UT Southwestern School of Health Professions

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Welcome to the UT Southwestern School of Health Profession’s electronic theses and dissertations (ETD) collection. (Note: The school was previously named the UT Southwestern School of Allied Health Sciences.)

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Now showing 1 - 20 of 68

Ability of the Pain Disability Questionnaire in Predicting Healthcare Utilization
(2014-09-01) Rankin, McKenna Blair; Gatchel, Robert J.; Noe, Carl; Robinson, Richard C.
BACKGROUND: Chronic pain is one of the most expensive and prevalent healthcare problems in the United States. It affects not only the individual but also society as a whole. The Biopsychosocial Model of chronic pain is the standard model for understanding and treating the pain experience. As such, it is important to have accurate ways of predicting healthcare outcomes for the chronic pain population. Prior research has evaluated the predictive abilities of health outcome measures and healthcare utilization. However, only one study to our knowledge has evaluated the Pain Disability Questionnaire’s (PDQ) ability to predict healthcare utilization. SUBJECTS: The current study consisted of 50 [Mage = 54.76 (12.41) years] adult patients diagnosed with chronic pain who completed an interdisciplinary treatment program at the Eugene McDermott Center for Pain Management. METHOD: The PDQ was administered at baseline and total health care cost was obtained at three-month follow-up. Participants were placed in either the high or low health care cost group depending on how they compared to a national average estimate for chronic pain patients. Logistic and linear regression modeling, as well as receiver operator characteristic analyses were used to evaluate the predictive ability of the PDQ in determining healthcare utilization cost at a three-month follow-up time point. RESULTS: The logistic regression analysis indicated the PDQ accurately placed participants in the respective high or low healthcare cost group [X2 (1) = 10.67, p < .001]. Receiver operator characteristic analysis yielded an area under the curve of .76. A PDQ cutoff score of 96 produced the optimal sensitivity (.70) and specificity (.67) for determining whether patients fall in the high or low healthcare cost group. The linear regression established that PDQ scores at baseline statistically significantly predicted total healthcare utilization at three months following the end of their treatment program, where higher PDQ scores were related to higher healthcare cost [F (1, 48) = 11.41, p = .001]. DISCUSSION: These findings offer support for the use of the PDQ in predicting healthcare cost. Use of the PDQ in this context may help clinicians, caregivers, and patients in planning the cost of the chronic pain sufferers’ treatment. Knowing what to expect financially could help increase the patient’s quality of life.
Adapting Behavioral Interventions to Better Support Alzheimer's Disease and Lewy Body Dementia Care Partners Based on Their Unique Needs and Differences
(2021-12-16) Kew, Chung Lin; Krumwiede, Kimberly Hoggatt; Juengst, Shannon B.; Osborne, Candice L.; Tzen, Yi-Ting; Kelley, Brendan; Smith, Scott Alan
Care partners of individuals with Alzheimer's disease (AD) and Lewy body dementia (LBD) are typically family members or friends. They often experience physical and psychological strain associated with caregiving. Hence, the long-term goal is to improve the physical and psychological health and well-being of care partners of individuals with AD and LBD through the provision of a self-management intervention, problem-solving training (PST). To achieve this goal, the following gap in literature has to be addressed. Firstly, although AD and LBD have different symptom presentations, little is known about challenges specific to LBD care partners and how these challenges differ between AD and LBD care partners. Next, research to date has yet to identify specific care partner characteristics that could impact uptake and outcomes of behavioral interventions that promote self-management, like PST. Therefore, this (ORBIT model Phase I) study aims to (1) identify differences between the challenges faced by care partners of AD and LBD patients to support the transferability of care partner interventions to all care partners, and (2) identify whether PST needs to be adapted (i.e., optimized) to account for unique individual differences that may affect how much a person benefits from the intervention. Results of both these aims will provide a concrete understanding of both AD and LBD care partner experiences and specific care partner characteristics and intervention components that could impact how we can better support care partners.
ADHD and Medical Correlates of Bullying of Pediatric Neurofibromatosis Patients
(2016-08-25) Patel, Sarita; Holland, Alice A.; Faith, Melissa A.; Silver, Cheryl H.
Neurofibromatosis Type 1 (NF1) is an autosomal dominant disorder that involves nervous system tumor growth, and it is one of the most frequently occurring genetic disorders. NF1 is a multisystem disease with a complex phenotype. Given the range in severity of presentation in NF1, research has shown that disease severity could impact children's social-emotional functioning. Physical deformities such as tumor growth often are associated with NF1, and as a result, children and adolescents with NF1 may be at greater risk for being victims of bullying by peers. Children with NF1 also tend to have higher rates of Attention-Deficit/Hyperactivity Disorder (ADHD) as compared to children without NF1 (Barton & North, 2004; Martin et al., 2012). Common issues experienced by children with ADHD, such as social immaturity and behavioral dysregulation, may put them at higher risk for both bullying and peer victimization (Wiener & Mak, 2009; Unnever & Cornell, 2003). Overall, the current study found that parentreported ADHD symptoms predicted parent-reported but not self-reported bullying. Furthermore, the current study found that parent-reported ADHD symptoms were more predictive of being bullied than provider-rated severity of physical deformity. Since the present study was the first to examine whether physical appearance and ADHD symptoms may be associated with bullying in children with NF1, the novel information gained from the study may be used to direct future research, educate parents and teachers, and inform the development of interventions specific to the NF1 population.
ADHD Subtypes and the Convergent Validity of the Brief Three-Factor Approach and D-KEFS Color-Word Interference Test
(2014-05-02) Oasay, Larry M. K.; Silver, Cheryl H.; Glasier, Paul; Stavinoha, Peter L.
