Prediction of function in daily life following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain; a prospective study

Background: The prevalence of chronic musculoskeletal pain is high, with widespread negative economic, psychological, and social consequences for the individual. It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life. The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function, and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain. Methods: A prospective study was conducted among one hundred and forty three (N = 143) musculoskeletal pain patients. Measures of pain, function, and functional health status were obtained at baseline, after 5 weeks of intensive training, at the end of the 57-week rehabilitation programme, and at a 1 year follow-up, using validated self-administrated measures. Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain, individual- , and psychosocial factors in function. Results: The participants studied showed a significant increase in function during the 57 weeks rehabilitation period. There was also a significant increase in function from the end of the rehabilitation period (57th week) to the one year follow-up measures. Pain intensity associated significantly with pain experience over all measurement periods. High levels of pain intensity (β = .42**) and pain experience (β = .37*), and poor psychological capacity (β = -.68*) at baseline, as well as poor physiological capacity (β = -.44**) and high levels of anxiety (β = .48**) and depression (β = .58***) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods. Conclusion: The data suggest that physical capacity, emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life

Systematic review: conservative treatments for secondary lymphedema

<p>Abstract</p> <p>Background</p> <p>Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments.</p> <p>Methods</p> <p>We searched MEDLINE^®, EMBASE^®, Cochrane Central Register of Controlled Trials^®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups) that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies.</p> <p>Results</p> <p>Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (< 1% incidence) and mostly minor (e.g., headache, arm pain).</p> <p>Conclusions</p> <p>The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.</p

Geschlechtsunterschiede im Studienfortgang an der Medizinischen Universität Wien

The analysis of two freshmen's cohorts at the Medical University of Vienna consistently yielded four predictors for passing the first summative integrative exam (SIP1) at the end of the first study year: male sex, German mother tongue, good school performance, and high learning capacity. In particular the - against international trends - worse ratio of successful female students needs clarification.In this analysis of their further study progress we are able to show that a considerable number of those female students who did not succeed at first or second examination date and thus did not enter third semester immediately, show up in class schedules with at least one year's delay. While the other three predictors stay effective the large quantity of this group annihilates the initial sex-effect. We conclude that the loss of time results not from a lack of cognitive abilities but from a combination of SIP-specific demands and sex-specific learning behaviour. From our view, the splitting of the SIP into several small chapters could eliminate the disadvantage of female students.Die Untersuchung zweier Jahrgänge an StudienanfängerInnen der Medizinischen Universität Wien ergab übereinstimmend vier Prädiktoren für das Bestehen der ersten summativen integrativen Prüfung (SIP1) am Ende des ersten Studienjahres: männliches Geschlecht, deutsche Muttersprache, gute Schulleistungen, hohe Lernkapazität. Vor allem das schlechtere Abschneiden weiblicher Studierender bedarf angesichts der weltweit gegenläufigen Befunde einer Erklärung. Die vorliegende Untersuchung des weiteren Studienverlaufs zeigt nun, dass ein beträchtlicher Teil jener weiblichen Studierenden, die wegen Nichtbestehens der SIP1 nicht in das dritte Semester zugelassen wurden, mit einem Jahr Verlust wieder im Studium aufscheinen. Der Anteil dieser Gruppe ist so groß, dass der anfängliche Geschlechtseffekt egalisiert wird, während die anderen drei Prädiktoren unverändert bestehen bleiben. Wir kommen zu dem Schluss, dass der Zeitverlust weiblicher Studierender nicht durch den Mangel an kognitiven Fähigkeiten, sondern durch ein Zusammenspiel SIP-spezifischer Erfordernisse und geschlechtsspezifischen Lernverhaltens erklärt werden können. Mehrere Teilprüfungen an Stelle der SIP könnten aus unserer Sicht die Benachteiligung weiblicher Studierender beheben