A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home: and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional Outcome in real life settings

The relationship between approach to activity engagement, specific aspects of physical function, and pain duration in chronic pain

Objectives:To examine: (1) the relationships between habitual approach to activity engagement and specific aspects of physical functioning in chronic pain; and (2) whether or not these relationships differ according to pain duration.Materials and Methods:Outpatients (N=169) with generalized chronic pain completed a set of written questionnaires. Categories of approach to activity engagement were created using the confronting and avoidance subscales of the Pain and Activity Relations Questionnaire. An interaction term between approach to activity engagement categories and pain duration was entered into analysis with age, sex, pain intensity, the categorical approach to activity engagement variable, and pain duration, in 9 ordinal regression models investigating functioning in a variety of daily activities.Results:The approach to activity engagement category predicted the personal care, lifting, sleeping, social life, and traveling aspects of physical functioning but, interestingly, not the performance skills used during these activities, that is, walking, sitting, and standing. The interaction term was significant in 2 models; however, the effect of pain duration on associations was the inverse of that theorized, with the relationship between variables becoming less pronounced with increasing duration of pain.Discussion:The results of this study do not support the commonly held notion that avoidance and/or overactivity behavior leads to deconditioning and reduced physical capacity over time. Findings do, however, suggest that a relationship exists between avoidance and/or overactivity behavior and reduced participation in activities. Implications for the clinical management of chronic pain and directions for further research are discussed

Associations among gender, coping patterns and functioning for individuals with chronic pain: a systematic review

BACKGROUND: Developing strategies for coping with chronic pain is an integral part of successfully living with this often debilitating health condition. While gender differences in pain coping strategies have long been investigated, the relationship between gender-specific engagement in coping and associated functioning in individuals experiencing chronic pain is yet to be clearly understood

A randomized controlled trial of prospective memory rehabilitation in adults with traumatic brain injury

Objective: To examine the efficacy of compensatory prospective memory training, preceded by self-awareness training for adults with traumatic brain injury

The trial is owned by the team, not by an individual:A qualitative study exploring the role of teamwork in recruitment to randomised controlled trials in surgical oncology

BACKGROUND: Challenges exist in recruitment to trials involving interventions delivered by different clinical specialties. Collaboration is required between clinical specialty and research teams. The aim of this study was to explore how teamwork influences recruitment to a multicentre randomised controlled trial (RCT) involving interventions delivered by different clinical specialties. METHODS: Semi-structured interviews were conducted in three centres with a purposeful sample of members of the surgical, oncology and research teams recruiting to a feasibility RCT comparing definitive chemoradiotherapy with chemoradiotherapy and surgery for oesophageal squamous cell carcinoma. Interviews explored factors known to influence healthcare team effectiveness and were audio-recorded and thematically analysed. Sampling, data collection and analysis were undertaken iteratively and concurrently. RESULTS: Twenty-one interviews were conducted. Factors that influenced how team working impacted upon trial recruitment were centred on: (1) the multidisciplinary team (MDT) meeting, (2) leadership of the trial, and (3) the recruitment process. The weekly MDT meeting was reported as central to successful recruitment and formed the focus for creating a ‘study team’, bringing together clinical and research teams. Shared study leadership positively influenced healthcare professionals’ willingness to participate. Interviewees perceived their clinical colleagues to have strong treatment preferences which led to scepticism regarding whether the treatments were being described to patients in a balanced manner. CONCLUSIONS: This study has highlighted a number of aspects of team functioning that are important for recruitment to RCTs that span different clinical specialties. Understanding these issues will aid the production of guidance on team-relevant issues that should be considered in trial management and the development of interventions that will facilitate teamwork and improve recruitment to these challenging RCTs. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN): ISRCTN89052791

Perceptions of Feedback among Undergraduate and Postgraduate Students of Four Health Science Disciplines

Feedback is an important support for student learning. Yet data suggests that some students are often under-whelmed with the feedback they receive. Two factors potentially influencing this perception are entry level and type of health science program. To investigate this further, 492 undergraduate and postgraduate students from four health science disciplines (occupational therapy, physiotherapy, speech pathology and audiology) at a large Australian university were asked to complete a survey on the feedback that they had received during their studies. Students reported that they valued feedback with 93% seriously engaging with their feedback and 88% considering that feedback assisted their learning. However, different perceptions on some areas of feedback were reported by different groups. Postgraduate students had significantly (p\u3c 0.01 to 0.0005) higher satisfaction with several aspects of feedback than undergraduate students, while audiology students reported significantly (p\u3c 0.05 to 0.0001) higher satisfaction levels than the other disciplinary groups. Fifty-eight percent of the students felt that feedback would be improved if it was more timely and if there was more of it, particularly in practical classes (55%). Methods of improving the feedback provided to these students are discussed

Perceptions of Assessment Among Undergraduate and Postgraduate Students of Four Health Science Disciplines

The use of different types of assessment to improve student learning needs to be balanced with reports that student perception, rather than the objective features of the task, significantly influences how students approach learning. The present study surveyed 492 undergraduate and postgraduate students from four health science disciplines (occupational therapy, physiotherapy, speech pathology, and audiology) at a large Australian university on how helpful different types of assessment had been in assisting their learning. Between 73.4% and 90.4% of the students valued practical exams, individual tasks, written assignments, and written exams requiring application of knowledge. Between 29.1% and 59.7% of the students valued oral presentations, group tasks, portfolios, online assessment, and multiple choice exams. Entry level and type of program were found to influence perceptions. Postgraduate students valued tutorial participation more than undergraduate students (

Overactivity: is it a valid construct?

Overactivity is a frequently used term in chronic pain literature. It refers to the phenomenon whereby individuals engage in activity in a way that significantly exacerbates pain, resulting in periods of incapacity. Overactivity, as a construct, has been derived solely from patients’ self-reports, raising concerns about the legitimacy of the construct. Self-reported overactivity reflects an individual’s belief, collected retrospectively, that their earlier activity levels have resulted in increased levels of pain. This may be different to an individual actually engaging in activity in a way that significantly exacerbates pain. In the present study, a five-day observational study design was employed to investigate the validity of overactivity as a construct by examining the relationship between a self-report measure of overactivity, patterns of pain, and objectively measured physical activity over time. A sample of 68 adults with chronic pain completed a questionnaire investigating self-reported habitual engagement in overactivity and activity avoidance behaviour, before commencing five days of data collection. Over the five-day period participants wore an activity monitor, and recorded their pain intensity six times a day using a handheld computer. Associations were found between: 1) high levels of pain and both high overactivity and high avoidance, 2) high levels of overactivity and more variation in pain and objective activity across days, and 3) high levels of overactivity and the reoccurrence of prolonged activity engagement followed by significant pain increases observed in data sets. These results offer some preliminary support for the validity of overactivity as a legitimate construct in chronic pain