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3. Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain

Author

McLaughlin, Kevin H., Fritz, Julie M., Minick, Kate I., Brennan, Gerard P., McGee, Terrence, Lane, Elizabeth, Thackeray, Anne, Bardsley, Tyler, Wegener, Stephen T., Hunter, Stephen J., and Skolasky, Richard L.

Subjects
Medical research -- Health aspects, Medicine, Experimental -- Health aspects, Coronavirus infections -- Risk factors -- Care and treatment, Therapeutics, Physiological -- Health aspects, Physical therapy -- Health aspects, Evidence-based medicine -- Health aspects, Coronaviruses -- Health aspects, Backache -- Risk factors -- Care and treatment, Health
Abstract

Objective. The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP). Methods. This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a [greater than or equal to]50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. Results. Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. Conclusion. Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. Impact. This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach. Keywords: Patient-Centered Care, Precision Medicine, Risk Factors, Telemedicine, Introduction During the early phases of the coronavirus disease-2019 (COVID-19) pandemic, state and federal policies were modified, allowing many physical therapists in the United States to begin providing care through [...]

Published
2024
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16. Pain Self-Efficacy (PSEQ) score of

Author

Mo, Kevin C., Gupta, Arjun, Movsik, Jonathan, Covarrubius, Oscar, Greenberg, Marc, Riley, Lee H., III, Kebaish, Khaled M., Neuman, Brian J., and Skolasky, Richard L.

Published
2023
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22. Patient-Centered Goals After Lumbar Spine Surgery: A Secondary Analysis of Cognitive-Behavioral-Based Physical Therapy Outcomes From a Randomized Controlled Trial

Author

Coronado, Rogelio A., Master, Hiral, Bley, Jordan A., Robinette, Payton E., Sterling, Emma K., O'Brien, Michael T., Henry, Abigail L., Pennings, Jacquelyn S., Vanston, Susan W., Myczkowski, Brittany, Skolasky, Richard L., Wegener, Stephen T., and Archer, Kristin R.

Subjects
Cognitive therapy -- Complications and side effects -- Patient outcomes, Spine -- Surgery, Health
Abstract

Objective. The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral-based physical therapy (CBPT) intervention after spine surgery. Methods. In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2-6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score [greater than or equal to] 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression. Results. Participants set a median of 3 goals (range = 1-6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted. Conclusions. Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning. Impact. This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery. Keywords: Arthrodesis, Back Pain, Postoperative Care, Psychotherapy, Rehabilitation, Introduction Patient-centered goal setting is a core behavioral component of rehabilitation programs, where individuals, in collaboration with a health care provider, identify and set meaningful goals based on what is [...]

Published
2022
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29. How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery?

Author

Master, Hiral, Pennings, Jacquelyn S., Coronado, Rogelio A., Bley, Jordan, Robinette, Payton E., Haug, Christine M., Skolasky, Richard L., Riley, Lee H., III, Neuman, Brian J., Cheng, Joseph S., Aaronson, Oran S., Devin, Clinton J., Wegener, Stephen T., and Archer, Kristin R.

Published
2021
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39. Prevalence of HIV-associated neurocognitive disorders in the Multicenter AIDS Cohort Study

Author

Sacktor, Ned, Skolasky, Richard L, Seaberg, Eric, Munro, Cynthia, Becker, James T, Martin, Eileen, Ragin, Ann, Levine, Andrew, and Miller, Eric

Subjects
Mental Health, Clinical Research, Brain Disorders, HIV/AIDS, Behavioral and Social Science, Neurosciences, Infectious Diseases, 2.4 Surveillance and distribution, Aetiology, AIDS Dementia Complex, Adult, Antiretroviral Therapy, Highly Active, Comorbidity, Disease Progression, Follow-Up Studies, Humans, Hypercholesterolemia, Male, Middle Aged, Neuropsychological Tests, Prevalence, Severity of Illness Index, Clinical Sciences, Cognitive Sciences, Neurology & Neurosurgery
Abstract

ObjectiveTo evaluate the frequency of HIV-associated neurocognitive disorder (HAND) in HIV+ individuals and determine whether the frequency of HAND changed over 4 years of follow-up.MethodsThe Multicenter AIDS Cohort Study (MACS) is a prospective study of gay/bisexual men. Beginning in 2007, all MACS participants received a full neuropsychological test battery and functional assessments every 2 years to allow for HAND classification.ResultsThe frequency of HAND for the 364 HIV+ individuals seen in 2007-2008 was 33% and for the 197 HIV+ individuals seen at all time periods during the 2007-2008, 2009-2010, and 2011-2012 periods were 25%, 25%, and 31%, respectively. The overall frequency of HAND increased from 2009-2010 to 2011-2012 (p = 0.048). Over the 4-year study, 77% of the 197 HIV+ individuals remained at their same stage, with 13% showing deterioration and 10% showing improvement in HAND stage. Hypercholesterolemia was associated with HAND progression. A diagnosis of asymptomatic neurocognitive impairment was associated with a 2-fold increased risk of symptomatic HAND compared to a diagnosis of normal cognition.ConclusionHAND remains common in HIV+ individuals. However, for the majority of HIV+ individuals on combination antiretroviral therapy with systemic virologic suppression, the diagnosis of HAND is not a progressive condition over 4 years of follow-up. Future studies should evaluate longitudinal changes in HAND and specific neurocognitive domains over a longer time period.

Published
2016

40. Examining the Relationship Between Individual Patient Factors and Substantial Clinical Benefit From Telerehabilitation Among Patients With Chronic Low Back Pain

Author

McLaughlin, Kevin H, primary, Fritz, Julie M, additional, Minick, Kate I, additional, Brennan, Gerard P, additional, McGee, Terrence, additional, Lane, Elizabeth, additional, Thackeray, Anne, additional, Bardsley, Tyler, additional, Wegener, Stephen T, additional, Hunter, Stephen J, additional, and Skolasky, Richard L, additional

Published
2023
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