No description available.

No description available.

Approximately 18 months ago, an Arthritis Men's Group was started by the Social Work Department at the Vancouver Arthritis Centre. Having identified the need for such a group, interim objectives were proposed for the group which was still in the pilot stage of its development. The purpose of the study was to conduct a formative evaluation of the Men's Group to take a closer look at what was happening in the sessions, to examine the feasibility of the objectives and whether these objectives were being achieved. This information would be used by the planners to improve and/or modify the program. The underlying conceptual approach to the study was 'naturalistic'. In the context of this framework, several data collection methods were used including: interviews, quantitative measures, monitoring and narrative descriptions of group sessions. The findings suggested that interim objectives were being met in the sessions which focussed specifically on psycho-social issues. In addition, other sessions were serving an important 'informational' function which was recognized and valued by group members. Interviews with core-group members did indicate the perceived acceptance and usefulness of open discussions on psycho-social issues. However, over the short duration of the monitoring period no significant changes were found on the measures pre to post so that the positive or negative effects of the achievement of higher levels of emotional openness is not known. The study did provide a good preliminary data base on the nature of the group process and the heterogeneity of the membership. Useful information was gathered both on the kind of group process which may facilitate the achievement of the specific program objectives as well as the informational function of the group. Overall, group members seemed satisfied with group process and content and wanted to see the group continue. / Arts, Faculty of / Social Work, School of / Graduate

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (School of Communication) / Simon Fraser University. Also issued in digital format and available on the World Wide Web.

Over the past decade results from a series of research studies have contributed to the development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led patient education program for persons with arthritis. To date, these studies have primarily focussed on program effectiveness, process, implementation, and dissemination. In these studies self-efficacy was identified as an important construct contributing to the program's effectiveness, however, the exact relationship between self-efficacy and health outcomes has not been determined. In this dissertation research I investigate the evidence of a causal relationship between self-efficacy and three program outcomes (a decrease in depression, less pain, and a higher self-rating of overall health status), and attempt to determine the nature of that relationship. The research methodology involved the use of structural equation modeling (SEM) with two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other (n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired separately with depression, pain and perceived health status. The results of the SEM failed to confirm a dominant causal relationship from self-efficacy to depression, or to pain. This may indicate that these variables have a reciprocal or "spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however, show that higher self-rated health status leads to higher self-efficacy at a later time. The data did not show statistical significance for other causal patterns among these variables. The findings suggest that self-efficacy may play a moderator role in the complex relationship involving individuals with arthritis, their behaviors, and health outcomes. As well, the findings have implications for health promotion planning and research in that they reinforce the complex interplay of psychological and behavioral variables (probably influenced by social variables) in programs which attempt to give individuals greater control over their health. The efficacy and effectiveness of the ASMP has been established in previous studies. This study in no way calls these into question. It does, however, suggest that the mechanism by which these effective outcomes are achieved warrants further investigation.

