The journal of pain : official journal of the American Pain Society, Jan 14, 2015
The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical ... more The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) program for improving outcomes in patients following lumbar spine surgery. A randomized controlled trial was conducted in 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an Education program occurred at 6 weeks after surgery. Assessments were completed pre-treatment, post-treatment and at 3 month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10 Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in...
Purpose: To identify and gain agreement on successful outcomes of and important factors to consid... more Purpose: To identify and gain agreement on successful outcomes of and important factors to consider in rehabilitation following upper limb absence (ULA). Method: Fifty-three participants consisting of multidisciplinary rehabilitation professionals, and individuals with ULA were invited to complete a three-round modified Delphi iterative survey. Following three Delphi questionnaire rounds, participants clarified the definitions of success in three areas (prosthesis use, activities and participation and self-image). In addition, participants identified and agreed the important factors to consider in rehabilitation after ULA. Results: Results showed that participants reached agreement (having a SD 51) over the three rounds on 78 out of 81 rated items. Of these, 54 rated items were ''accepted'' as important by panel members (mean score of 4 on a five-point Likert scale). Twenty-four items were rejected. Only three rated items had not reached agreement by the third round. Conclusions: Clarification of successful outcomes and factors that should be taken into consideration in a patient's rehabilitation allows a clearer evaluation of what should be the focus of rehabilitation. The findings from the Delphi study can help form the basis for a screening tool for clinicians to be able to identify areas of concern and subsequent treatment for a patient in their care. ä Implications for Rehabilitation To date, there has been no definitive guidance on which outcomes should be assessed in amputation rehabilitation. This study identified the seven core domains of importance regarding the rehabilitation of individuals with ULA and created a starting point for developing a new portfolio of research that aims to address all relevant aspects of patients' rehabilitation. This study reached a consensus and enabled an insight into what defines successful prosthesis use, self-image and activities and participation, and provided evidence that the current definition of prosthesis use in the literature does not sufficiently capture what RPs and individuals with ULA consider important, such as specific use of the prosthesis, as often as an individual wishes, while using it as intended. This study provided RPs and individuals with ULA an opportunity to communicate their opinions and knowledge anonymously regarding the important areas to consider in rehabilitation.
The number of prescription opioid overdose deaths has increased dramatically in recent years and ... more The number of prescription opioid overdose deaths has increased dramatically in recent years and many prescribers are unsure how to balance treatment of pain with secondary prevention. Guidelines recommend low-severity injury patients not receive opioids early in the course of their care, but evidence supporting this guideline is limited. Data from 123 096 workers' compensation claims with back and shoulder injuries were analysed to evaluate this guideline. Back and shoulder injury claimants with early opioid use (≤1 month after injury) had 33% lower (95% CI 24% to 41% lower) odds and 29% higher (95% CI 6% to 58% higher) odds, respectively, of long-term opioid use (>3 months) than claimants with late opioid use, after adjusting for key covariates. Stratified analyses indicate that early opioid use does not appear to increase the risk of long-term use except in cases where no diagnosis or only the diagnosis of unspecified shoulder pain is given prior to prescription.
Objective: To establish psychometric properties of the Acceptance and Action Questionnaire (AAQ),... more Objective: To establish psychometric properties of the Acceptance and Action Questionnaire (AAQ), a measure of avoidance, in medical rehabilitation populations. Study Design: Cross-sectional and longitudinal. Setting: Three acute, inpatient rehabilitation units. Participants: One hundred thirty-nine adults with spinal cord dysfunction, stroke, amputation, or orthopedic surgery. Measures: AAQ, Hope Scale, Spiritual Well-Being Scale, Positive and Negative Affect Scale, Brief Symptom Inventory,
Few published intervention studies in the rehabilitation literature have included consumers in th... more Few published intervention studies in the rehabilitation literature have included consumers in the research process other than as study participants. This lack of consumer involvement in intervention research may contribute to the challenges encountered developing, translating, disseminating, and sustaining evidence-based rehabilitation interventions in clinical practice. The overall objective of this article is to promote the integration of participatory action research (PAR) into rehabilitation intervention research as a mechanism for addressing these gaps. First, we outline essential components of a PAR model across 5 key phases of intervention research, specifically: agenda setting, methods, implementation, diffusion/dissemination, and sustainability. Second, we describe the use of PAR in rehabilitation intervention research within each of these phases by reviewing relevant literature and by providing an illustrative research example from a randomized controlled trial that integ...