Deficits in executive functioning (EF) often translate to significant impairment in real-life situations. EF can be assessed by performance-based tests or through the use of behavior ratings; however, most research has found little to no associations between performance-based EF tests and parent ratings. ADHD is a neurodevelopmental disorder characterized by EF deficits, but some studies have found differences on EF measures between subtypes of ADHD. The first aim of this study is to examine the convergent validity between the D-KEFS CWIT, a performance-based EF task, and the recently revised three-factor BRIEF. The second aim of this study is to examine whether there are differences between ADHD-I and ADHD-HI/C subtypes on either of these EF measures. A sample of 49 children with ADHD, aged 6 to 12 years, were administered the D-KEFS CWIT and their parents were given the BRIEF to complete. No significant correlations between Condition 3 of the CWIT and the new Self-Monitor and Inhibit subdomains of the BRIEF were obtained, but the Shift subdomain of the BRIEF significantly correlated with Condition 3. Participants with ADHD-HI/C were rated by parents as having greater executive dysfunction compared to participants with ADHD-I. No significant differences between subtypes were observed on the CWIT after controlling for symptoms of inattention. It would be beneficial to continue developing EF measures with the goal of greater convergent validity between performance-based and informant-report measures. Also, more research should be conducted in identifying differences between ADHD subtypes in their EF profiles as it can potentially aid in improving evaluation and treatment of this disorder.
Adherence as a Mediating Variable Between Depression and Health Outcomes in Adolescents with Type 1 Diabetes
(2013-12-30) Wolfe, Kristin Linette; Wiebe, Deborah J.; Kennard, Beth D.; Germann, Julie
Adolescence is often a time of diabetes mismanagement and poor metabolic control in adolescents with type 1 diabetes. Symptoms of depression are related to poor metabolic control, but the mechanism that links them is under debate. Because depression tends to be associated with poorer adherence and poor adherence has been shown to be related to poor metabolic control, it is possible that adherence serves as a mediator between the two. The present study tested this mediation pathway in a sample of adolescents with type 1 diabetes. Participants (N=252) were recruited from endocrinology clinics in Utah during their routine diabetes clinic visits. Participants fell between the ages of 10 and 14, were able to read and write in either English or Spanish, had a diagnosis of type 1 diabetes for at least one year, and did not have a condition that would interfere with measurement completion. Participants were drawn from a larger longitudinal observational study. This study analyzed the first three time points of data, which were obtained six months apart. Demographic and illness information was obtained from self-report and participant medical files. Questionnaires were used to assess depression and adherence. Metabolic control was measured through HbA1c levels retrieved from medical records. Data were analyzed to test the mediation hypotheses. Higher levels of depression were correlated with poorer metabolic control in cross-sectional analyses at study entry, and in longitudinal analyses measured one year later. Adherence was found to be a partial mediator in cross-sectional analyses, but did not mediate changes in metabolic control across time.
Analysis of Practice Effects Across Cognitive Domains in Mild Cognitive Impairment
(2014-09-01) Rao, Shruthi; Lacritz, Laura; Cullum, C. Munro; Martin-Cook, Kristin
Serial assessments provide clinically useful information about progression of a disease. Since individuals with mild cognitive impairment are less likely to show decline in cognitive areas other than memory, it is important to analyze which domains are more susceptible to practice effects than others. The appearance of practice effects in serial assessments is a common challenge for clinicians interpreting neuropsychological tests. Detecting true change can be altered by factors such as test intervals, standardization procedures, alternate forms, respondent characteristics, and cognitive domains impaired in a clinical population. Some cognitive domains such as learning, memory, and executive functioning are known to be more susceptible to practice effects than others such as processing speed, attention, and language. Normal adults are also shown to have greater practice effects over multiple exposures than disease populations. The review supports the claim that healthy adult individuals are more likely to improve and show greater practice effects during serial assessments than clinical populations. In patients with mild cognitive impairment (MCI), domains that rely on recall and learning test rules like learning, memory, and executive functioning tend to be more susceptible to practice effects than crystallized and skill - based domains such as language, processing speed, and attention. Future research should focus on developing reliable change indices for each cognitive domain and possibly each neuropsychological test to help provide a comparison and detect true change in test scores. Studies should also focus on developing alternate equivalent forms, which would help minimize practice effects across populations.
Association Between Health-Related Perceptions and Treatment Outcomes in an Interdisciplinary Pain Management Program
(2014-12-22) Mader, Megan Denise; Gatchel, Robert J.; Robinson, Richard C.; Noe, Carl
BACKGROUND: Adherence to treatment recommendations, specifically chronic pain treatment, is a particular area of importance in the elderly. It has been suggested that patient beliefs/perceptions play a role in treatment outcome, and the current study seeks to further explore this relationship in order to determine the extent to which health-related beliefs and perceptions effect treatment outcome. SUBJECTS: The study consisted of a total of 103 patients, ages 20-82, who were treated at the Eugene McDermott Center for Pain Management at University of Texas Southwestern Medical Center over the past two years. METHOD: Initial and discharge responses to Computerized Adaptive Testing (CAT) items were collected. Select measures, such as the PMQ (Pain Medication Questionnaire), BIPQ (Brief Illness Perception Questionnaire), PROMIS Global Health, Composite Pain Rating, and other PROMIS measures were analyzed via SPSS. RESULTS: Strong correlations were found between Global Health and outcomes, specifically initial Global Health and initial outcome responses. Strong correlations were also found between initial BIPQ and initial outcome measure scores. DISCUSSION: The results supported the hypotheses and showed that as health-related perceptions change, outcome measures can also change accordingly with the progression of treatment.
