Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review

Background Psychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention. Methods This is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), coping (catastrophizing, avoidant coping), and affect (depression, anxiety). We evaluated constructs for its predictive value of at least one outcome. Outcomes were informed by this review. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against. Results Of 1170 references, 40 distinct publications based on 35 datasets were included (intervention type: 20 surgical; 20 conservative). Overall, 22 studies (20 cohort studies and 2 RCTs) were classified as high quality and 18 studies (16 cohort studies, 2 RCTs) were classified as moderate quality. Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Based on the review, of the psychological constructs explored, these data would suggest that expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety may predict outcome for patients managed surgically. In patients undergoing conservative intervention the evidence was either against (catastrophizing, depression, anxiety) or inconclusive (self-efficacy, expectation of recovery, avoidant coping) for the predictive value of psychological factors on outcome. Conclusions Five constructs were predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach (i.e., preoperative screening, intervention by a trained clinician) may be advantageous for patients recommended for shoulder surgery,,. The same is not indicated for conservatively managed patients as no conclusive association of MPF with outcomes was noted. The importance of other MPF on outcome requires further investigation.

Predictors of Diabetes Self-Management Behaviors in Type 2 Diabetes Patients

Objective: Type 2 diabetes mellitus (T2DM) is a chronic condition that requires consistent medical care to help control glycemic indices. Diabetes self-management is found to be essential for optimal glycemic control. This study aimed to investigate the predictors of diabetes self-management in adult with T2DM. Materials and Methods: A cross-sectional study was conducted. A purposive sample of 142 adults with T2DM attended an outpatient endocrine clinic in an academic hospital in Ilam, Iran was invited to participate in this study from September to October 2016. The data were collected using a combination of validated questionnaires and the blood sample. IBM SPSS software version 22 used to conduct the analysis. Hierarchical linear regression analysis with the stepwise method was used to explore the predictors of diabetes self-management. Results: The mean age of participants was 54.2 ± (11.8) years. The mean duration of diabetes was 8.9 ± (7.4). Hierarchical linear regression analysis determined that self-management behaviors had positive relationship with efficacy expectation (B= 0.445, P-value< 0.01), quality of life (B= 0.222, P-value= 0.02), and has a negative relationship with HbA1c (B= -0.194, P-value= 0.01). Conclusion: The result of our study indicate that better diabetes self-management behaviors can be predicted by higher efficacy expectation, the better quality of life and lower HbA1c levels. Future interventions should focus on enhancing efficacy expectation, quality of life and optimizing glycemic control to improve self-management of diabetes.

The Will to Beauty as a Therapeutic Agent: Aesthetic Values in the Treatment of Addictive Disorders

Addiction and its comorbid disorders lead not only to massive losses in lifestyle but also to a loss of values. On the other hand, therapy and thus healing always means a resumption of the value discussion. In the present case vignette, the change in values of an alcohol-dependent woman and her turn to the beautiful in the sense of a resource-oriented therapy are described. Enjoying beautiful things led the patient to increase the self-efficacy expectation; at the same time, it was the initial step to emerge from the victim role and to start a self-responsible life again. The Will to Beauty is an integral part of the Orpheus Programme, a resource-oriented therapy for treating substance use disorders and behavioural addictions.

Information and Trust in Parent-Teacher Cooperation – Connections with Educational Inequality

There is an ongoing debate on how parents and the cooperation between parents and teachers contribute to educational inequality. In this study, the assumption that information and trust in parent–teacher cooperation mediate the effects of parent socioeconomic status (SES) on student achievement in mathematics and instruction language (German) was examined. The effects of information and trust on achievement were assumed to be mediated by parent self-efficacy expectation in German. The hypotheses were tested using a sample with 1001 students from 4th to 6th grade and their parents in Swiss primary schools using questionnaires and achievement tests at the beginning and the end of a school year. Results from structural equation models with longitudinal data showed that parent trust and parent self-efficacy expectation fully mediated the effect of SES and student achievement in language instruction but not in mathematics. Information did not correlate with SES nor with student achievement, but with trust. Parental trust in the cooperation with teachers affected achievement in both mathematics and German. The model combines the research on parental involvement with the research on educational inequality in school. Teachers need to establish trust in cooperation with low-SES parents to reduce educational inequality in school.