Archives of physical medicine and rehabilitation, Jan 20, 2015
To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain ... more To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Prospective observational cohort study. Academic medical center. Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40) undergoing spine surgery for a degenerative condition from March 2012 to April 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Not applicable. The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated wi...
... Six dimensions define patient centered care: (1) respect for patients' values, preferenc... more ... Six dimensions define patient centered care: (1) respect for patients' values, preferences, and expressed needs; (2 ... The approach has since been adapted and validated in randomized clinical trials aimed ... signs of depression); (4) how to bounce back, part II (building on strengths ...
The purpose of this study was to determine whether pain at hospital discharge is associated with ... more The purpose of this study was to determine whether pain at hospital discharge is associated with general health and depression and post-traumatic stress disorder (PTSD) at 1 year following traumatic orthopaedic injury. This study prospectively enrolled 213 patients, 19 to 86 years of age, admitted to an Academic Level 1 trauma center for surgical treatment of a traumatic lower-extremity or upper-extremity orthopaedic injury. Pain at hospital discharge was measured with the Brief Pain Inventory. At 1 year follow-up, physical and mental health was assessed with the SF-12 and depressive and PTSD symptoms with the 9-item Patient Health Questionnaire (PHQ-9) and PTSD Checklist-Civilian Version (PCL-C), respectively. Cut-of scores of 10 on the PHQ-9 and 44 on the PCL-C classified patients as having depression or PTSD. 133 patients (62%) completed follow-up at 1 year. Responders and nonresponders did not differ significantly on baseline characteristics. Multivariable regression found that ...
Archives of physical medicine and rehabilitation, 2014
To explore patterns of change in positive affect, general adjustment to lower-limb amputation, an... more To explore patterns of change in positive affect, general adjustment to lower-limb amputation, and self-reported disability from rehabilitation admission to 15 months postdischarge, and to examine whether goal pursuit and goal adjustment tendencies predict either initial status or rates of change in these outcomes, controlling for sociodemographic and clinical covariates. Prospective cohort study with 4 time points (t1: on admission; t2: 6wk postdischarge; t3: 6mo postdischarge; t4: 15mo postdischarge). Inpatient rehabilitation. Consecutive sample (N=98) of persons aged ≥18 years with major lower-limb amputation. Not applicable. Positive affect subscale of the Positive and Negative Affect Schedule; general adjustment subscale of the Trinity Amputation and Prosthesis Experience Scales-Revised; and World Health Organization Disability Assessment Schedule 2.0. Positive affect decreased from t1 to t4 for the overall sample, whereas general adjustment increased. Self-reported disability ...
The purpose of this study was to test the feasibility of a new model of health care designed to i... more The purpose of this study was to test the feasibility of a new model of health care designed to improve the quality of life and the efficiency of resource use for older adults with multimorbidity. Guided Care enhances primary care by infusing the operative principles of seven chronic care innovations: disease management, self-management, case management, lifestyle modification, transitional care, caregiver education and support, and geriatric evaluation and management. To practice Guided Care, a registered nurse completes an educational program and uses a customized electronic health record in working with two to five primary care physicians to meet the health care needs of 50 to 60 older patients with multimorbidity. For each patient, the nurse performs a standardized comprehensive home assessment and then collaborates with the physician, the patient, and the caregiver to create two comprehensive, evidence-based management plans: a Care Guide for health care professionals, and an A...
The journals of gerontology. Series A, Biological sciences and medical sciences, 2008
The quality of health care for older Americans with multiple chronic conditions is suboptimal. We... more The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed "Guided Care" (GC) to enhance quality of care by integrating a registered nurse, intensively trained in chronic care, into primary care practices to work with physicians in providing comprehensive chronic care to 50-60 multimorbid older patients. We hypothesized that GC would improve the quality of health care for this population. In 2006, we began a cluster-randomized controlled trial of GC at eight practices (n = 49 physicians). Older patients of these practices were eligible to participate if they were at risk for using health services heavily during the coming year. Teams of two to five physicians and their at-risk older patients were randomized to either GC or usual care (UC). Six months after baseline, participants rated the quality of their health care by answering validated closed-ended questions from telephone interviewers who were masked to group assignment....
