. Questionnaires from 388 operatively and non-operatively treated patients were administered before and 6 months after treatment to assess: socio-demographic data, disability (Roland and Morris), pain severity, fear-avoidance beliefs, depression (ZUNG) and heightened somatic awareness (MSPQ). Complete baseline and follow-up questionnaires were available from 255 participants. The corrected item-total correlations, coefficients of test-retest reliability and internal consistencies of the two scales of the questionnaire were highly satisfactory. In a confirmatory factor analysis (CFA), all items loaded on the appropriate factor with minor loadings on the other. Cross-sectional regression analysis with disability and work loss as the dependent variables yielded results that were highly comparable with those reported for the original version. Prognostic regression analysis replicated the findings for work loss. The cross-cultural German adaptation of the FABQ was very successful and yielded psychometric properties and predictive power of the scales similar to the original version. The inclusion of fear-avoidance beliefs as predictor variables in studies of low back pain is highly recommended, as they appear to have unique predictive power in analyses of disability and work loss.
Abstract: Most studies on occupational stress concentrate on chronic conditions, whereas research on stressful situations is rather sparse. Using an event-sampling approach, 80 young workers reported stressful events over 7 days (409 work-related and 127 private events). Content analysis showed the newcomers' work experiences to be similar to what is typically found in older samples (e.g., social stressors, quantitative overload, problems of cooperation). At work and in private life, social stressors were dominant. In multilevel-analyses active coping predicted higher success in calming down and problem solving, particularly in controllable situations. Palliation was positively related to successful calming down and negatively to event-related well-being. With regard to the relationship between chronic conditions and situational variables, (stable) job control was associated with successful calming down in stressful situations, and it buffered the effect of chronic job stressors on successful situational calming down, yielding a specific variant of the demands-control model. Number of work-related stressful events, weighted by significance, was moderately associated with chronic job stressors. However, while chronic job stressors predicted momentary well-being over and above the weighted number of events, events did not predict momentary well-being, and its prediction of stable well-being disappeared once chronic stressors were controlled. These results show how chronic conditions represent background variables that not only have a stronger influence on well-being but also influence the immediate reaction to stressful encounters.
Abstract: Research on stress at work often involves the analysis of urinary adrenaline and noradrenaline. It is usually assumed that samples have to be cooled quickly and stored at refrigerator temperature before freezing. This is often difficult to achieve in field studies. This experimental study therefore tests the robustness of results when samples are not cooled immediately. Samples of 9 men and women, collected at 3 points in time, were immediately frozen, kept for a variable delay in a warm room, or stored in a refrigerator before freezing. Two indices were calculated: (a) the ratio of hormones to liquid volume, period of excretion, and body weight; and (b) the ratio of hormones to urinary creatinine. The reliability of high performance liquid chromatography analysis was satisfactory, as was the comparability of the 2 indices. Unfavorable storage up to 24 hr did not cause bacteria-driven decreases of catecholamines, regardless of storage temperature or sampling time. Results suggest high stability for at least 24 hr without cooling, provided the samples are immediately acidified. Cooling may therefore be handled less restrictively than has been assumed. The application of this research is to facilitate research in settings where samples are collected at different places, such as participants' homes or different workplaces.
