Syömishäiriöpotilaiden ravitsemushoidon potilastyytyväisyyskysely – kehittäminen ja pilotointi

Tutkimuksen tavoitteena oli kehittää syömishäiriöpotilaiden ravitsemushoidon potilastyytyväisyyskysely,jota ravitsemusterapeutit voivat käyttää arvioidakseen ja kehittääkseen ravitsemushoidon laatua. Tutkimuksen tavoitteena oli myös selvittää potilastyytyväisyyskyselyn käytettävyyttä sekä syömishäiriöpotilaiden tyytyväisyyttä ravitsemushoitoon. Potilastyytyväisyyskysely kehitettiin hyödyntäen kirjallisuutta ja syömishäiriöpotilaita hoitavien ravitsemusterapeuttien (n=4) teemahaastatteluja, joissa löydettiin viisi syömishäiriön laadukkaan ravitsemushoidon järjestelyyn ja toteutukseen liittyvää osatekijää: hoidon järjestelyt, ravitsemusterapeutin valmiudet, ohjauksen asiasisältö, sen tunneulottuvuus ja toteutustapa. Kysymyslomake kattaa em. osatekijät ja sisältää yhteensä 32 suljettua ja kolme avointa kysymystä. Kyselylomakkeeseen vastasi 22 iältään 13–57-vuotiasta syömishäiriöpotilasta kahdeksasta eri terveydenhuollon yksiköstä eri puolelta Suomea. Enemmistö vastanneista oli naisia (91 %) ja sairasti laihuushäiriötä (68 %). Potilastyytyväisyyskyselyyn vastanneet syömishäiriöpotilaat olivat keskimäärin hyvin tyytyväisiä ravitsemusterapeutin toteuttamaan ravitsemushoitoon. Potilastyytyväisyyskyselyn toimivuuden arvioimiseksi kehitettiin käyttötyytyväisyyskysely, johon vastasi seitsemän ravitsemusterapeuttia ja 19 syömishäiriöpotilasta. Sekä ravitsemusterapeutit että potilaat pitivät tutkimuksessa kehitettyä potilastyytyväisyyskyselyä tärkeitä teemoja mittaavana ja kattavana. Tosin ravitsemusterapeutit kokivat kyselyn pituuden rajoittavan sen käytettävyyttä potilastyössä. Ravitsemusterapeuttien mielestä potilastyytyväisyyskysely olisi hyödyksi oman työn kehittämisessä ja he olisivat myös halukkaita käyttämään sitä työssään

Multiple psychological factors predict pain and disability among community-dwelling knee osteoarthritis patients : a five-year prospective study

Objective: To identify predictors of long-term pain and disability in knee osteoarthritis. Design: A longitudinal cohort study of five years. Setting: Primary care providers. Subjects: In all, 108 patients (mean age = 63.6 years, standard deviation (SD) = 7.2 years) with knee pain (> 40 mm on a 100 mm visual analogue scale in the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index pain scale) and radiographic grading (Kellgren-Lawrence: 2-4) of knee osteoarthritis who participated in a randomized controlled trial. Main measures: Disease-specific pain and functioning were assessed using the corresponding WOMAC subscales. Generic functioning was assessed by the RAND-36 subscales for function and physical and mental component summary scores. Possible baseline predictors for these outcomes were (1) demographic and disease-related variables and (2) psychological variables of mood (anxiety, depression), pain-related cognitions (pain self-efficacy, pain catastrophizing, kinesiophobia), and positive resource factors (life satisfaction, sense of coherence). Results: Multivariate linear mixed model analyses revealed that minimal anxiety at baseline predicted significantly better results for pain (WOMAC, P = 0.019) and function (WOMAC, P = 0.001, RAND-36 function P = 0.001). High pain self-efficacy predicted significantly better scores in RAND-36 function (P = 0.006), physical (P = 0.004) and mental (P = 0.001) component summaries. Pain catastrophizing predicted higher pain (P = 0.015), whereas fear of movement predicted poorer functioning in RAND-36 physical (P = 0.016) and mental (P = 0.009) component summaries. Those satisfied with life reported higher scores in RAND-36 function (P = 0.002) and mental component summary (P = 0.041). A low number of comorbidities predicted significantly better results in pain (WOMAC P = 0.019) and function (WOMAC P = 0.033, RAND-36 P = 0.009). Conclusion: Anxiety, pain-related cognitions, and psychological resources predict symptoms in knee osteoarthritis in the long term.Peer reviewe

Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: A two-year perspective

<p>Abstract</p> <p>Background</p> <p>Previous research has shown an association between preoperative depressive symptoms and a poorer surgery outcome in lumbar spinal stenosis (LSS). It is not known whether depressive symptoms throughout the recovery period are relevant to the outcome of surgery in LSS. In this prospective clinical study the predictive value of preoperative and postoperative depressive symptoms with respect to the surgery outcome is reported.</p> <p>Methods</p> <p>96 patients (mean age 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires preoperatively and 3 months, 6 months, 1 year and 2 years postoperatively. Depressive symptoms were assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability and VAS rating. Logistic regression analyses were used to examine the predictive value of preoperative and postoperative depressive symptoms regarding the surgery outcome. A "good" outcome was defined in two ways: first, by gaining a 30% improvement in relation to the preoperative disability and pain, and second, by having a score at or below the median value for disability and pain on 2-year follow-up.</p> <p>Results</p> <p>Having elevated depressive symptoms particularly on 3-month follow-up was predictive of a poorer surgery outcome regarding pain and disability: when the outcome was defined as less than 30% improvement from the baseline, the OR's (with 95% confidence intervals) were 2.94 (1.06-8.12), <0.05 for Oswestry and 3.33 (1.13-9.79), <0.05 for VAS. In median split approach the OR was 4.11 (1.27-13.32), <0.05 for Oswestry. Predictive associations also emerged between having depressive symptoms on 6-month and 1-year follow-ups and a poorer outcome regarding disability. The predictive value of elevated depressive symptoms particularly with respect to 2-yeard disability was evident whether the outcome was defined as a 30% improvement compared to the preoperative status or as belonging to the better scoring half of the study population on 2-year follow-up.</p> <p>Conclusions</p> <p>Preoperative and postoperative depressive symptoms may indicate those patients at greater risk of a poorer postoperative functional ability. For these patients, further clinical evaluation should be carried out, especially during postoperative stages.</p

Unemployment and ill health: a connection through inflammation?

<p>Abstract</p> <p>Background</p> <p>Unemployment is a source of acute and long-term psychosocial stress. Acute and chronic psychosocial stress can induce pronounced changes in human immune responses. In this study we tested our hypothesis that stress-induced low-grade tissue inflammation is more prevalent among the unemployed.</p> <p>Methods</p> <p>We determined the inflammatory status of 225 general population subjects below the general retirement age (65 years in Finland). Those who had levels of both interleukin-6 (≥ 0.97 pg/mL) and high-sensitivity C-reactive protein (≥ 1.49 mg/L) above the median were assessed to have an elevated inflammatory status (n = 72).</p> <p>Results</p> <p>An elevated inflammatory status was more common among the unemployed than among other study participants (59% versus 30%, p = 0.011). In the final multivariate model, those who were unemployed had over five-fold greater odds for having an elevated inflammatory status (OR 5.20, 95% CI 1.55-17.43, p = 0.008).</p> <p>Conclusion</p> <p>This preliminary finding suggests that stress-induced low-grade inflammation might be a link between unemployment and ill health.</p

Psychological well-being of lumbar spinal stenosis patients before and after surgical treatment