The measurement of disability in low-income countries is recognised as a major deficiency in heal... more The measurement of disability in low-income countries is recognised as a major deficiency in health information systems, especially in Africa. The Iganga and Mayuge Demographic Surveillance System (IM-DSS) in Uganda provides a special opportunity to develop population-based data to inform national health policies and evaluate innovations in assessing the burden of disability in Uganda. In this study, we apply a new instrument to screen for physical disabilities at the IM-DSS. The study utilised a modified version of the short set of questions proposed by the Washington Group on Disability Statistics. The instrument was applied at the household level and information was collected on all individuals over the age of 5, who were residents of the IM-DSS. The study was based at the IM-DSS, which covers the parts of Iganga and Mayuge districts in Eastern Uganda. 57,247 individuals were included in the survey, with 51% of the study population being women. Activity limitations The overall prevalence of physical disability at the IM-DSS was 9.4%, with vision being the most common type of difficulty reported in this population, and communication being least prevalent. Disability was less likely to be observed among males than their female counterparts (OR 0.75; 95% CI 0.71 to 0.81; p<0.001). Statistically significant associations were found between disability and increasing age, as well as disability and decreasing household wealth status. This study shows that the modified short set of questions can be readily applied in a DSS setting to obtain estimates on the prevalence and types of disability at the population level. This instrument could be adapted for use to screen for disability in other LMIC settings, providing estimates that are comparable across different global regions and populations.
Anosognosia and Denial: Their Relationship to Coping and Depression in ... Kathleen Bechtold Kort... more Anosognosia and Denial: Their Relationship to Coping and Depression in ... Kathleen Bechtold Kortte Southern Illinois University at Carbondale and Johns Hopkins University ... Kathleen Chwalisz Southern Illinois University at Carbondale ... Objective: To evaluate relations among ...
The journal of pain : official journal of the American Pain Society, Jan 14, 2015
The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical ... more The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) program for improving outcomes in patients following lumbar spine surgery. A randomized controlled trial was conducted in 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an Education program occurred at 6 weeks after surgery. Assessments were completed pre-treatment, post-treatment and at 3 month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10 Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in...
Purpose: To identify and gain agreement on successful outcomes of and important factors to consid... more Purpose: To identify and gain agreement on successful outcomes of and important factors to consider in rehabilitation following upper limb absence (ULA). Method: Fifty-three participants consisting of multidisciplinary rehabilitation professionals, and individuals with ULA were invited to complete a three-round modified Delphi iterative survey. Following three Delphi questionnaire rounds, participants clarified the definitions of success in three areas (prosthesis use, activities and participation and self-image). In addition, participants identified and agreed the important factors to consider in rehabilitation after ULA. Results: Results showed that participants reached agreement (having a SD 51) over the three rounds on 78 out of 81 rated items. Of these, 54 rated items were ''accepted'' as important by panel members (mean score of 4 on a five-point Likert scale). Twenty-four items were rejected. Only three rated items had not reached agreement by the third round. Conclusions: Clarification of successful outcomes and factors that should be taken into consideration in a patient's rehabilitation allows a clearer evaluation of what should be the focus of rehabilitation. The findings from the Delphi study can help form the basis for a screening tool for clinicians to be able to identify areas of concern and subsequent treatment for a patient in their care. ä Implications for Rehabilitation To date, there has been no definitive guidance on which outcomes should be assessed in amputation rehabilitation. This study identified the seven core domains of importance regarding the rehabilitation of individuals with ULA and created a starting point for developing a new portfolio of research that aims to address all relevant aspects of patients' rehabilitation. This study reached a consensus and enabled an insight into what defines successful prosthesis use, self-image and activities and participation, and provided evidence that the current definition of prosthesis use in the literature does not sufficiently capture what RPs and individuals with ULA consider important, such as specific use of the prosthesis, as often as an individual wishes, while using it as intended. This study provided RPs and individuals with ULA an opportunity to communicate their opinions and knowledge anonymously regarding the important areas to consider in rehabilitation.