Do Psychological Factors Affect Outcomes in Musculoskeletal Shoulder Disorders? A Systematic Review

BackgroundThe aim is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF), those that can be changed with intervention, on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MethodsThis is a systematic literature review. We searched five databases for longitudinal studies investigating the influence of MPF on the prognosis of patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. We assigned each MPF identified in the included references to one of six constructs and categorized all constructs into three domains. We then evaluated each construct for its predictive value of at least one outcome, and all outcomes reported were considered. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against each construct.ResultsOf 1140 publications, 35 publications based on 33 studies were included (intervention type: 15 surgical; 18 conservative). Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Six modifiable psychological constructs were explored including self-efficacy, expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety. The majority of the evidence suggested the prognostic value of all constructs except self-efficacy for patients managed surgically. In patients undergoing conservative intervention the evidence was inconclusive or against the prognostic value of MPF on outcomes. ConclusionsFive constructs were found to be predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach to patients with musculoskeletal shoulder disorders managed surgically may be advantageous. The same was not observed for conservative care. The importance of other MPF on outcome requires further investigation.

Influence of Compliance to Diet and Self-Efficacy Expectation on Quality of Life in Patients with Celiac Disease in Spain

The purpose of this study is to understand the health-related quality of life (HRQoL) in patients with celiac disease (CD) and analyze its main determinants. A transversal descriptive study of 738 patients with celiac disease was carried out. A series of questionnaires were answered related to their HRQoL, adherence to a gluten-free diet (GFD), and self-efficacy beliefs among other relevant variables. Regression analyses were carried out in order to explore the predictive variables in adherence to the GFD and HRQoL. A total of 61.2% showed a good HRQoL, and the main predictors of HRQoL were specific self-efficacy, adherence to the diet, risk perception, time since diagnosis, and age. While 68.7% of participants showed good or excellent adherence to the GFD, and the main predictors of adherence were specific self-efficacy, perceived adoption of recommended behaviors, HRQoL and gender. The HRQoL of patients with CD, and adherence to the GFD in Spain, are good. It is the self-efficacy expectation, measured specifically and not generally, which is the best predictor of both adherence and HRQoL. It is necessary to develop programs to improve the HRQoL of patients with CD that focus on improving specific self-efficacy.

Assessment of Adherence and Self-Efficacy of People with VIH/ AIDS

Adherence to antiretroviral therapy (ART) for VIH/AIDS is essential to maintain the health status of the person living with VIH/AIDS. How people experience, think, motivate, and behave can be determined by beliefs of effectiveness. Such beliefs produce diverse effects through four main processes: cognitive, motivational, affective, and selective. In this study, the possible relationship between adherence and self-efficacy was assessed, the role of the patient as a decisive factor in maintaining adherence for antiretroviral treatment. CEAT-VIH (measuring compliance) and the Self-Efficacy Expectation Scale were used to follow the Antiretroviral Prescription. There were 53 VIH/AIDS patients, men and women, whose regression analysis revealed a relationship between the capacity for self-efficacy and the level of adherence and significance. The analysis showed that the role of the patient during his treatment is important for the success of the treatment and maintenance of adherence based on self-efficacy

Determining the Effect of Two Different Approaches to Orientation on Self-Efficacy in Inexperienced Nurses

Self-efficacy is an extensively studied, yet underutilized, indicator of the effectiveness of current education, the measurement of which could contribute to planning the direction of future education. An efficacy expectation is the conviction that one can successfully execute the behavior required to produce the outcomes (Bandura, 1977). This article presents the results of a study that compared the self-reported self-efficacy of newly hired nurses before and after a nurse residency program.