Bandura's Social Cognitive Concepts and Physical Activity of People with Multiple Sclerosis: A Hierarchical Regression Analysis
(2013-12-30) Gaylord, Kathryn Lee; Chiu, Chung-Yi; Froehlich-Grobe, Katherine; Rose, Lindsey
BACKGROUND: Social Cognitive Theory (SCT), developed by Alfred Bandura, is a theory often employed for health promotion. This theory focuses on a set of determinants, examining how each operates, and translating information about the determinants into health practices. The combination and interaction of the primary determinants of SCT (perceived self-efficacy, outcome expectations, goals, and perceived facilitators and barriers) not only determine, but also influence the health behaviors individuals engage in. Through the use of this theory, determinants to change and adoption of a new behavior can be assessed, and individual treatment plans may be developed to effectively focus on the most influential targets for behavioral change. Multiple Sclerosis, a chronic and debilitating health problem estimated to affect hundreds of thousands of individuals in the United States, often leads to individual suffering and an overall decreased quality of life. Currently, there is no cure for MS, so symptom management and a decrease in debility remain a critical area of focus for health professionals working with MS patients. While there is no cure for this disorder, physical activity has been shown to alleviate multiple symptoms of MS such as mobility impairment, fatigue, pain, and depression, which then improves the quality of one’s life. Furthermore, there is strong empirical evidence to support the use of SCT as an efficacious treatment approach for employing health promotion practices. The purpose of this study is to extend previous findings by examining how various SCT concepts relate to physical health, mental health, stage of change for exercise, and action planning and coping planning for exercise. Additionally, the present study examines how disability affects self-efficacy thereby impacting physical activity. SUBJECTS: A total of 214 individuals (185 females [86%] and 29 males [14%] with self-reported MS recruited from the National Multiple Sclerosis Society and a neurology clinic of a university teaching hospital in the Midwest participated in the current study. The average age among participants was 46.97 years (SD = 9.92). Around 36% of participants were retired due to MS, and approximately 72% of participants reported being treated for secondary health problems (e.g., overweight, high blood pressure, and diabetes). METHOD: Participant demographic data were gathered from self-reports and include age, gender, ethnicity, marital status, years since onset of MS, secondary health issues, education level, vocational status, occupation, area of residence, current and past rehabilitation services received, source of income, total income, access to physical exercise in community, and changes in health practice since onset of MS. SCT concepts were assessed using the following measures: Action Self-Efficacy Scale-Physical Exercise (ASES-PE), Outcome Expectancy Scale-Physical Exercise (OES-PE), Health/Safety Risk Perceptions Scale (HRPS), Health/Safety Expected Benefits Scale (HEBS), Barriers to Health Promoting Activities for Disabled Persons Scale (BHADP), the Action Planning and Coping planning Scale-Physical Exercise (APCPS-PE), the Physical Activity Stages of Change Instrument (PASC). Participant disability and health were assessed using the following measures: Minimal Record of Disability (MRD) and the MOS Short form Health Survey (SF-12v2). The present study used a hierarchical regression analysis to examine associations between various domains and a set of social cognitive concepts (self-efficacy, knowledge of health and risk benefits, and outcome expectancy). RESULTS: There were several significant findings when examining the four domains of action planning and coping planning, stage of change, physical health, and mental health. Results indicated action planning and coping planning was predicted by action self-efficacy (R2 = 45%, ß = .45, p < .001), outcome expectancy (R2 = 45%, ß = .20, p < .01), risk perception (R2 = 45%, ß = .14, p < .05), and perceived barriers (R2 = 16%, ß = -.14, p < .05). Results indicated that stage of change was predicted by action planning and coping planning (R2 = 28%, ß = .26, p < .01). When “physical health” was the outcome variable, it was predicted by age (R2 = 8%, ß = -.20, p < .01), severity of disability (R2 = 14%, ß = -.28, p < .01), action self-efficacy (R2 = 22%, ß = -.16, p < .05), and outcome expectancy (R2 = 22%, ß = .27, p < .01). Lastly, when “mental health” was the outcome variable, it was predicted by age (R2 = 6%, ß = .18, p < .05), perceived barriers (R2 = 11%, ß = -.23, p < .01), outcome expectancy (R2 = 18%, ß = -.25, p < .01), and action self-efficacy (R2 = 18%, ß = .22, p < .05). DISCUSSION: The research findings support the applicability of Bandura’s Social Cognitive Theory as a model for exercise or physical activity for people with MS. This study found unique relationships between physical health and action self-efficacy, and mental health and outcome expectancy (with both relationships having a negative correlation). The current study includes a unique subset of the MS population who are well-educated, affluent, and report greater access to services and who expressed the negative correlate between action self-efficacy and physical health. The aforementioned factors are supposed to support physical health. However, the current group has high action self-efficacy to exercise, and given that they likely have good knowledge about exercise benefits to MS and good environmental support to engage in exercise, their motivation has likely surpassed, and is greater than, their experienced physical health, such as suffering pain and fatigue, which decreases physical health. Furthermore, it may be that the participants in the current study have good knowledge about how physical activity benefits their MS symptoms and progress management; consequently, they have high intention to push themselves to engage in exercise even though they may have experienced pain and fatigue, both of which have affected physical health significantly. Additionally, considering that high outcome expectations of a behavior may lead to stress and anxiety, such stress may decrease mental health, particularly if the positive effects of an activity (such as exercise) are not experienced as soon as and as much as expected. Examining the social cognitive, physical health, and mental health domains provides a well-rounded and empirical basis for employing health promotion efforts in clinical work with persons with MS. Rehabilitation professionals may help persons with MS implement physical activity through the use of SCT, which may improve their mobility impairment, pain, fatigue, and depression. The present study’s findings enable clinicians and rehabilitation professionals to better create and customize treatment to best meet individual patients’ needs and improve their overall quality of life.