Abstract: A comparison of 234 call centre agents with 572 workers in traditional jobs with long lasting training revealed lower job control and task complexity/variety and higher uncertainty among call agents. However, time pressure, concentration demands, and work interruptions were lower in call agents. Within the call agent sample, controlling for negative affectivity and other working conditions, job control predicted intention to quit, and job complexity/variety predicted job satisfaction and affective commitment. Social stressors and task-related stressors predicted uniquely indicators of well-being and job-related attitudes. Furthermore, data confirm the role of emotional dissonance as a stressor in its own right, as it explained variance in irritated reactions and psychosomatic complaints beyond other working conditions. Results indicate that strong division of labour may be a rather general phenomenon in call centres. Therefore, working conditions of call agents require a redesign by means of job enrichment or--better--organization development. Moreover, measures of social stressors and emotional dissonance should be integrated routinely into stress-related job analyses in service jobs. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Abstract: STUDY DESIGN: A longitudinal magnetic resonance imaging investigation of lumbar disc degeneration in asymptomatic individuals was conducted. OBJECTIVE: To investigate risk factors for the development or deterioration of lumbar disc degeneration. SUMMARY OF BACKGROUND DATA: Numerous studies have explored the significance of certain risk factors for the development or progression of disc degeneration, but no comprehensive longitudinal magnetic resonance imaging-based study has been reported that simultaneously considers clinical, morphologic, physical, psychosocial, and occupational risk factors. METHODS: In the 5-year follow-up evaluation of 41 asymptomatic individuals, the risk factors for the development of lumbar disc degeneration and its progression were investigated. All 41 individuals had a magnetic resonance imaging scan at baseline and at the minimum 5-year follow-up assessment using the same scanner and protocol. The magnetic resonance images were analyzed independently by two radiologists with regard to disc degeneration. Various predictor variables were assessed both at baseline and follow-up, with special emphasis on physical job characteristics, sports activities, and magnetic resonance image-based morphologic findings. RESULTS: Of the 41 individuals, 17 (41%) exhibited a deterioration of the disc status. In 10 individuals, the progression of disc degeneration was one grade or more. Only a weak correlation existed between progressive disc degeneration and low back pain development during a 5-year follow-up period. Multiple logistic regression analysis demonstrated that the extent of disc herniation (odds ratio [OR], 12.63; confidence interval [CI], 1.24-128.49), the lack of sports activities (OR, 2.71; CI, 1.04-7.07), and night shift work (OR, 23.01; CI, 1.26-421.31) were significant predictors for disc degeneration during follow-up evaluation when control was used for the number of degenerated discs at baseline, gender, age, and body mass index. CONCLUSIONS: The results indicate that the extent of disc herniation, the lack of sports activities, and night shift work are significant risk factors for the development of lumbar disc degeneration and its progression.
Abstract: Spinal canal dimensions are assumed to play a significant role with regard to the development of symptoms in individuals with disc herniations. The literature is inconclusive on the significance of spinal canal size as a risk factor for sciatica, mainly because of study design problems. The objective of this study, therefore, was to test the hypothesis that spinal canal dimensions are a significant risk factor for the development of sciatica, comparing symptomatic and asymptomatic individuals. Thirty symptomatic patients undergoing lumbar discectomy and 45 asymptomatic volunteers were investigated by clinical and MRI examination. The size of the spinal canal and thecal sac as well as the midsagittal spinal canal diameter were measured using a point counting method and scanner software, respectively. Differences between the groups were compared separately for each level L3/4 to L5/S1. The intra- and inter-observer error ranged between 0.95 and 0.99 for all measurements. In symptomatic patients, the dimensions of the spinal canal and thecal sac as well as the midsagittal spinal canal diameter were smaller at all disc levels. Unpaired t-test demonstrated a significant difference, ranging from P<0.05 to P<0.001. When controlled for age, sex and body height, the odds ratio for a symptomatic disc herniation increased to as high as 35, depending on the spinal level, when the size of the spinal canal was smaller than the mean for controls by two standard deviations or more. In symptomatic patients, spinal canal dimensions are significantly smaller than those in asymptomatic individuals. Spinal canal dimension is an important factor discriminating patients from control subjects. A clinically relevant grading system for disc herniation should therefore be based on the spatial relationship between herniated disc material and neurogenic structures.
Abstract: In a 5-year longitudinal study, social support was investigated as a predictor of low back pain (LBP) in 46 initially asymptomatic individuals. Distinguishing between colleagues in general and the colleague one feels closest to, the authors analyzed constellations of support from supervisor (which had positive effects) and closest colleague (which had detrimental effects). Configural frequency analysis yielded a type characterized by high support from one's closest colleague and low support from one's supervisor at Time 1 and more LBP and disability at Time 2. Controlling for negative affectivity did not change findings. Results are interpreted in terms of being dependent on that one source of support in an unsupportive environment, which creates feelings of dependence, incompetence, and reciprocity obligations.
