To investigate the relationship of the patient's criteria of successful treatment to emotional factors in patients with chronic musculoskeletal pain.
Patients who visited our outpatient hospital due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Patients were evaluated with the Patient-Centered Outcomes Questionnaire (PCOQ) to investigate their expectation and criteria for success regarding treatment of chronic musculoskeletal pain. Beck Depression Inventory and State-Trait Anxiety Inventory were used to check for psychological variables. Correlations among each of the variables were evaluated statistically.
Patients with higher levels of depression and anxiety needed larger improvements to consider the treatment as a success in the pain domain (depression, r=0.398, p=0.04; anxiety, r=0.447, p=0.02) and emotional distress domain (depression, r=0.617, p=0.001; anxiety, r=0.415, p=0.03), but had lower level of expectation of the treatment in the pain domain (depression, r=-0.427, p=0.01; anxiety, r=-0.441, p=0.004), emotional distress domain (depression, r=-0.454, p=0.01; anxiety, r=-0.395, p=0.04), and interference of daily activities domain (depression, r=-0.474, p=0.01; anxiety, r=-0.396, p=0.04). Patients were classified into 3 clusters based on the importance rating of each domain via a hierarchical analysis. The cluster of the patients with the higher rating of importance across all domains (importance of pain domain, 9.54; fatigue domain, 9.08; emotional distress domain, 9.23; interference of daily activities domain, 9.23) had the highest level of depression and anxiety.
Consideration of psychological factors, especially in patients who require larger improvements in all treatment domains, may be helpful for the successful treatment of chronic musculoskeletal pain.
Citations
To evaluate the effect of the Whirlpool hydrotherapy on pain and anxiety in chronic myofascial pain syndrome (MPS) patients, compared to the conventional hydrocollator pack therapy.
Forty-one subjects who have MPS in the upper trapezius muscles without depression were recruited. The patients were randomly assigned into two groups: the whirlpool therapy group whose bodies were immersed in a whirlpool bath at 34℃-36℃ for 30 minutes; the hydrocollator group who took a 30-minute application of a standard hot hydrocollator pack. Patients in both groups received therapy three days a week for 2 weeks and underwent several evaluations at baseline and after treatment. The variables we analyzed during evaluations were as follows: the primary outcome we considered was pain severity using a visual analogue scale. And the secondary outcomes examined included anxiety using the Korean version of the Beck Anxiety Inventory and quality of life (QoL) using the Korean version of the World Health Organization QoL Assessment, Brief Form. All follow-up values were compared with the baseline values.
The baseline parameters did not show significant differences between two groups. And after 2-week treatment, both groups revealed significant improvement in anxiety levels and QoL, as well as in pain. However, the improvement on pain (p=0.002) and anxiety (p=0.010) was significantly greater in the whirlpool group, compared to the hydrocollator group.
The whirlpool hydrotherapy can be used as a more effective therapeutic method to reduce pain and anxiety in chronic MPS patients without depression.
Citations
To determine the associating factors of fear of falling (FOF) and the correlations between FOF and quality of life (QOL) on subacute stroke patients in Korea.
Fifty hemiplegic subacute stroke patients in our clinic were recruited. We directly asked patients with their fear of falling and interviewed them with the Korean version of falls efficacy scale-international (KFES-I). We divided the participants into two groups; with FOF and without FOF. We compared these groups with the strength of hemiplegic hip abductor, knee extensor, ankle plantar flexor, functional ambulation category (FAC) scale, stroke specific quality of life (SSQOL), and hospital anxiety depression scale (HADS).
Thirty-four participants were enrolled, and more than half of the patients with subacute stroke had FOF. We compared the patients with and without FOF. According to the results, FOF was associated with the strength of hemiplegic hip abductor, knee extensor and ankle plantar flexor, FAC, total SSQOL, and domains (energy, mobility, self care, upper extremity function) of SSQOL (p<0.05). FOF was also associated with the anxiety score of HADS (p<0.05). KFES-I had a significant negative correlation with the strength of hemiplegic hip abductor, knee extensor and ankle plantar flexor, FAC, total SSQOL, and domains (energy, mobility, self care, upper extremity function) of SSQOL (p<0.01).
The FOF was associated with not only QOL but also with the physical and psychological factors, and in particular, anxiety. Therefore, further concerns about FOF in subacute stroke patients might be required.
Citations
MethodTwenty patients with acute (pain duration ＜2 months) and chronic (pain duration ＞3 months) musculoskeletal pain were recruited. Pain intensity was assessed using 3 measures: ratings of average pain on a visual analogue scale (VAS), ratings of average pain on the short form McGill pain questionnaire (SF-MPQ), and ratings of pain on the present pain intensity (PPI) verbal rating scale. Quality of life and anxiety were assessed using 2 measures: the SF-36 (medical outcomes study 36-item short-form health survey) and the STAI (state-trait anxiety inventory).