Body Image and Age Effects in the Pediatric Cleft Population
(2015-12-03) Komachi, Candice Yuki; Heppner, Celia; Faith, Melissa A.; Seaward, James
BACKGROUND: While orofacial clefts affect the facial appearance of many children and adolescents with this birth defect, there has not been specific research examining the impact of orofacial clefts on developing body image. Body image development in the general population follows a trend in which adolescence is characterized by more negative body image than in prepubescent children. However, as children with orofacial clefts have altered appearances from birth, their body image may differ from that of the general population. This study aims to examine the relationship between orofacial clefts and body image throughout childhood and adolescence. PARTICIPANTS: Participants included children and adolescents who were seen in the multidisciplinary craniofacial clinic at Children's Health/Children's Medical Center between March 2011 and April 2015. Patients included in the sample had a diagnosis of cleft lip and/or palate (CL/P), were between the ages of 8 and 18 years of age, and had no complex medical or genetic diagnoses. METHOD: This study utilized a retrospective chart review of patients seen in the craniofacial clinic at Children's Health from March 2011 to April 2015. Data collected from the patient charts included demographic information, medical and surgical history, and history of speech intervention and recommendations. Each patient was interviewed by a clinician and filled out self-report questionnaires. Items from the self-report questionnaires relevant to body image and self-perception were used in this study along with a body image concern item asked during the clinician interview. Participants were separated into groups based on orofacial cleft diagnosis (bilateral CL/P, unilateral CL/P, cleft lip only, and cleft palate only). RESULTS: There was no significant relationship found between body image and category of orofacial cleft diagnosis. Age also did not correlate with body image scores. Body image scores that were taken from the body image-related items were also not highly correlated. DISCUSSION: There were no significant relationships found between the variables of interest in this study. However, orofacial clefts are unique conditions that may necessitate ongoing surgical and related medical intervention throughout childhood and adolescence. For patients with CL/P, body image development may not follow a typical trend and may fluctuate rapidly depending on the success of their treatment, how well treatment outcomes meet expectations, as well as patients' adaptability to their changing appearance. As a result, there may not be a clearly identifiable correlation between age and body image scores. Other factors such as the orofacial cleft diagnostic categories used for this study, the uneven group sizes, and the body image-related items used as a measure of body image may have impacted the results. As the body image-related items were not significantly correlated, another measure that has been validated to assess body image may be more efficient and necessary in future studies so that the relationship between age, orofacial cleft condition, and body image can be more precisely examined.
Borderline Personality Features and Treatment Outcomes in an Adolescent Intensive Outpatient Treatment Population
(2016-08-25) Rial, Katherine Vera; Foxwell, Aleksandra; Kennard, Beth D.; Moore, Patricia Sinclair
Borderline Personality Disorder (BPD) is a common psychiatric disorder associated with severe functional impairment, high rates of suicide, comorbid mental disorders, frequent utilization of mental health treatment, and therefore, high cost to society in both adults and adolescents. Although treatments have been developed to treat BPD in adults, little is known about the effectiveness of treatments in adolescents, in particular in an intensive outpatient setting. The current study examined differences in clinical characteristics among adolescents with and without borderline features who participated in an intensive outpatient program (IOP) for suicidal behaviors. In addition, this study examined whether borderline features predicted treatment outcomes at discharge. Fifty-eight participants, ages 13-17 (14.98±1.15), were categorized into adolescents with BPD features and those without. Assessments include the Concise Health Risk Tracking form (CHRT; self-report), Columbia Suicide Severity Rating Scale (C-SSRS; clinician-rated), Quick Inventory of Depressive Symptomatology- Adolescent version (QIDS-A; self-report), and the 11-item Borderline Personality Features scale for Children (BPFSC-11; self-report). Statistical analyses include chi-square and ANOVA for demographic and clinical characteristics. Spearman's correlations and a hierarchical linear regression were used to examine treatment outcomes. Results indicate that adolescents with BPD features presented to treatment with more severe depression and suicide risk than adolescents without BPD features. Following IOP treatment, adolescents with BPD features continued to endorse more severe depressive symptoms than those without BPD features. However, there was no statistical difference between groups in regards to suicidality. The presence of BPD features did not predict depression severity at discharge, but the relationship appeared to be trending.
Characterization and Differences Between Possible and Probable Mild Cognitive Impairment in an Alzheimer’s Disease Center
(2015-08-31) Weaver, Victoria Allison; Rossetti, Heidi; Lacritz, Laura H.; Silver, Cheryl H.
BACKGROUND: Mild cognitive impairment (MCI) is considered an intermediate state between normal aging and dementia. A subjective cognitive complaint (SCC) is a key component in the diagnosis of MCI. However, some individuals with SCCs do not show objective impairment on neuropsychological measures and there has been debate about the role of SCCs for the characterization of MCI. This study aimed to examine the differences in neurocognitive function and other risk factors between MCI subtypes and better understand the role of the SCC when objective cognitive impairment is not present. SUBJECTS: This retrospective study includes 395 participants [age (M, SD) =67.5(7.2), education (M, SD)=15.10(2.7)], from the Alzheimer’s Disease Center (ADC) at the University of Texas Southwestern Medical Center who were English speaking and between the ages of 50-90. Participants received a comprehensive clinical assessment including neuropsychological testing and diagnosis, which was made via multidisciplinary group consensus. This study consisted of participants classified at their baseline ADC visit as individuals with SCC but normal cognitive performance (possible MCI, n=83), individuals with SCC and abnormal cognitive performance (probable MCI, n=121), and normal controls (n=191). METHOD: Differences in performance on neuropsychological measures among possible MCI, probable MCI, and normal control groups were examined using MANOVA. Differences in the frequency of selected cognitive and vascular risk factors, including APOE4, hypertension, high cholesterol, and diabetes mellitus, were examined using chi square test of independence. Demographic differences (age, education, gender, depression, and premorbid intelligence) across groups were compared using either ANOVA or chi square. RESULTS: Normal controls performed significantly better than the probable MCI group on the MMSE, TMT-A, TMT-B, Block Design, WCST, FAS, Animal Fluency, and BNT (p<.05). On the CVLT, normal controls demonstrated fewer intrusion errors, higher total learning scores, and better long delay free recall than both the possible and probable MCI groups, and similarly, the possible MCI group performed significantly better than the probable MCI group. The frequency of APOE4 did not differ significantly among groups (p>.05). The probable MCI and possible MCI group had significantly higher rates of hypertension (58%, 59%) compared to the normal control group (46%). The probable MCI group had significantly higher rates of high cholesterol (66%) than the possible MCI group (18%). The probable MCI group had significantly more males, lower education, and higher GDS scores compared to NC groups (p<.05). DISCUSSION: This study demonstrated that the probable MCI group differed from normal controls on measures of memory, executive function, and language, and had higher rates of hypertension and high cholesterol. Although statistically significant differences among all three groups on measures other than complex verbal memory were not seen; closer examination of the neurocognitive test scores showed that the possible MCI group performances were qualitatively more similar to that of the probable MCI group rather than the NC group. This may support the notion that individuals with a SCC but without overt impairment on testing do share commonalities with those with clear MCI, indicating that SCC do carry clinical significance and warrant evaluation and monitoring over time in older individuals.
