Purpose. To determine whether changes in health outcomes result from changes in domains of functioning and relevant environmental factors in musculoskeletal conditions.Method. Longitudinal observational study on a convenience sample of 291 patients with low back pain, osteoarthritis, osteoporosis, rheumatoid arthritis and chronic widespread pain. The study was part of the MHADIE project. Data collection was performed at baseline, after 4 and 8 weeks using the ICF Core Sets for the corresponding musculoskeletal conditions. Multilevel models for change were used to determine which ICF categories explain the variability and change over time of the general, physical and mental health according to the SF-36.Results. There are only small fluctuations in the health outcomes. These are related to functions of the locomotor apparatus, such as muscle power, and to activities and participation domains related to them, such as lifting and carrying objects. A large amount of baseline variance is explained with a relatively small number of ICF categories of functioning.Conclusions. This study presents a list of functioning problems and environmental factors relevant to map out both the patterns and the variations in the experience of living with a chronic and painful condition. These are intervention targets common across MSC conditions.
The World Health Organization (WHO) has argued that functioning, and, more concretely, functioning domains constitute the operationalization that best captures our intuitive notion of health. Functioning is, therefore, a major public-health goal. A great deal of data about functioning is already available. Nonetheless, it is not possible to compare and optimally utilize this information. One potential approach to address this challenge is to propose a generic and minimal set of functioning domains that captures the experience of individuals and populations with respect to functioning and health. The objective of this investigation was to identify a minimal generic set of ICF domains suitable for describing functioning in adults at both the individual and population levels.We performed a psychometric study using data from: 1) the German National Health Interview and Examination Survey 1998, 2) the United States National Health and Nutrition Examination Survey 2007/2008, and 3) the ICF Core Set studies. Random Forests and Group Lasso regression were applied using one self-reported general-health question as a dependent variable. The domains selected were compared to those of the World Health Survey (WHS) developed by the WHO.Seven domains of the International Classification of Functioning, Disability and Health (ICF) are proposed as a minimal generic set of functioning and health: energy and drive functions, emotional functions, sensation of pain, carrying out daily routine, walking, moving around, and remunerative employment. The WHS domains of self-care, cognition, interpersonal activities, and vision were not included in our selection.The minimal generic set proposed in this study is the starting point to address one of the most important challenges in health measurement--the comparability of data across studies and countries. It also represents the first step in developing a common metric of health to link information from the general population to information about sub-populations, such as clinical and institutionalized populations.
To determine which environmental factors are associated with performance when controlling for capacity, using the International Classification of Functioning, Disability and Health (ICF).A psychometric study using a sample of 296 persons with musculoskeletal health conditions as a case in point. The following steps were carried out: (i) Rasch analyses created 2 interval measurement scales, capacity and performance, based on 22 Activities and Participation ICF categories that had been rated as capacity and performance. Capacity and performance scores, ranging from 0 (low level) to 100 (high level) were calculated; (ii) group lasso regression was used to identify the environmental factors associated with a person's performance when controlling for capacity. Gender, age and health condition were forced to remain in the model.A capacity scale based on 16 ICF categories (rated as capacity) and a performance scale based on 18 categories (rated as performance) were created. Thirteen environmental factors ICF categories covering the physical, social, attitudinal and political environment were identified as highly associated with patient's performance.Using an exclusively statistical approach this study identified environmental factors associated with a person's performance.
The brain is made up of thousands of cells that make sense of what a person experiences. These cells, which are called neurons, all have different jobs depending on where they are in the brain. Scientists use multiple methods to collect information about how and when neurons react; this is sort of like taking a picture of the brain’s activity! To understand the jobs neurons do, researchers generally use methods that do not go directly into the brain. These approaches are commonly used because they are convenient; however, because they are “pictures” taken from outside the skull, the information they provide scientists may be incomplete or inaccurate. Fortunately, it is also possible for researchers to use a method that goes directly inside the brain tissue, called single-cell recording, to more accurately capture what a neuron is doing.
Background: Chronic psychological distress appears to have increased in recent years, mainly among the working population.The data available indicate that mental and behavioral disorders, including burnout syndrome, represent not only a personal problem for those afflicted, but also a serious public health issue.This study aimed at evaluating the effects of an outpatient burnout prevention program in a mono-center health resort setting.Methods: Adults experiencing an above-average level of stress and thus being at an increased risk of burnout were randomized either to the intervention group (IG) or the waiting control group (WG).The 3-week program included stress management intervention, relaxation, physical exercise and moor applications.The primary outcome was change in perceived stress (PSQ) at 6 months post-intervention.Secondary outcomes included burnout symptoms, well-being, health status, psychological symptoms, back pain, and number of sick days.Participants were examined at baseline, post-intervention (3 weeks) and after 1, 3 and 6 months.Results: Data from 88 adults (IG=43; WG=45) were available for (per protocol) analysis (mean age: 50.85; 76.1% female).Participants in the IG experienced significant immediate improvement in all outcome measures, which declined somewhat during the first three months post-intervention and then remained stable for at least another three months.Those in the WG did not experience substantial change across time.For the 109 randomized persons, results for PSQ were confirmed in an intention-to-treat analysis with missing values replaced by last observation carried forward (between-group ANCOVA for PSQ-Score at 6 months, parameter estimator for the group: -20.57; 95% CI: [-26.09;-15.04]).Large effect sizes (Cohen's d for PSQ: 1.09-1.72)indicate the superiority of the intervention.Conclusions: The program proved to be effective in reducing perceived stress, emotional exhaustion and other targets.Future research should examine the long-term impact of the program and the effect of occasional refresher training.