ResultsThe SF-36 scale was lower and state anxiety scale was higher in chronic pain group. The SF-36 and the state anxiety scale revealed significant difference between the acute and chronic groups (p＜0.05), but there was no significant difference between the the groups regarding pain intensity and the trait anxiety scale.
ConclusionPatients with chronic pain showed low well-being status and increased anxiety level compared to acute pain patients. According to the above results, proper management of chronic pain might be helpful for enhancing their psychosocial function.
Objective: To estimate the level of depression, anxiety and self consciousness in mothers of cerebral palsy (CP) children according to the clinical type and family type.
Method: 39 mothers of CP children and 42 mothers of normal children (control) completed Beck Depression Inventory, State-Trait Anxiety Inventory, Ego strength scale and Family Adaptation and Cohesion Evaluation Scale. The data were statistically analyzed. There were no significant differences in mother's age, children's age and monthly income between the CP mothers and control.
Results: Mothers of CP children showed significantly higher level of BDI and State anxiety (p＜0.05), but there were no significant differences in the Trait anxiety. There were no differences in the BDI and State-Trait Anxiety Inventory according to the clinical severity and duration of CP children. There were no difference in BDI and State-Trait Anxiety Inventory according to the family adaptation and cohesion.
Conclusion: It is necessary to consider emotional problem of mothers with cerebral palsy children and support psychologically in comprehensive rehabilitation.
Objective: To evaluate the depression and anxiety level of caregivers of stroke patient
according to the severity and duration of disability and family type.
Method: The subjects were 38 caregivers of stroke patient, 39 mothers of cerebral palsy patient and 20 caregivers with nondisabled admission patient in general ward (control). The subjects completed Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Ego strength scale and Family Adaption and Cohesion Evaluation Scales. The data were statistically alalyzed.
Results: The caregivers of stroke patient showed significantly higher level of BDI and state anxiety inventory (p＜0.01) than control group, but there were no significant difference in the trait-anxiety inventry. There were no significant differences in the BDI and State- Ttrait Anxiety inventory according to the severity and duration of disability and family type. There were no significant difference in the BDI and State-Ttrait Anxiety inventory between caregivers of stroke patient and mothers of cerebral palsy patient.
Conclusion: It is necessary to consider depression and anxiety in caregivers with stroke patient and support their psychologic aspect for the comprehensive rehabilitation.
Objective: To investigate the influence of psychologic factors and stress on chronic pain syndrome and predictive factors of chronic pain.
Method: The subjects were 23 patients with chronic pain. The age was ranged from 25 to 66 years with an average of 45. We measured pain with initial visual analogue scale (VAS), one-week total VAS, and tenderness threshold by pressure algometer. We evaluated the degree of depression, anxiety and disability with chronic pain and the impact of stress of major versus minor daily events. Association between degree of pain and psychologic factors was studied by regression and stress of major versus minor daily events by correlation analysis. Predictive factors for chronic pain were determined by multiple regression analysis. Association of daily fluctuation of pain severity and stress from minor life events was also studied.
Results: One-week total VAS was associated with initial VAS (r=0.601, p＜0.05). Initial VAS had association with depression and anxiety. Predictive factors for one-week total VAS were initial VAS, static anxiety, and pain disability (r=0.624, p＜0.05).
Conclusion: Depression, anxiety, pain disability from chronic pain, and stress were major influencing factors in patients with chronic pain.
Objective: To investigate the relationship between activities of daily living (ADL) dependence and psychological parameters in the adult hemiplegic stroke patients.
Methods: The subjects were total 122 stroke patients who underwent rehabilitation therapy. Patients were surveyed with questionnaires for anxiety, stress, and depression. Cognitive functions were assessed by mini-mental status examination and their ADL functions were evaluated by modified Barthel index. The correlation between ADL function and psychological parameters was statistically analyzed by Pearson's correlation test.
Results: Results were as follows: The average stress score of stroke patients was 76.7 which was relatively high. Fourty-seven percent of stroke patients suffered from depression, and it was more frequent in the left hemiplegics. As the result of the Pearson's correlation test, ADL function is closely correlated with intrapersonal stress level, but not with the level of anxiety or depression. The cognitive function has correlation with intrapersonal stress level, but not with depression.
Conclusion: Understanding of the relationship between psychological status and ADL function in the stroke patients will be helpful to the physician for conducting efficient rehabilitation of these patients.
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