Comparing Distribution-Based and Anchor-Based Minimal Clinically Important Difference Values for Temporomandibular Disorder
(2011-10-03) Ingram, Megan Elizabeth; Gatchel, Robert J.; Haggard, Robbie; Chiu, Chung-Yi
The current study is a continuation of studies by Gatchel and colleagues. Data were collected from 101 patients at several community dental clinics. Based on the patients' initial evaluations, they were randomly assigned to one of three treatment groups: Low Risk/Non-intervention Group; High Risk/Biobehavioral Group; or High Risk/Self-Care Group. This study attempted to better understand and objectively quantify meaningful symptom relief by determining the minimal clinically important difference (MCID) for temporomandibular joint disorder (TMD). Despite limitations and controversy with determining the most appropriate method, this information will play an important role in determining treatment effectiveness for not only TMD, but for other pain conditions as well. The most commonly referenced methods for determining meaningful change are the distribution- and anchor-based approaches. Distribution-based minimal detectable change (MDC) values were calculated using the formula 95% CI=1.96 x Square Root(2) x SEM, while the anchor-based approach minimal clinically important change (MCID) values were calculated using a Receiver Operating Curve (ROC). Both mean particle size and broadness of distribution served as two separate functional anchors, and normal range and .5 SD as two separate cutoff methods. Despite some variability, the MCID values were relatively consistent with the MDC values regardless of method, anchor, or cutoff for both the Physical Component Scale (PCS) and Mental Component Scale (MCS) of the SF-36. The Characteristic Pain Inventory and Graded Chronic Pain Scale showed a narrow range of variation within the MCID values; however, the MCID values calculated were significantly higher than the MDC values reported for the same measures. Findings indicated that the PCS component of the SF-36 provided stronger evidence of clinically meaningful change. The PCS resulted in asymptotic values closer to .1 (at the 90% confidence interval) with areas under the curve that better fit the model compared to the other subjective measures (considered fair at .701 when using the normal range and .740 when using .5SD for the Biobehavioral Group). Additionally, broadness of distribution resulted in more clinically meaningful changes as a result of better metric values when comparing the biobehavioral versus the self-care groups.
Cross-Cultural Comparison of Parental Perspectives of Health-Related Quality of Life in Children with Cochlear Implants
(2012-11-28) Kumar, Roshini Ruth; Silver, Cheryl H.; Warner-Czyz, Andrea D.; Tobey, Emily A.
BACKGROUND: Assessing health-related quality of life (HRQoL) is a useful way to quantify benefits that cochlear implants (CI) provide children with hearing loss. Since children often are too young or lack communication skills to convey their HRQoL, parents serve as a reliable proxy. This study examines parent report of HRQoL (categorized in eight domains) and demographic variables in children with CI. Lastly, this study compares parent HRQoL ratings in the United States (US) to parent ratings in the Netherlands, Finland and the United Kingdom (UK). SUBJECTS: Parents of 33 children with CIs participated in the US component of this study. METHOD: An analysis of variance was used to measure differences among HRQoL domains. Correlations between HRQoL and demographic variables, and correlations among HRQoL domains were assessed using Spearman and point bi-serial correlations. Cross-cultural differences in HRQoL domain scores were computed using one sample t-tests. RESULTS: In this US sample, education and effects of CI domains were rated least positively. Cross-culturally, US parents rated HRQoL more positively than parents in the Netherlands, generally less positively than parents in Finland and aligned most closely with parents in the UK. DISCUSSION: Limited access to CI-related accommodations and varying parent expectations likely explain the differences in low ratings of education and effects of implantation in the US, as well as the differences seen cross-culturally. Providing useful CI accommodations at school and preparing parents for realistic outcomes could greatly benefit children with CI and their families.
