Services and Interventions for People who are Homeless with Companion Animals (Pets)

Background: Many people who are homeless own a companion animal (a ‘pet’). Pet ownership has positive impacts on health and wellbeing. However, for people who are homeless, pet ownership also creates multiple challenges and may be a barrier to exiting homelessness. This systematic review will identify the types, and outcomes, of services and interventions to support people who are homeless with pets.  Methods/Design: This review will be conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches will be undertaken on five databases. Combinations of search terms and subject headings or index terms will be used. Citation chaining and citation tracking will also be undertaken. Literature will be screened for relevance in a two-step process. Each study will be quality assessed using an evidence-based tool relevant to its methods. Relevant data will be extracted and synthesised using a meta-analytic, or narrative, approach. Discussion: This review will address an identified gap in the knowledge about the types, and outcomes, of services/interventions for people who are homeless with pets. The results may increase recognition about the importance of protecting and promoting the relationship between people who are homeless and their pets, and inform future work

Whiplash patients' responses on the impact of events scale-R - congruent with pain or PTSD symptoms?

Post-traumatic stress disorder (PTSD) symptoms are common among people with whiplash following a motor vehicle crash. The Impact of Events Scale - Revised (IES-R) screens for PTSD symptoms with psychologist referral recommended for above-threshold scores. Recent data indicate that PTSD symptoms post-whiplash may relate more to pain and disability than the crash itself. This study explored the interpretation of IES-R items by people with whiplash to establish whether responses relate to the crash or to whiplash pain and disability.Adults with whiplash scoring >24 on the IES-R were eligible. The Three-Step Test-Interview technique was used and responses analysed using content analysis. A coding framework was developed, comprising five categories: "congruent" - responses related to the crash; "incongruent" - responses did not relate to the crash; "ambiguous" - responses were both congruent and incongruent; "confusion" - participants misunderstood the item content; "not applicable" - irrelevancy of items to participants' circumstances.The 15 participants (mean IES-R= 37/88) were inclined to respond congruently to specific PTSD items and incongruently to non-specific PTSD items. Participants were more inclined to rate non-specific PTSD items in terms of pain and disability, e.g., >60% responded incongruently to item 2: "I had trouble staying asleep"; item 4: 'I felt irritable and angry"; item 15: "I had trouble falling asleep"; and item 18: "I had trouble concentrating".Incongruent responses on non-specific PTSD items may inadvertently inflate levels of PTSD symptoms measured with the IES-R for some whiplash patients, raising implications for the assessment and treatment of the psychological sequelae of whiplash

Information needs of patients with whiplash associated disorders: a Delphi study of patient beliefs

Whiplash associated disorders (WAD) result in significant personal and economic costs. Patient education and reassurance are recommended treatments for acute WAD but the information needs of patients have not been investigated.To determine what information whiplash-injured patients believe is important to help recovery in the acute stage of injury.A Delphi design survey series with three rounds.Thirty-three participants who had sustained a whiplash injury within the last three years were invited to participate. Participants were asked to provide five statements, in response to an open-ended question, regarding what they believed was the most important information to provide to patients following a whiplash injury. Nineteen patients responded and 85 statements were collected and reviewed independently by two of the authors to remove duplicates. The importance of the remaining items was rated by the participants in the second survey round. Items rated by >50% of participants as important were included in the third survey round. To be deemed key information, >80% of participants had to rate an item as important in this final round.Eighteen items met the criteria for key information. These points addressed four areas: assessment and treatment, recovery and symptoms, patient attitudes during treatment and relationships with health practitioners.The key information points endorsed by patients in this study may provide useful information to constitute a basis for reassurance and education provided to patients with WAD. The results also suggest that improved relationships between patients with whiplash and health practitioners is required

What information do patients need following a whiplash injury? The perspectives of patients and physiotherapists

