Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain

BACKGROUND: The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity. METHOD: The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design. RESULTS: Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative. CONCLUSION: Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience

Critical Reflections on the Physiotherapy Profession in Canada

A rethinking of scope of practice, patient access, accountability and payment is coming to bear on healthcare systems around the world . . . We must be ready to meet these changes and effect a positive outcome for our patients and our profession. —Michel Landry, President, Canadian Physiotherapy Association (2007–2009)1 Physiotherapists are faced with a number of unprecedented opportunities and challenges that require new ways of thinking about and practising physiotherapy. Significant among these is legislation recently tabled in Ontario that will enable physiotherapists to order tests such as x-rays and to diagnose patient conditions that are within the profession’s scope of practice. This expansion of scope follows closely on the heels of progressive changes to physiotherapy (PT) in Canada and other countries, including the move to entry-level master’s and doctoral training programmes, increasing privatization of PT services, licensure of alternative practitioners, and health workforce reform. Because of the current global economic crisis, federal budgets are being tightened; in Canada, this has implications for transfer payments to provinces and for alterations to the funding of PT services. Collectively, these changes signal profound shifts that are underway for PT as our profession continues to evolve in response to social, political, and economic influences. In order to respond, we argue, it is crucial for PT to engage in rigorous critical reflection on the theoretical basis of physiotherapy practice. As we outline below, critical reflection will assist us in further developing the foundations of PT, opening up new opportunities for growth and change in PT practice, research, and education.No abstract