ABSTRACT
The growing emphasis on achieving therapeutic practice that is informed by research evidence or 'evidence-based' has been well documented. However, if therapists are to operate effectively within evidence-based services, it is necessary to develop a better understanding of factors that influence their attitudes towards research in routine clinical work. Within this context, there is a need to re-examine the scientist-practitioner model as potentially complementing or competing with evidence-based practice. This study explores the beliefs about research and the scientist-practitioner model amongst a diverse group of therapists whose work is contextualized by evidence-based practice. In-depth, qualitative interviews were used to elicit significant themes that related to current practices, previous training and contact with other professionals. The findings suggest that the therapists' beliefs were shaped by different levels of influence that range from personal values to organizational and political issues. The results also highlighted how the therapists had constructed more idiosyncratic definitions of the scientist-practitioner model that related to perceptions of its value. Implications for further research, training and practice are discussed.
Subject(s)
Attitude , Counseling , Evidence-Based Medicine , Psychotherapy , Science , Humans , Professional Competence , WorkforceABSTRACT
This study reports the cognitive abnormalities of a group of 58 patients with definite multiple sclerosis (MS). The psychometric functions measured were: 'IQ deficit', verbal and visual memory, abstracting ability, visual and auditory attention and naming ability. The presence of brain pathology was investigated using magnetic resonance imaging (MRI). A group of 46 physically disabled controls without significant brain disease was used for comparison. Normative MRI data were obtained from a group of 40 normal volunteers. The psychometric performance of the MS group was compared to the previously reported findings in patients with clinically isolated syndromes. MS patients had widespread cognitive deficits sparing naming ability and affecting verbal memory less severely than other intellectual functions. The overall performance on psychometric tests was related to the severity of the MRI abnormalities and to the duration of the illness, but was not significantly influenced by the presence of psychiatric morbidity or the degree of physical disability. Patients with clinically isolated syndromes occupied an intermediate position between MS patients and disabled controls in terms of cognitive and MRI abnormalities.
Subject(s)
Brain Damage, Chronic/psychology , Magnetic Resonance Imaging , Multiple Sclerosis/psychology , Neurocognitive Disorders/psychology , Neuropsychological Tests , Activities of Daily Living/psychology , Adult , Aged , Attention/physiology , Brain/pathology , Brain Damage, Chronic/diagnosis , Cohort Studies , Female , Humans , Intelligence/physiology , Male , Mental Recall/physiology , Middle Aged , Multiple Sclerosis/diagnosis , Nervous System Diseases/diagnosis , Nervous System Diseases/psychology , Neurocognitive Disorders/diagnosis , Neuropsychological Tests/statistics & numerical data , Psychometrics , Wechsler Scales/statistics & numerical dataABSTRACT
Twenty-three patients with multiple sclerosis (MS) and 1 patient with isolated optic neuritis (mean age 37.5 yrs, average duration of disease 10 yrs) were tested with auditory and visual cognitive event-related potentials (ERPs) using an oddball paradigm. The results were compared with data from 19 age-matched healthy controls. All patients had magnetic resonance imaging (MRI) head scans and 19 had comprehensive neuropsychological testing. The stimulus-related components of the ERPs were normal for nearly all patients, but 10 showed abnormalities of the later cognitive-related components and another 3 had waveforms in which the cognitive components could not be identified. These abnormalities were found mainly for the auditory test. Of these 13 patients, 11 had significantly prolonged reaction times (RT) or reduced target recognition performance. Five of 8 MS patients with normal IQ and memory function tests had abnormal ERPs with the reverse being true for 4 of 10 patients. Patients with abnormal ERPs showed a higher MRI cerebral lesion score and had a longer duration of illness and greater physical disability than patients with normal ERPs. It is concluded that the generation of ERPs is in part dependent on the integrity of cerebral white matter and that ERPs may indicate subtle degrees of cognitive dysfunction not always detected by standard tests of intellect.
Subject(s)
Evoked Potentials , Multiple Sclerosis/physiopathology , Adult , Brain/pathology , Cognition/physiology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis/diagnosis , Multiple Sclerosis/psychology , Neuropsychological Tests , Reaction Time , Regression AnalysisABSTRACT
This study reports the performance on psychometric tests of a group of 48 patients with clinically isolated lesions of the type seen in multiple sclerosis (optic neuritis, brainstem and cord lesions). The cognitive functions studied were: 'IQ deficit', verbal and visual memory, abstracting ability, visual and auditory attention, and naming ability. The presence of brain pathology was investigated by means of magnetic resonance imaging (MRI). A group of 46 patients with rheumatic and neurological conditions not known to cause brain disease was used for comparison. Normative MRI data were obtained from a group of 40 normal volunteers. An overall 'Cognitive Ability Index' was significantly worse in patients with clinically isolated lesions when compared with physically disabled controls. IQ deficit and defective auditory attention were the more severely affected parameters. These deficits were significantly correlated with the duration of neurological symptoms and with the degree of brain pathology detected by MRI.
Subject(s)
Cognition Disorders/etiology , Multiple Sclerosis/complications , Adult , Aged , Brain/pathology , Cognition Disorders/diagnosis , Cognition Disorders/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis/pathology , Multiple Sclerosis/psychology , PsychometricsABSTRACT
This study reports the psychiatric morbidity in 76 patients with clinically isolated lesions of the type seen in multiple sclerosis (optic neuritis, brain stem and cord lesions). The presence or absence of brain pathology was investigated using magnetic resonance imaging (MRI). A group of 33 patients suffering from rheumatic and neurological conditions not known to involve the brain was used for comparison. Normative MRI data were obtained from a group of 40 normal volunteers. Over half of the patients with the clinical presentation of single lesions had MRI abnormalities in the brain, but past and present psychiatric morbidity were similar in patients and controls and no significant associations were found between the presence of MRI abnormalities and psychiatric morbidity. The degree of social stress experienced by the patients with clinically isolated lesions appeared to be highly relevant in the causation of psychiatric symptoms.