Purpose: The aims of the present study were to identify information that individuals with whiplash associated disorders (WAD) need to know in the early stages of recovery and to establish whether there is a difference between what physiotherapists and whiplash-injured patients perceive as important information.Method: Forty-one participants were recruited (20 whiplash-injured patients, 21 physiotherapists). Participants were asked to provide five statements to one open-ended question about what they believe is the most important information individuals with WAD need to know in the early stages of recovery. Participants provided 182 statements which were reviewed independently and organised into themes by two of the authors.Results: Six key themes emerged from the statements. These included general information about whiplash injury, treatment and recovery, reassurance, provision of poor information and patients' interaction with general practitioners, maintaining daily activities, and compensation claims and litigation. Both patients and physiotherapists agreed on the type of general whiplash information that should be provided however, major differences were found with regard to information pertaining to compensation claims and litigation and maintaining daily activities.Conclusions: The findings of this study provide some insight into the type of information that WAD individuals require in the early stages of recovery.IMPLICATIONS FOR REHABILITATIONThe provision of reassurance can be an effective communication tool to decrease patients concerns about their injury and help strengthen the patient-health practitioner relationship.Although clinical guidelines for the management of whiplash injuries recommend that individuals must remain physically active post-injury, statements from the patient group indicate that this information is not always provided and clearly explained to patients.Keeping in line with the patient centred care approach of being responsive to patient needs and values, it is essential for health practitioners to be attentive to patients' preferences regarding the level of participation in treatment decisions.Processes need to be developed to deliver individuals with WAD accurate information regarding compensation claims so that these factors do not distract from focusing on recovery

The capacity for health promotion survey

Objective: The objective was to develop and examine the psychometric properties of the Capacity for Health Promotion Survey designed to assess the practice of health promotion in the area of severe mental illness. Method: Seven hundred and eighty-five health professionals in Queensland, Australia, completed the survey. A principal component analysis was used to assess the factor structure of the scale and investigations of internal consistency, interitem correlation and item-discriminant validity were conducted to establish the reliability and validity of the survey. Results: The final survey is a 22-item scale comprising five subscales: Beliefs about Behavior Change, Intention to Promote Health, Health Promotion Skills, Effectiveness of Health Promotion and Health Promoting Norms. The survey demonstrated satisfactory internal consistency for the five subscales. Items were more strongly correlated within their own subscales than with other subscales, providing evidence of discriminant validity. Conclusion: The Capacity for Health Promotion Survey is a psychometrically sound measure to assess the practice of health promotion in the area of severe mental illness

Investigating the fear avoidance model in people with whiplash the association between fear of movement and in vivo activity

Objectives: The aims of this study were to examine the relationship between fear of movement and activity levels in people with whiplash-associated disorders (WAD) over the first 3 months postinjury, to determine the mediating effect of: fear of movement on the relationship between catastrophizing and activity levels, and activity levels on the relationship between fear of movement and disability in patients with WAD. Materials and Methods: Ambulatory monitoring of physical activity was conducted for a minimum of 8 waking hours on 2 consecutive days within 4 weeks postinjury and at 12 weeks postinjury for 103 (74 female) people with WAD. Time spent in upright postures (uptime) and time in motion (TIM) were collected along with measures of pain, disability, pain catastrophizing, and fear of movement. The association of self-report outcome measures with uptime and TIM were examined. Mediation analyses were performed to determine the mediating effect of: fear of movement on the relationship between catastrophizing and activity, and activity levels on the relationship between fear of movement and disability. Results: Fear of movement was significantly related to uptime but not TIM. Mediation analyses showed that the relationship between fear of movement and disability was not mediated by activity levels, and that the relationship between catastrophizing and activity levels was not mediated by fear of movement. Discussion: Our data suggests measures of Fear Avoidance Model are not related to general physical activity in people with WAD. Investigation of movements specific to the cervical spine and alternative explanatory models may be required

Attachment insecurity as a vulnerability factor in the development of chronic whiplash associated disorder – a prospective cohort study

Objectives: Attachment theory represents a dynamic model for understanding how pre-existing personality factors may contribute to the development of chronic pain and disability after whiplash injury. The aim of the present study was to investigate the impact of attachment insecurity on disability 6-months post-injury. It was hypothesized that: (1) levels of attachment insecurity assessed at baseline would predict levels of disability six months post-injury, and (2) both attachment dimensions (anxiety and avoidance) would moderate associations between pain and disability, and psychological distress and disability. Methods: Questionnaire data were collected consecutively from a 1-year cohort of whiplash-injured. Data were collected from the emergency room within 1-month post-injury and at follow up 6-months post-injury (n = 205). Results: Both attachment dimensions were significantly associated with physical and psychosocial disability. Moreover, when attachment avoidance and attachment axiety were at the mean value (0SD) and high (+1SD), there was a significant positive relationship between pain intensity and disability (physical and psychosocial), with the exception of attachment anxiety, that only moderated the association between pain intensity and psychosocial disability when high. Also, when attachment avoidance and attachment axiety were high there was a significant positive relationship between depression and disability. Finally, when attachment avoidance was at the mean level and high there was a significant positive relationship between pain-catastrophizing and psychosocial disability. Conclusion: Although the effects sizes for the moderations were small, the results support claims that attachment insecurity, measurable before onset of injury, represents a valuable pre-trauma vulnerability for less optimal recovery after whiplash injury