The number of prescription opioid overdose deaths has increased dramatically in recent years and ... more The number of prescription opioid overdose deaths has increased dramatically in recent years and many prescribers are unsure how to balance treatment of pain with secondary prevention. Guidelines recommend low-severity injury patients not receive opioids early in the course of their care, but evidence supporting this guideline is limited. Data from 123 096 workers' compensation claims with back and shoulder injuries were analysed to evaluate this guideline. Back and shoulder injury claimants with early opioid use (≤1 month after injury) had 33% lower (95% CI 24% to 41% lower) odds and 29% higher (95% CI 6% to 58% higher) odds, respectively, of long-term opioid use (>3 months) than claimants with late opioid use, after adjusting for key covariates. Stratified analyses indicate that early opioid use does not appear to increase the risk of long-term use except in cases where no diagnosis or only the diagnosis of unspecified shoulder pain is given prior to prescription.
Objective: To establish psychometric properties of the Acceptance and Action Questionnaire (AAQ),... more Objective: To establish psychometric properties of the Acceptance and Action Questionnaire (AAQ), a measure of avoidance, in medical rehabilitation populations. Study Design: Cross-sectional and longitudinal. Setting: Three acute, inpatient rehabilitation units. Participants: One hundred thirty-nine adults with spinal cord dysfunction, stroke, amputation, or orthopedic surgery. Measures: AAQ, Hope Scale, Spiritual Well-Being Scale, Positive and Negative Affect Scale, Brief Symptom Inventory,
Few published intervention studies in the rehabilitation literature have included consumers in th... more Few published intervention studies in the rehabilitation literature have included consumers in the research process other than as study participants. This lack of consumer involvement in intervention research may contribute to the challenges encountered developing, translating, disseminating, and sustaining evidence-based rehabilitation interventions in clinical practice. The overall objective of this article is to promote the integration of participatory action research (PAR) into rehabilitation intervention research as a mechanism for addressing these gaps. First, we outline essential components of a PAR model across 5 key phases of intervention research, specifically: agenda setting, methods, implementation, diffusion/dissemination, and sustainability. Second, we describe the use of PAR in rehabilitation intervention research within each of these phases by reviewing relevant literature and by providing an illustrative research example from a randomized controlled trial that integ...
Archives of physical medicine and rehabilitation, Jan 20, 2015
To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain ... more To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Prospective observational cohort study. Academic medical center. Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40) undergoing spine surgery for a degenerative condition from March 2012 to April 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Not applicable. The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated wi...
... Six dimensions define patient centered care: (1) respect for patients' values, preferenc... more ... Six dimensions define patient centered care: (1) respect for patients' values, preferences, and expressed needs; (2 ... The approach has since been adapted and validated in randomized clinical trials aimed ... signs of depression); (4) how to bounce back, part II (building on strengths ...
The purpose of this study was to determine whether pain at hospital discharge is associated with ... more The purpose of this study was to determine whether pain at hospital discharge is associated with general health and depression and post-traumatic stress disorder (PTSD) at 1 year following traumatic orthopaedic injury. This study prospectively enrolled 213 patients, 19 to 86 years of age, admitted to an Academic Level 1 trauma center for surgical treatment of a traumatic lower-extremity or upper-extremity orthopaedic injury. Pain at hospital discharge was measured with the Brief Pain Inventory. At 1 year follow-up, physical and mental health was assessed with the SF-12 and depressive and PTSD symptoms with the 9-item Patient Health Questionnaire (PHQ-9) and PTSD Checklist-Civilian Version (PCL-C), respectively. Cut-of scores of 10 on the PHQ-9 and 44 on the PCL-C classified patients as having depression or PTSD. 133 patients (62%) completed follow-up at 1 year. Responders and nonresponders did not differ significantly on baseline characteristics. Multivariable regression found that ...