Abstract: OBJECTIVES: This study had two objectives. First, it addressed concern with the contribution of work stressors and resources to the development of back pain, over and above the influence of biomechanical work factors. Second, using recent models about the role of the sympathetic-adrenal medullar system in musculoskeletal problems as its basis, it tested whether low-back pain is associated with higher levels of catecholamines. METHODS: Altogether 114 nurses filled out a questionnaire in their first year of practice and again one year later. In addition, in a subsample of 24 nurses studied intensively at follow-up, urinary catecholamines were assessed at noon, before the end of work, in the evening, and at corresponding times on a day off. Daily stressful experiences and daily mood were also recorded. RESULTS: With control for baseline pain, biomechanical workload, and other potentially confounding variables, time control at the beginning of the study predicted low-back pain a year later. In the subsample, the epinephrine and norepinephrine levels were higher in those reporting more frequent episodes of back pain, the largest differences occurring at the end of work. In addition, control over stressful events at work was lower in this group. CONCLUSIONS: Time control is a risk factor for low-back pain among nurses beyond the influence of physical work load. Low control at work may increase the activity of the sympathetic-adrenal medullar system, which seems to play an important role in the development of musculoskeletal pain.
Abstract: The dispositional approach to job satisfaction was tested in a sample of young people. Questionnaires were administered shortly before the end of vocational training and again one year later. Stabilities in job satisfaction were investigated in terms of mean changes, autocorrelations, and an index of individual consistency. Autocorrelations were lower for job satisfaction than for the Big Five personality dimensions and for an index measuring the centrality of work in life. Change in mean levels in job satisfaction and in centrality of work was higher for those who changed employer than for those who did not. Autocorrelations and consistency scores of leavers were lower for job satisfaction but did not differ for centrality of work. Controlling for personality dimensions did not lead to significantly lower stabilities. Since stability in job satisfaction was lower for leavers but still significant, and since there was a small but significant correlation between neuroticism (as a measure of negative affectivity) and individual consistency scores for job satisfaction, it is concluded that the dispositional approach does get some support, but only to a modest degree, explaining between 10 and 15 per cent of the variance. Situational influences should, therefore, not be underestimated. The use of different indicators for stability is recommended for future studies.
Abstract: Young people in five occupations were investigated before the end of vocational training and again one year later (N = 675). In general, working conditions were within the range found in adult samples, with some values for stressors, however, being on the higher end. Conditions were especially good for electronic technicians, rather good for bank clerks, but comparatively worse for cooks and salespeople. For nurses, a stressful job was combined with good social conditions. Attitudes are positive towards life in general but rather low towards work. Stress symptoms (irritability) are on the high end of the typical range for adults, Where there are changes over time, they are to the better for many working conditions and for work attitudes, Stress symptoms, however, tend to increase, More than 50 per cent of participants change employers. They seem to profit from leaving which is remarkable because many of them did not have a choice, Overall, stability seems more prominent.
Abstract: STUDY DESIGN: Prospective study on individuals with asymptomatic lumbar disc abnormalities detected in magnetic resonance imaging. OBJECTIVES: To determine the natural history of asymptomatic disc abnormalities in magnetic resonance imaging and to identify predictors of future low back pain-related medical consultation and work incapacity. SUMMARY OF BACKGROUND DATA: The natural history of individuals with asymptomatic disc herniations has not been well established, but the high rate of lumbar disc alterations recently detected in asymptomatic individuals by magnetic resonance imaging demands reconsideration of a pathomorphology-based explanation of low back pain and sciatica. METHODS: Forty-six asymptomatic individuals who had a high rate of disc herniations (73%) were observed for an average of 5 years (range, 54-72 months). Four classes of variables (medical data including magnetic resonance imaging-identified disc abnormalities, general psychological factors, physical job characteristics, and psychosocial aspects of work) were assessed at baseline and follow-up. RESULTS: Disc herniations and neural compromise did not significantly worsen at follow-up, whereas disc degeneration progressed in 17 individuals (41.5%). Minor episodes of low back pain occurred in 19 individuals (41.3%), 6 of whom had to seek medical treatment and 5 of whom had to stop work temporarily. The requirement for low back pain-related medical consultation was predicted with high accuracy by listlessness, job satisfaction, and working in shifts (P < 0.001). Work incapacity was best predicted by physical job characteristics, job disaffection, and working in shifts (P < 0.01). CONCLUSION: Physical job characteristics and psychological aspects of work were more powerful than magnetic resonance imaging-identified disc abnormalities in predicting the need for low back pain-related medical consultation and the resultant work incapacity. However,the conclusions are still preliminary, and replication of the findings in larger and more representative study samples is needed.