The goal of this thesis was to examine the processing of clinical pain in two patient groups with well defined primary pathologies, i.e. neuropathic pain patients and patients with rheumatoid arthritis (RA). It was hypothesized that chronic pain is associated with plastic changes in pain processing brain structures that can be detected using functional magnetic resonance imaging (FMRI). The first study, presented in Chapter 3, demonstrates that the neural representation of experimental heat pain is different in neuropathic pain patients than in age- and gender-matched healthy control subjects, although the pain stimulus was applied outside clinically affected areas. Increased activation was found in amygdala and anterior insula in the patient group and was accompanied by increased state anxiety and depression scores. Anterior insula is the focus of Chapter 4 in which it is demonstrated that clinical pain processing is located significantly more anteriorly in the insula than experimental pain processing, in close proximity to neural correlates of highly negative emotions and the conscious perception of bodily sensations. This offers a potential explanation for the shift of clinical pain processing. In Chapter 5, clinical pain is contrasted with experimental pain in the same patient population, i.e. patients with RA. In addition to comparing clinical and experimental pain processing, it was investigated if emotional and cognitive determinates of the pain experience, specifically depression and catastrophizing, exert different influences on the two types of pain. It is shown that clinical pain, but not experimental pain, is likely to be driven partially by depressive symptoms whereas catastrophizing is associated with the same neural activation pattern in both conditions. The cerebral representation of allodynic pain in neuropathic pain patients is presented Chapter 6. Chapters 6 and 7 demonstrate that the FMRI signal encodes the perceived intensity of clinical allodynic pain across subjects and that it reflects longitudinal variations of the perceived intensity within subjects. This thesis illustrates that FMRI can reveal subtle differences in the processing of clinical and experimental pain, despite brain activation patterns being similar on the whole. It also indicates that FMRI can be used to elucidate the origin of these differences, for instance by studying the influence of emotional and cognitive variables. This suggests that neuroimaging methods, in particular FMRI, have the potential to dissect clinical pain into its constituent parts, including central sensitization, brainstem facilitation and amplification by psychological factors. Such knowledge could potentially be exploited to target treatment selectively at different components of clinical pain and to monitor longitudinal changes of these components separately.

Over the past decade results from a series of research studies have contributed to the development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led patient education program for persons with arthritis. To date, these studies have primarily focussed on program effectiveness, process, implementation, and dissemination. In these studies self-efficacy was identified as an important construct contributing to the program's effectiveness, however, the exact relationship between self-efficacy and health outcomes has not been determined. In this dissertation research I investigate the evidence of a causal relationship between self-efficacy and three program outcomes (a decrease in depression, less pain, and a higher self-rating of overall health status), and attempt to determine the nature of that relationship. The research methodology involved the use of structural equation modeling (SEM) with two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other (n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired separately with depression, pain and perceived health status. The results of the SEM failed to confirm a dominant causal relationship from self-efficacy to depression, or to pain. This may indicate that these variables have a reciprocal or "spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however, show that higher self-rated health status leads to higher self-efficacy at a later time. The data did not show statistical significance for other causal patterns among these variables. The findings suggest that self-efficacy may play a moderator role in the complex relationship involving individuals with arthritis, their behaviors, and health outcomes. As well, the findings have implications for health promotion planning and research in that they reinforce the complex interplay of psychological and behavioral variables (probably influenced by social variables) in programs which attempt to give individuals greater control over their health. The efficacy and effectiveness of the ASMP has been established in previous studies. This study in no way calls these into question. It does, however, suggest that the mechanism by which these effective outcomes are achieved warrants further investigation. / Graduate and Postdoctoral Studies / Graduate

published_or_final_version / Psychiatry / Master / Master of Philosophy

No description available.

The purpose of this investigation was to determine the validity and reliability of the Nicholas Manual Muscle Tester (NMMT), a portable dynamometer, as a measure of the isometric strength in women with arthritis. Female subjects (N=13; 66 �� 13.89 yrs.) with arthritis were tested for isometric muscle strength on the shoulder and hip (abduction, adduction, flexion, extension). Subjects were tested on three separate days using NMMT and Kincom 500-H dynamometers. Each subject performed three maximal isometric contractions for each joint action. A visual analog pain scale was used to determine level of pain prior to testing. Reliability values based on intraclass correlations coefficients (R) ranged from .85 to .93., with the exception of shoulder abduction being .49. Validity was determined correlating the mean value of the NMMT score with corresponding Kincom isometric measure. Pearson product moment correlations ranged from (r) .02 to .86, with 4 of 8 values meeting .05 level of significance. Correlation coefficients for pain and isometric force values were inconclusive and ranged from -.305 to .218. Major conclusions were: a) NMMT had high test-retest reliability in this sample; b) NMMT provides little criterion evidence of validity with the Kincom for most movements of hip and shoulder; c) level of pain was not a significant factor in subject reliability. / Graduation date: 1995