Demoralization as a Factor in a Vocational Rehabilitation Population Using the Demoralization Scale (RCd) of the MMPI-2-RF
(2012-08-15) Wishart, Alfred B.; Casenave, Gerald W.; Turner, Mary; Whitfill, Travis
BACKGROUND: Demoralization has come to be recognized as an essential element of psychological health. Its prevalence and role as a factor in discreet populations has been studied such as with medical and psychiatric populations though not in the field of Vocational Rehabilitation (VR). In most of this research, the Demoralization Scale (RCd) of the MMPI-2-RF was not used. This study looks at the prevalence of demoralization in a VR population using the RCd. SUBJECTS: The subjects for this study (N = 54) were evaluated for vocational potential by the University Rehabilitation Services (URS) in the Department of Rehabilitation Counseling at the Southwestern School of Health Professions. They were referred by the Department of Assistive and Rehabilitative Services (DARS) of Texas except for one client who was self-referred. METHOD: Basic demographic data (age, ethnicity, IQ, and gender), along with the scores of the MMPI-2-RF scales were gathered. Comparisons were made between the study population and normative populations for the prevalence and degree of demoralization. Further, two correlation analyses were run. The first was for intercorrelations between the RCd and the other Restructured Clinical Scales (RCS) of the MMPI-2-RF and the Clinical Scales (CS) of the MMPI-2. The second, was for intercorrelations between the RCd and other, selected scales of the MMPI-2. RESULTS: The prevalence of demoralization in the study population was higher than in the general population. There were data to suggest that the degree of demoralization in the study population was greater than in the general population, though further research is needed to confirm this. The data on the intercorrelations between the RCd, the RCS, and the CS replicated earlier research; variations are discussed. Unexpected correlations between the RCd and selected scales for the study population were noted and discussed. DISCUSSION: The higher prevalence of demoralization in the study population than in the normative population bears particular significance for VR. Research has shown that demoralization is a key factor in psychological health and in VR. The degree of demoralization in the study population is high and further research is needed to determine if there is are greater degrees of demoralization in a VP population as compare to a normative population. For correlations of the RCd to other scales, there were several unexpected differences in the intercorrelations between the RCd, the RCS, the CS. These data suggest that the study population may have a higher prevalence of somatic symptoms and antisocial traits, and a lower prevalence of cynicism. The strong correlation between the RCd and the WRK scale suggests that demoralization may be a key factor in VR. The absence of recent data on the prevalence of demoralization in the general population diminished the generalizability of the findings. However, the results of this study revealed gaps in the literature that provide direction for future investigations.
Developmental Expectations and Adolescent Type 1 Diabetes Management in Latino and Caucasian Families
(2013-12-30) Sundaram, Saranya Easwar; Wiebe, Deborah J.; Wetherington, Crista E.; Gross-Toalson, Jami
BACKGROUND: Transfer of responsibility for diabetes management is important across adolescence. It may contribute to poorer adherence and family conflict if unmatched to adolescent development. Research has primarily studied Caucasian samples, which may have different expectations for autonomy compared to Latino samples. This study examined developmental expectations for independence in both general and diabetes-related tasks in age- and sex-matched samples of Caucasian and Latino youth with type 1 diabetes. SUBJECTS: Participants included 118 10- to 15-year-old Caucasian and Latino adolescents with type 1 diabetes [M (SD) = 13.24 (1.69) years; 54% female] and their mothers. METHOD: Participants independently completed questionnaires measuring expectations for independence, diabetes responsibility and conflict, and adherence to diabetes management. In addition, adolescents completed an inventory measuring depressive symptoms, and HbA1c levels were obtained through medical records. RESULTS: Mothers and adolescents held different expectations for the age at which adolescents should make independent decisions about general and diabetes-related activities. In the overall sample, adolescents expected independence at younger ages for prudential activities, but at older ages for diabetes activities than did parents. These mother-adolescent differences occurred in different domains across ethnicity; Caucasians displayed mother-adolescent differences in expectations for diabetes activities, while Latinos displayed differing expectations for prudential activities. In the overall sample, expectations were associated with mother-reported conflict, but were minimally correlated with parental diabetes responsibility. Younger age expectations for prudential items were associated with poorer diabetes outcomes, but age expectations for personal and diabetes items were generally unrelated to diabetes outcomes. In contrast to expectations, associations of developmental expectations with diabetes responsibility, conflict, and outcomes were similar across Caucasian and Latino youth. DISCUSSION: Findings support that there were differing age expectations between parents and adolescents in prudential and diabetes-related activities. Different factors may influence how these expectations were associated with parental responsibility, conflict, and diabetes outcomes.
Do Concussion History and Gender Influence Neurocognitive Testing Performance
(2016-11-21) Borque, Brandy; Silver, Cheryl H.; Cullum, C. Munro; Resch, Jacob
BACKGROUND: To date, the literature regarding sport concussion (SC) has concentrated primarily on male athletes. Generally, as research on female athletics has increased, there is an overall agreement that female athletes show more impairment post-injury than males. However, more data are needed to determine how SC impacts the female athlete and if that impact is influenced by factors such as age or history of prior concussion. SUBJECTS: Subjects with and without a previous history of concussion at the high school and college level were included and carefully matched for age, gender, height, and weight. After careful matching, five high school athletes with a history of prior SC were compared with five high school athletes without a concussion history, and 14 college athletes with a history of prior SC were compared with 14 matched college athletes without a concussion history. METHOD: Data for this study were acquired from a larger study conducted at the University of Texas at Arlington that examined sport concussion in high school and college athletes. Variables included previous concussion history and baseline scores from the ImPACT test. It was hypothesized that female athletes with a previous SC would show more impairment on baseline neurocognitive measures and would report greater symptom severity at baseline testing compared to athletes without a prior SC. In addition, it was hypothesized that female athletes with a previous SC at the high school level would show more impairment on baseline neurocognitive measures than college athletes with prior SC and that high school players would show greater symptom severity compared to college athletes at baseline. RESULTS: No significant differences were seen on any ImPACT baseline composite scores between athletes with and without a reported history of prior concussion. Similarly, no differences on ImPACT baseline total symptom scores were seen between athletes with concussion versus without a history of prior concussion. Finally, there were no differences on ImPACT composite or total symptom scores between college and high school athletes.
