Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome?

Title: Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome? Authors: Molly Geiger SPT1, Stephanie Juhnke SPT1, Ellen Maloney SPT1, Danny McMillian DSc.1 Affiliation: 1. School of Physical Therapy, University of Puget Sound Purpose: Several studies have linked psychosocial factors, such as depression, self-efficacy, and fear-avoidance to poor outcomes, increased disability, and the development of chronic pain. In a primary care setting, Foster has shown self-efficacy to be the most important for determining outcomes. The aim of this study is to examine the relationship between self-efficacy (SE) levels and physical therapy (PT) outcomes. We believe a patient’s SE levels will be positively correlated with PT outcomes. Specifically, higher SE levels will be associated with successful outcomes. Subjects: 11 Subjects (5 females and 6 males, ages 21-76 years old) from the University of Puget Sound’s outpatient musculoskeletal clinic participated in this study. Patients presented with a wide range of musculoskeletal impairments. Materials & Methods: Subjects from the University of Puget Sound’s musculoskeletal clinic were recruited for the study. Subjects completed the General Self-Efficacy Questionnaire prior to their initial evaluation and a specified relevant outcome measure and the Numeric Pain Rating Scale on both the initial and final treatments. Changes in outcomes were compared to the minimal clinically important difference (MCID) and then correlated with the GSE score. Results: The results of this study reveal no statistically significant relationship between SE levels and physical therapy outcome. A Point Biserial Correlation showed that the initial GSE score was only moderately correlated with the pain scale, r=0.589 p-value=0.296, and with the results on the outcome measures, r=0.503 p=0.114. Notably, for all subjects the average GSE score was high at 79.8%. The average GSE scores for those who saw improvement (met MCID or not) versus those who saw no change or worse outcomes was 85.0% and 65.8% respectively. Conclusion: While this study only shows a moderate correlation between SE levels and PT outcomes, it does shine a light on the uniqueness of PT performed in an educational setting. Because student physical therapists were treating patients under supervision of the clinical instructors, it is conceivable patients pursuing treatment in this setting have high SE levels. This could explain the lack of variability in the data collected as well as indicate a need to expand the psychosocial parameters measured. Although significant results were not achieved, a comparison of SE averages between groups (improved or not) does suggest the potential for a relationship between psychosocial factors and therapeutic outcomes to exist. Clinical Relevance: The lack of variability obtained in this study indicates the need for larger sampling and an expansion of the psychosocial factors measured. Additionally, when collecting data in an educational setting, clinical researchers should acknowledge that generalizability might be limited by the unique characteristic of patients receiving care in that setting. References: Tijou I, Yardley L, Sedikides C, Bizo L. Understanding adherence to physiotherapy: Findings from an experimental simulation and an observational clinical study. Psych Health. 2010;25(2). Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain. 2010;148(3):398-406. Bergbom S, Boersma K, Overmeer T, Linton SJ. Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. PHYS THER. 2011;91:754-764. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. PHYS THER. May 2011;91:700-711. Overmeer T, Boersma K, Denison E, Linton SJ. Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? A randomized controlled trial. PHYS THER. 2011;91(5):804-819. Foster NE, Delitto A. Embedding psychosocial perspectives within clinical management of low back pain: Integration of psychosocially informed management principles into physical therapist practice--challenges and opportunities. PHYS THER. 2011;91:790-803

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

Upregulation of Endothelin-1 May Predict Chemotherapy-Induced Cardiotoxicity in Women with Breast Cancer

As survival in breast cancer patients from newer therapies increases, concerns for chemotherapy-induced cardiotoxicity (CIC) have offset some of these benefits, manifesting as a decline in left ventricular ejection fraction (LVEF). Patients receiving anthracycline-based chemotherapy followed by trastuzumab are at risk for CIC. Previous research evaluating whether clinical biomarkers predict cardiotoxicity has been inconsistent. Recently, angiotensin II type 1 receptor (ATR1) and endothelin 1 (ET1) have been shown to play a role in breast tumor growth. We evaluated ATR1 and ET1 expression in breast cancer tissue and its association with CIC. A total of 33 paraffin-embedded breast tissue specimens from women with breast cancer treated with anthracycline-based chemotherapy and trastuzumab were analyzed by immunohistochemistry (IHC) and qRT-PCR. We found that ET1 expression was increased in patients with an LVEF ≤ 50% (p = 0.032) with a lower LVEF correlating with higher ET1 expression (r = 0.377, p = 0.031). In patients with a change in LVEF of greater than 10%, greater ET1 expression was noted compared to those without a change in LVEF (p = 0.017). Increased ET1 expression in breast tumor tissue is associated with reduced LVEF. Future studies need to examine whether ET1 may be a tissue biomarker that helps predict the risk of developing CIC in women with breast cancer

Development of <i>Toxoplasma gondii</i> Calcium-Dependent Protein Kinase 1 (<i>Tg</i>CDPK1) Inhibitors with Potent Anti-<i>Toxoplasma</i> Activity

Toxoplasmosis is a disease of prominent health concern that is caused by the protozoan parasite <i>Toxoplasma gondii</i>. Proliferation of <i>T. gondii</i> is dependent on its ability to invade host cells, which is mediated in part by calcium-dependent protein kinase 1 (CDPK1). We have developed ATP competitive inhibitors of <i>Tg</i>CDPK1 that block invasion of parasites into host cells, preventing their proliferation. The presence of a unique glycine gatekeeper residue in <i>Tg</i>CDPK1 permits selective inhibition of the parasite enzyme over human kinases. These potent <i>Tg</i>CDPK1 inhibitors do not inhibit the growth of human cell lines and represent promising candidates as toxoplasmosis therapeutics

Potent and Selective Inhibitors of CDPK1 from <i>T. gondii</i> and <i>C. parvum</i> Based on a 5‑Aminopyrazole-4-carboxamide Scaffold

5-Aminopyrazole-4-carboxamide was used as an alternative scaffold to substitute for the pyrazolopyrimidine of a known “bumped kinase inhibitor” to create selective inhibitors of calcium-dependent protein kinase-1 from both <i>Toxoplasma gondii</i> and <i>Cryptosporidium parvum</i>. Compounds with low nanomolar inhibitory potencies against the target enzymes were obtained. The most selective inhibitors also exhibited submicromolar activities in <i>T. gondii</i> cell proliferation assays and were shown to be nontoxic to mammalian cells