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Longitudinal changes in functioning and disability in patients with disorders of consciousness: the importance of environmental factors.

ABSTRACT: Disorders of consciousness are neurological conditions associated with low levels of functioning which pose a serious challenge to public health systems. The current study aimed to examine longitudinal changes in functioning in patients with disorders of consciousness and to identify associated biopsychosocial factors using the International Classification of Functioning, Disability, and Health. An Italian sample of 248 patients was assessed longitudinally. Differences in relative variability (an index of change that controls for baseline levels) between acute and chronic patients and predictors of relative variability in "Activities & Participation" were examined. Results showed that there were subgroups of patients whose functioning improved over time. The number of problems in "Activities & Participation" decreased in acute patients over time, whereas in chronic patients, an increase was found. The significant difference in relative variability for the environmental factor "support and relationships" reflects the increase in facilitators in acute patients, whereas the number of facilitators in chronic patients remained unchanged over time. Age at event, time from event, and relative variability in "Environmental Factors" were significant predictors of relative variability in "Activities & Participation". It is of clinical relevance that patients with disorders of consciousness are kept in a supportive and facilitative environment, in order to prevent a decline in their functioning. Moreover, caregivers should receive tailored support in order to enhance and facilitate appropriate care of patients with disorders of consciousness.

SUBMITTER: Willems M

PROVIDER: S-EPMC4410211 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Longitudinal changes in functioning and disability in patients with disorders of consciousness: the importance of environmental factors.

Willems Michelle M Sattin Davide D Vingerhoets Ad J J M AJ Leonardi Matilde M

International journal of environmental research and public health 20150401 4

Disorders of consciousness are neurological conditions associated with low levels of functioning which pose a serious challenge to public health systems. The current study aimed to examine longitudinal changes in functioning in patients with disorders of consciousness and to identify associated biopsychosocial factors using the International Classification of Functioning, Disability, and Health. An Italian sample of 248 patients was assessed longitudinally. Differences in relative variability (a ...[more]

PMID: 25837348

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Project description:ObjectivesTo identify psychological covariates of longitudinal changes in back-related disability in patients undergoing acupuncture.Materials and methodsA longitudinal postal questionnaire study was conducted with data collection at baseline (pretreatment), 2 weeks, 3, and 6 months later. A total of 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from 4 theories (fear-avoidance model, common-sense model, expectancy theory, social-cognitive theory), clinical and sociodemographic characteristics, and disability. Longitudinal multilevel models were constructed with disability over time as the outcome.ResultsWithin individuals, reductions in disability (compared with the person's individual mean) were associated with reductions in: fear-avoidance beliefs about physical activity (?=0.11, P<0.01) and work (?=0.03, P<0.05), catastrophizing (?=0.28, P<0.05), consequences (?=0.28, P<0.01), concerns (?=0.17, P<0.05), emotions (?=0.16, P<0.05), and pain identity (?=0.43, P<0.01). Within-person reductions in disability were associated with increases in: personal control (?=-0.17, P<0.01), comprehension (?=-0.11, P<0.05) and self-efficacy for coping (?=-0.04, P<0.01). Between individuals, people who were less disabled had weaker fear-avoidance beliefs about physical activity (?=0.12, P<0.01), had more self-efficacy for coping (?=-0.07, P<0.01), perceived less severe consequences of back pain (?=0.87, P<0.01), had more positive outcome expectancies (?=-0.30, P<0.05), and appraised acupuncture appointments as less convenient (?=0.92, P<0.05).DiscussionIllness perceptions and, to a lesser extent, self-efficacy and expectancies can usefully supplement variables from the fear-avoidance model in theorizing pain-related disability. Positive changes in patients' beliefs about back pain might underpin the large nonspecific effects of acupuncture seen in trials and could be targeted clinically.

Dataset Information

Longitudinal changes in functioning and disability in patients with disorders of consciousness: the importance of environmental factors.

Publications

Longitudinal changes in functioning and disability in patients with disorders of consciousness: the importance of environmental factors.

Similar Datasets

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