A qualitative comparison of reassurance approaches used by physical therapists to address fears and concerns of patients with nonspecific neck pain and whiplash associated disorders: an online survey

The study aimed 1) to identify and compare what physical therapists perceive to be the main concerns, fears, and worries that patients with WAD and NTNP have as a result of their condition and 2) to identify and compare the strategies used by physical therapists to address these fears and concerns.Using convenience sampling, 30 physical therapists completed 2 online open-ended surveys. The responses were analysed using 2 descriptive analytic methods (thematic analysis and constant comparative analysis) and then themes were examined for areas of convergence and divergence.Four similar themes for both neck pain groups were produced from our analysis of the survey responses: 1) interference with daily life, 2) concerns related to pain, 3) psychological distress, and 4) When I will recover? Subthemes differed between the groups. For example, the theme "psychological distress" had subthemes of anger and thoughts about no resolution for the WAD group, whereas, for the NTNP group, subthemes were anxiety and uncertainty. The only divergent theme was (5) fear-avoidance, present in the NTNP group only. Analysis of physical therapist strategies identified 3 consistent themes and 5 divergent themes across the 2 groups.Physical therapists described a wealth of reassurance strategies for individuals with NTNP and WAD. There were several shared themes but also some discordant ones. Reassurance is multifactorial and needs to be nuanced and not prescriptive.Impact Statement.These qualitative findings may be key to inform the differentiated content of training programs for physical therapists delivering reassurance for these 2 populations

A Systematic review and meta-analysis of the effectiveness of psychological interventions delivered by physiotherapists on pain, disability and psychological outcomes in musculoskeletal pain conditions

This systematic review and meta-analysis examined the effectiveness of physiotherapist delivered psychological interventions combined with physiotherapy on pain, disability and psychological outcomes for patients with musculoskeletal pain conditions.The review was conducted in accordance with the (PRISMA) guidelines. Five databases were systematically searched for randomised controlled trials from inception to May 2016. Studies were required to compare a psychological intervention delivered by physiotherapists combined with physiotherapy to physiotherapy alone or usual care. Physiotherapists delivering the interventions must have undergone training by a psychologist or a health professional trained in the delivery of psychological interventions.34 articles met the eligibility criteria, of those, 30 were suitable for meta-analysis. There was low to high quality evidence that physiotherapist delivered psychological intervention combined with physiotherapy decreased pain in the short (26 studies, MD=-0.37; 95% [CI], -0.65 to -0.09) and long term (22 studies, MD=-0.38; 95% [CI], -0.67 to -0.10) and decreased disability in the short term (29 studies, SMD=-0.14; 95% [CI], -0.26 to -0.01). Effect sizes were small. Low to high quality evidence demonstrated small to medium effects for some psychological outcomes at short and long term follow-ups.The results indicate that psychological interventions delivered by physiotherapist show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions

A comparison of perceptions of reassurance in patients with nontraumatic neck pain and whiplash-associated disorders in consultations with primary care practitioners—an online survey

Neck pain remains highly prevalent and costly worldwide. Although reassurance has been recommended as a first line of treatment, specific advice on the best ways to provide reassurance has not been provided due to lack of evidence. Pain symptoms and experiences differ between patients with whiplash-associated disorder (WAD) and those with nontraumatic neck pain (NTNP). The aims of this study were to 1) identify and compare the concerns, fears, and worries of patients with WAD and NTNP; and 2) determine if patients believe their concerns are addressed by primary care providers.These questions were investigated through an online survey, with a convenience sample of 30 participants with NTNP and 20 with WAD.A thematic analysis of survey responses resulted in the following seven themes related to common concerns, and two regarding how well concerns were addressed. Common concerns expressed by both groups shared four themes: 1) further structural damage, 2) psychological distress, 3) concerns about the future, and 4) hardships that eventuate. Theme 5), pain/disability is long term, was specific to WAD. Themes 6), pain is current or reoccurring, and 7), interference with daily life, were specific to NTNP. Regarding how well patient concerns were addressed, two overarching themes were common to both conditions: 1) concerns were addressed, with both groups sharing the subthemes "successful treatment," "reassurance," and "trust"; and 2) concerns were not addressed, where all subthemes were shared with the exception of two unique to NTNP.This detailed comparison provides information about neck pain patients' concerns and fears, while providing health practitioners support for selecting strategies to promote reassurance appropriately for individual patient needs. Our findings from patients' perspectives enhance the understanding for providing reassurance for neck pain as proposed by our analysis