Effect of Physical Activity on Community Participation among Breast Cancer Patients
(2015-08-31) Dean, Victoria Nicole; Casenave, Gerald W.; Chiu, Chung-Yi; Rose, Lindsey
BACKGROUND: Breast cancer patients who engage in physical activity are shown to have a reduction in difficulties during daily living as a result of treatment side effects; however, it is unknown if participation in physical activity will reduce the limitations experienced by these individuals while participating in community activities. SUBJECTS: Female breast cancer patients, with a mean age of 51.81(SD = 7.88, range 30-64), diagnosed with stage 1 (n = 16, 21.3%), stage II (n = 37, 49.3%), stage III (n = 15, 20.0%) cancer who have completed chemotherapy (n = 63, 84.0%), are undergoing chemotherapy (n = 9, 12.0%), or have not yet started chemotherapy (n = 1, 1.3%). The majority of the participants were individuals were employed full time (n = 39, 52.0%), employed part time (n = 13, 17.3%). The majority of these women were married (n = 49) or divorced (n = 11). These women were college graduates (n = 30) or finished some graduate school (n = 20). These participants were European American (n = 34, 45.3%) and African American (n = 13, 17.3%). The BMI of these participants had a mean of 27.28 with a range from 16.30 to 44.81(SD = 5.35). Some of these individuals (n = 53) reported co-occuring medical conditions such as high cholesterol, high blood pressure, diabetes, and being overweight. METHOD: We recruited female breast cancer patients between the age of 18-66, with stage I, II, or III cancer, who are starting, in the process of, or have completed chemotherapy. Participants who met the inclusion criteria were selected to participate. Research assistants invited these patients to volunteer the survey study. For the current study purpose, we analyzed the association between the International Physical Activity Questionnaire (IPAQ) and the World Health Organization Disability Assessment Scale version 2.0 (WHODAS 2.0), using the Pearson product-moment correlation at the level of statistical significance at .05. The survey packages were sent to the participants through the United States Postal Service. Once the surveys were returned by mail the participants received a $10 gift card for compensation. RESULTS: A significant negative association was observed between limitations in participation in society (r = -.31, p =.004, medium effect size) and walking. Significant negative associations were also discovered between the limitations in life activities and vigorous activity (r = -.24, p = .023, small to medium effect size), along with walking (r = -.23, p = 0.25, small to medium effect size). Lastly, a significant negative association was seen between the limitations in communication and understanding and walking (r = -.20, p = .046, small to medium effect size). DISCUSSION: Engaging in physical activity decreases the limitations in understanding and communication, life activities, and participation in society an individual encounters. Vigorous activity is not required to experience reductions in community limitations. Simply engaging in light physical activity, like walking, produces results.
The Effect of Rapamycin Paired with Traumatic Memory Activation on Cognitive Performance in Veterans Diagnosed with PTSD
(2012-05-18) Anderson, Elizabeth Hallen; Surís, Alina; North, Carol S.; Powell, Craig M.
BACKGROUND: Many individuals with posttraumatic stress disorder (PTSD) experience cognitive impairment in addition to the characteristic psychological symptoms. Animal studies have shown that rapamycin, a protein synthesis inhibitor that targets the protein kinase mTOR, can prevent the reconsolidation of a reactivated fear memory, thereby reducing its emotional strength at a neurochemical level. The aim of the current study was to determine if pairing rapamycin with traumatic memory reactivation in male veterans with combat-related PTSD would lead to an improvement in cognitive performance, based on scores from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline and 1-month follow-up. SUBJECTS: A sample of 54 male veterans with combat-related PTSD receiving healthcare at a large southwestern VA medical center participated in the study. METHODS: In a double-blind, placebo-controlled study, male veterans with combatrelated PTSD were administered either a single dose of rapamycin or placebo, followed by a script-driven memory reactivation task. Measures included the RBANS, Clinician Administered PTSD Scale (CAPS), and the Quick Inventory of Depressive Symptomatology (QIDS). RESULTS: A repeated measures ANOVA was conducted to assess the impact of two different interventions (rapamycin, placebo) on participants' scores on the RBANS, across two time periods (baseline, one-month follow-up). The main effect comparing the two type of interventions revealed no significant differences in the effectiveness of the two interventions in the entire sample; F (1,48) = .01, p = .921, partial eta squared < .001. When the sample was limited to participants who demonstrated a clinically significant reduction (≥ 20 points) in their CAPS score, a repeated measures ANOVA revealed a significant interaction between time and treatment intervention; Wilks Lambda = .44, F (1, 13) = 16.74, p = .001, partial eta squared = .563. Pairwise comparisons showed a significant improvement between baseline and one-month follow-up on the RBANS for participants in the placebo group, mean difference = 10.00, p = .002. DISCUSSION: Based on these results, a single rapamycin treatment does not appear to be detrimental or beneficial to cognitive performance. Furthermore, a clinically significant reduction in PTSD symptoms due to rapamycin is not associated with an improvement in cognitive performance.
The Effectiveness of Biopsychosocial Interventions at the Dallas Spinal Rehabilitation Center: Applying the NIDRR Logic Model
(2013-09-10) Siles, Melisa Garcia; Chiu, Chung-Yi; Wolf, Tina; Casenave, Gerald W.