Archives of physical medicine and rehabilitation, 2014
To explore patterns of change in positive affect, general adjustment to lower-limb amputation, an... more To explore patterns of change in positive affect, general adjustment to lower-limb amputation, and self-reported disability from rehabilitation admission to 15 months postdischarge, and to examine whether goal pursuit and goal adjustment tendencies predict either initial status or rates of change in these outcomes, controlling for sociodemographic and clinical covariates. Prospective cohort study with 4 time points (t1: on admission; t2: 6wk postdischarge; t3: 6mo postdischarge; t4: 15mo postdischarge). Inpatient rehabilitation. Consecutive sample (N=98) of persons aged ≥18 years with major lower-limb amputation. Not applicable. Positive affect subscale of the Positive and Negative Affect Schedule; general adjustment subscale of the Trinity Amputation and Prosthesis Experience Scales-Revised; and World Health Organization Disability Assessment Schedule 2.0. Positive affect decreased from t1 to t4 for the overall sample, whereas general adjustment increased. Self-reported disability ...
The purpose of this study was to test the feasibility of a new model of health care designed to i... more The purpose of this study was to test the feasibility of a new model of health care designed to improve the quality of life and the efficiency of resource use for older adults with multimorbidity. Guided Care enhances primary care by infusing the operative principles of seven chronic care innovations: disease management, self-management, case management, lifestyle modification, transitional care, caregiver education and support, and geriatric evaluation and management. To practice Guided Care, a registered nurse completes an educational program and uses a customized electronic health record in working with two to five primary care physicians to meet the health care needs of 50 to 60 older patients with multimorbidity. For each patient, the nurse performs a standardized comprehensive home assessment and then collaborates with the physician, the patient, and the caregiver to create two comprehensive, evidence-based management plans: a Care Guide for health care professionals, and an A...
The journals of gerontology. Series A, Biological sciences and medical sciences, 2008
The quality of health care for older Americans with multiple chronic conditions is suboptimal. We... more The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed "Guided Care" (GC) to enhance quality of care by integrating a registered nurse, intensively trained in chronic care, into primary care practices to work with physicians in providing comprehensive chronic care to 50-60 multimorbid older patients. We hypothesized that GC would improve the quality of health care for this population. In 2006, we began a cluster-randomized controlled trial of GC at eight practices (n = 49 physicians). Older patients of these practices were eligible to participate if they were at risk for using health services heavily during the coming year. Teams of two to five physicians and their at-risk older patients were randomized to either GC or usual care (UC). Six months after baseline, participants rated the quality of their health care by answering validated closed-ended questions from telephone interviewers who were masked to group assignment....
The measurement of disability in low-income countries is recognised as a major deficiency in heal... more The measurement of disability in low-income countries is recognised as a major deficiency in health information systems, especially in Africa. The Iganga and Mayuge Demographic Surveillance System (IM-DSS) in Uganda provides a special opportunity to develop population-based data to inform national health policies and evaluate innovations in assessing the burden of disability in Uganda. In this study, we apply a new instrument to screen for physical disabilities at the IM-DSS. The study utilised a modified version of the short set of questions proposed by the Washington Group on Disability Statistics. The instrument was applied at the household level and information was collected on all individuals over the age of 5, who were residents of the IM-DSS. The study was based at the IM-DSS, which covers the parts of Iganga and Mayuge districts in Eastern Uganda. 57,247 individuals were included in the survey, with 51% of the study population being women. Activity limitations The overall prevalence of physical disability at the IM-DSS was 9.4%, with vision being the most common type of difficulty reported in this population, and communication being least prevalent. Disability was less likely to be observed among males than their female counterparts (OR 0.75; 95% CI 0.71 to 0.81; p<0.001). Statistically significant associations were found between disability and increasing age, as well as disability and decreasing household wealth status. This study shows that the modified short set of questions can be readily applied in a DSS setting to obtain estimates on the prevalence and types of disability at the population level. This instrument could be adapted for use to screen for disability in other LMIC settings, providing estimates that are comparable across different global regions and populations.
Anosognosia and Denial: Their Relationship to Coping and Depression in ... Kathleen Bechtold Kort... more Anosognosia and Denial: Their Relationship to Coping and Depression in ... Kathleen Bechtold Kortte Southern Illinois University at Carbondale and Johns Hopkins University ... Kathleen Chwalisz Southern Illinois University at Carbondale ... Objective: To evaluate relations among ...
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Papers by Stephen Wegener