Surgical treatment of lumbar spinal stenosis (LSS) is a treatment option for those patients who remain severely symptomatic after a course of conservative treatment. Majority of the patients treated surgically enjoy good-to-excellent outcomes with respect to pain alleviation and functional recovery. However, between 20% and 40% of the patients who have surgery for LSS do not benefit from it. The knowledge of the psychological factors associated with recovery and treatment outcome is still scarce. The aim of this study was to assess LSS patients selected for surgical treatment. Specifically, the study assessed the prevalence of depression (Beck Depression Inventory, BDI) before surgical treatment and three months after the treatment. Also preoperative life satisfaction (four-item Life Satisfaction scale) of the LSS patients was studied. Furthermore, the patients satisfaction with surgery outcome at the three months postoperative stage was studied. One-fifth (20%) of the LSS-patients were found to have depression preoperatively. The patients assessments of the pain intensity or location were not associated with depression. The factors that did associate with depression were subjective disability of everyday living and poor life satisfaction. In addition to this, low sense of coherence and poor life satisfaction were associated with depression in logistic regression models. Significant associations were seen between preoperative depression and postoperative high disability scores, high symptom severity scores and higher pain intensity ratings. The patients with continuous depression (60% of the patients who had preoperative depression) showed less improvement in symptom severity, disability, pain and walking capacity than the patients who did not experience depression at any stage. In those patients who recovered from depression (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. One-fourth (25%) of the preoperative patients with LSS were found to be dissatisfied with life. The dissatisfied patients were significantly younger and had more self-reported somatic comorbidity. The dissatisfied patients had also elevated subjective disability scores and more extensive pain locations. Also lower coping resources and higher BDI scores were associated with life dissatisfaction. Younger age and somatic comorbidity were associated with life dissatisfaction in regression models. Two-thirds (66%) of the patients were at least clearly satisfied with the surgery outcome at three months postoperative stage. In group comparisons, the lack of physical, functional and emotional well-being was associated with the patients dissatisfaction with the surgery outcome. Younger age, postoperative symptom severity, disability and depression were independently associated with dissatisfaction with the surgery outcome. The results show that depression and psychological well-being are important factors with respect to LSS patients functional ability and recovery both before and three months after surgical treatment. Therefore, the clinical practice recommendations should include an assessment of depressionSelkäpotilaan masennus heikentää leikkaustulosta Masentuneet lannerangan ahtaumaa sairastavat potilaat eivät hyötyneet leikkaushoidosta yhtä hyvin kuin ne ahtaumapotilaat, joilla ei ollut masennusta tai jotka toipuivat masennusoireilusta. Tämä käy ilmi marraskuussa Helsingin yliopistossa tarkastettavasta psykologian väitöskirjatutkimuksesta, johon osallistui sata Kuopion yliopistollisessa sairaalassa leikattua lannerangan ahtaumaa sairastavaa potilasta. Tutkimuksessa todettiin, että kolmen kuukauden seurannassa ne potilaat, jotka eivät kärsineet masennusoireilusta, hyötyivät leikkauksesta, kun tulosta arvioitiin kivun vähenemisen ja toimintakyvyn parantumisen avulla. Ne potilaat, joiden masennusoireilu lievittyi seurannan aikana, raportoivat lähes yhtä hyvästä leikkauksen jälkeisestä toimintakyvyn kohenemisesta. Sen sijaan koko ajan masennusoireita poteneet potilaat raportoivat olennaisesti huonommasta leikkauksen jälkeisestä kiputilanteen ja toimintakyvyn kohenemisesta. Tulosten perusteella viidesosa lannerangan ahtaumaa sairastavista kärsi masennusoireista ennen leikkaushoitoa. Potilaiden masennusoireilu liittyi toimintakyvyn alenemaan, elämän hallitsemattomuuden ja merkityksettömyyden tunnelmaan sekä yleiseen tyytymättömyyteen elämään. Masennusoireilu ei ollut yhteydessä kipuoireilun intensiteettiin tai laaja-alaisuuteen. Yleisväestöön verrattuna masennusoireilun esiintyvyys lannerangan ahtaumapotilailla on lähes kolminkertainen, kun taas muita somaattisia sairauksia sairastavilla on todettu suunnilleen samansuuruista masennuksen esiintyvyyttä. Masennusoireilu jää usein tunnistamatta. Vain kaksi tutkimuspotilaista oli käyttänyt masennuslääkitystä. Suurin osa niistä potilaista, jotka olivat masentuneita ennen leikkausta, oli masentuneita myös leikkauksen jälkeen, joten masennuksesta ei toivuta ilman hoitoa. Mieliala ja psyykkinen hyvinvointi ovat tärkeitä tekijöitä lannerangan ahtaumapotilaiden toimintakyvyn ja kuntoutumisen kannalta. Näiden potilaiden masennusta tulisi arvioida nykyistä useammin, sillä masennusoireilun yhteydet huonompaan psyykkiseen hyvinvointiin ja alentuneeseen toimintakykyyn olivat todettavissa sekä ennen leikkaushoitoa että kolme kuukautta sen jälkeen

Depressive symptoms decrease health-related quality of life of patients with coronary artery disease and diabetes: a 12-month follow up study in primary care

AbstractObjective Health-related quality of life (HRQoL) is a multidimensional patient-related outcome. Less is known about the role of depressive symptoms on HRQoL in chronic diseases. This follow-up study analyzed depressive symptoms’ association with HRQoL change measured with 15D in patients with chronic diseases.Design and setting A total of 587 patients from the Siilinjärvi Health Center, Finland were followed up due to the treatment of hypertension (HA), coronary artery disease (CAD) or diabetes (DM). Depressive symptoms were based on Beck Depression Inventory (BDI) (BDI ≥10 =depressive symptoms). HRQoL was assessed at the baseline and after 12 months.Results There were 244 patients with HA (mean age 70 years, 59% women); 103 patients (72 years, 38%) with CAD and 240 with DM (67 years, 52%). The change from baseline to the 12-month follow-up in 15D was significantly different between patients without and with depressive symptoms in CAD (p < 0.001) and DM (p = 0.024). In CAD with depressive symptoms, the change was −0.064 (95% CI: −0.094 to −0.035) and in DM −0.018 (95% CI: −0.037 to 0.001). In the 15 HRQoL dimensions of 15D, a depressive symptoms-related decrease was found in three dimensions with HA, in 9 with CAD and in 7 with DM. As a function of the BDI at baseline, the 15D score decreased significantly among patients with CAD and DM.Conclusions Depressive symptoms impact negatively on future HRQoL among primary care patients with coronary artery disease and diabetes emphasizing that mood should be acknowledged in their care and follow-up.Trial registration Clinical Trials registration number: NCT02992431, registered December 14th 201