BACKGROUND: The National Institute on Disability and Rehabilitation Research has developed a program evaluation framework, the NIDRR logic model describing and assessing the relationship between planning, implementing, and evaluating outcomes in rehabilitation service environments, such as the Dallas Spinal Rehabilitation Center. Standard primary care facilities have treated chronic pain with narcotic medications; however, controversies surrounding the lack of long-term efficacy, risk of addiction, and the physical and psychological side effects of these medications continue to be heavily debated. There is strong evidence to support a biopsychosocial treatment approach for chronic pain which reduces narcotic dependence and restores daily functioning. The purpose of this study is to assess the effectiveness of the comprehensive interdisciplinary pain rehabilitation (IPR) program at the DSRC based on the NIDRR logic model. SUBJECTS: A total of 226 patients (131 males [58%] and 95 females [42%]) with chronic pain were admitted to the IPR program at the DSRC between January 2010 and December 2012. Among the 226 patients, 150 patients required medication tapering at admission. The average age of patients was 47 years old (SD= 9.74). The DSRC assigned patients to one of two groups after assessing the severity of their chronic pain curbing their ADL limitations, their social functioning, and their individualized treatment goals; 60 patients were in the chronic pain program, and 166 patients were in the functional restoration program. Patients attended between 80 hours to 160 hours of treatment that included medication management, physical therapy, cognitive-behavioral therapy with psychoeducation and biofeedback, and vocational counseling. METHOD: The current study is a descriptive design. All patients completed self-report measures assessing their current level of pain, functioning, depression, anxiety, and fear-avoidance beliefs at pre- and post-treatment. A dependent paired-samples t-test was used to assess the significance of treatment effect. RESULTS: Overall, significant improvements were seen among patients in the areas of independent functioning, depression, anxiety, fear-avoidance beliefs, medication tapering, and return to work status. Physical demand level, assessing independent functioning, improved significantly, t(225)=27.79, p=.000, among all patients. Results indicated significant improvements in depression scores, t(225)=13.38, p= .000, and anxiety scores, t(225)= 12.94, p= .000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(225)= 13.68, p= .000, as did those beliefs pertaining to work, t(223)= 15.33, p= .000. Additionally, 93% of patients successfully returned to work after completion of the program, and 96% of patients who required tapering at admission successfully tapered or discontinued their medication use. Improvements were also found within each treatment group. Physical demand level in the chronic pain program improved significantly, t(59)=12.19, p.000. Results indicated significant improvements in depression scores, t(59)= 5.79, p= .000, as well as anxiety scores, t(59)= 5.83, p=.000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(59)= 7.16, p= .000, as did those beliefs pertaining to work, t(59)=8.77, p= .000. Forty-four (73%) patients in the chronic pain program successfully returned to work. Of the 45 patients that required medication tapering at admission, 101 (96%) tapered or discontinued their medications. DISCUSSION: The NIDRR logic model has provided an excellent framework to assess treatment effectiveness in rehabilitation centers. Findings suggest that a biopsychosocial approach for chronic pain (e.g., the IPR program) is effective and efficient in diminishing overall distress and corroborating more biopsychosocial long-term effects than a short term quick fix of narcotic medications.
The Effectiveness of Electroconvulsive Therapy for Major Depressive Disorder According to Patient Self-Report
(2013-08-28) Metoyer, Melissa C.; Chiu, Chung-Yi; McClintock, Shawn Michael; Brewer-Mixon, Karen
BACKGROUND: Major depressive disorder (MDD) is a common, typically recurrent, often chronic, and disabling disorder affecting approximately 14 million adults in the United States (US) each year. Electroconvulsive therapy (ECT) is a neurostimulation therapeutic intervention that is highly effective and most often used to treat certain psychiatric conditions, in particular MDD. Despite the proven effectiveness of using ECT to treat MDD there have been no other studies that have addressed methods of assessing the severity of depressive symptoms using patient self report instrument. SUBJECTS: Ninety-four participants, comprised of 58 (61.7%) females and 36 (38.3%) males who ranged from 20 to 85 years of age (M=51.76, SD=15.19) participated in this study. All subjects had a diagnosis of MDD and were treated with ECT over an average of 11 sessions on an inpatient or outpatient basis at the UT Southwestern Medical Center Zale Lipshy University Hospital (ZLUH, Dallas, TX). METHOD: The 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR16) measure was used to determine the effectiveness of ECT in treating MDD. Data was acquired at baseline and after the end of the acute ECT treatment course. Paired t-tests were applied to determine if there were significant depression improvements and effect size (r) was calculated to determine the effect size between pre- and post- treatment scores on the Quick Inventory of Depressive Symptomatology-Self Report₁₆ total score and each domain score. RESULTS: The overall baseline average total score of QIDS-SR₁₆ (M=18, SD=4.34) for the study sample was in the severe range. After completion of the acute ECT course, the QIDS-SR₁₆ total score on average significantly decreased to the mild range (M=7.18, SD=4.74). The overall total QIDS-SR₁₆ score had a large effect size (E.S.) (E.S. (r) =.91; t = 20.98, df = 93, p =. 000). Consistent with this, the domain scores also had a large effect size. The E.S. (r)-scores from greatest to the least for the domain scores are mood (E.S. (r) =.88; t = 17.58, df = 93, p =.000), suicide (E.S. (r) =.83; t = 9.19, df = 93, p =.000), fatigue (E.S. (r) =.78; t = 12.13, df = 93, p=.000), self-outlook (E.S. (r) =.75; t = 11.07, df = 93, p =.000), concentration (E.S. (r) =.72; t = 10.03, df = 93, p =.000), sleep (E.S. (r) =.68; t = 8.96, df = 93, p =.000), loss of interest (E.S. (r) =.68; t = 14.58, df = 93, p = .000), psychomotor(E.S. (r) =.65; t = 8.35, df = 93, p = .000), and appetite change (E.S. (r) =.62; t = 7.74, df = 93, p = .000). Data revealed few differences between electrode configuration placements. The sad mood and suicide domains resulted in a greater decline in symptom ratings than the remaining seven domains over the course of an acute ECT treatment. DISCUSSION: The findings of the study are consistent with prior research suggesting that ECT is an effective treatment for MDD. Specifically, depressive symptoms as rated by self report showed a significant decrease from baseline to completion of the acute ECT course. The data from the QIDS-SR16 revealed an overall marked improvement in total depression severity, and in specific depressive domains including mood, suicidal ideation, energy, self-outlook and concentration/decision making. IMPLICATIONS: The research has some limitations. the present study only recruited patients from one hospital, which may limit the generalizability of the findings. This was a naturalistic study based on a clinical database. There could have been possible comorbidities (both medical and neuropsychiatric) that could have affected outcome. The switch of electrode placement was non-systematic and based on physician judgment and not based on the study’s criteria.

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