Efficacy of a multimodal lifestyle intervention (The Lift Project) for improving the mental health of individuals with an affective mood disorder living in South Africa.

Background: Affective disorders are becoming more pervasive worldwide, including in Southern Africa, where treating patients with these conditions is challenging due to social and financial constraints. A variety of non-pharmacological approaches including lifestyle medicine (e.g., exercise, nutrition, sleep) and positive psychology practices (e.g., gratitude, service), are effective for treating mental health (MH) conditions. Methods: Twenty-six individuals from South Africa with a diagnosed MH condition participated in a 10-week multimodal intervention incorporating a diverse range of non-pharmacological strategies for improving MH. MH metrics were assessed pre-and post-intervention, including general MH, vitality/energy (VIT), depression, anxiety, stress, and satisfaction with life. MH and VIT were also measured weekly. Results: Improvements were observed in all mental metrics from pre-to post-intervention: MH (59%, p < 0.001, Cohen's D = 1.36), VIT (110%, p < 0.001, Cohen's D = 1.71), depression (-46%, p < 0.001, Cohen's D = -1.06), anxiety (-48%, p < 0.001, Cohen's D = -1.21), stress (-36%, p < 0.001, Cohen's D = -1.08) and life satisfaction (23%, p < 0.001, Cohen's D = 0.66). Significant improvements in MH and VIT were observed after only 1 week of the intervention and progressively increased until the seventh week, after which further improvements were not statistically significant. Conclusion: The findings of this cohort study indicate that a multimodal intervention that incorporates lifestyle and positive psychology practices may benefit individuals living with an affective disorder. Non-pharmacological, multimodal interventions might offer a stigma-free way of providing MH promotion and treatment at a population level.

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions.

PURPOSE: Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States. DESIGN: Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012. SETTING: Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012. SUBJECTS: Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years). MEASURES: Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose. ANALYSIS: Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes. RESULTS: The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen's d .1-.2). CONCLUSIONS: Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

Factors predicting the mental health of adolescents attending a faith-based Australian school system: a multi-group structural equation analysis.

Background: Adolescents attending Seventh-day Adventist schools (Adventist) in Australia tend to experience good health and exhibit better health behaviors than national norms, however few studies have investigated factors predicting their mental health.Aims: The aim of this study was to explore the complex network of factors that predict the mental health status (MHS) of adolescents attending Adventist schools in Australia.Methods: A survey instrument was used to collect data from 1527 secondary school students attending Adventist schools across Australia. Structural equation modeling was employed to examine concomitantly the direct and indirect effects of childhood experiences, present attitudes and selected health behaviors on MHS.Results: Childhood family dynamics had the strongest association with MHS (ßtotal = 0.33) followed by a sense of meaning and purpose (ßtotal = 0.27), perceived social misfit status (ßtotal = -0.19), and school academic performance (ßtotal = 0.18). Multi-group analysis found significant pathway differences in the model for gender with regards to the association of meaning and purpose, physical activity and sleep quantity with MHS.Conclusions: The outcomes of the study highlight the importance of early positive childhood family dynamics and the discovery of meaning and purpose during adolescence to promote positive mental health among adolescents.

HDL subfraction changes with a low-fat, plant-based Complete Health Improvement Program (CHIP).

BACKGROUND AND OBJECTIVES: Low HDL concentrations are considered an important risk factor for cardiovascular disease. Interventions promoting a low-fat, plant-based eating pattern appear to reduce CVD risk while paradoxically also reducing HDL concentrations. Recent studies show HDL to comprise a range of subfractions, but the role these play in ameliorating the risk of CVD is unclear. The purpose of this study was to characterise changes in HDL subfractions in participants where HDL decreased following the CHIP intervention which promotes a low-fat, plant-based diet, with physical activity. METHODS AND STUDY DESIGN: Individuals (n=22; mean age=55.4±16.3 years; 45.5% men, 54.5% women) participating in a CHIP intervention were assessed at baseline and 30 days for changes in BMI, blood pressure, lipid profile, (including large-, intermediate- and small-HDL subfractions) and fasting glucose. RESULTS: HDL significantly decreased (10.6%, p<0.001) together with BMI (2.5%, p=0.028), systolic blood pressure (7.1%, p=-0.005), total cholesterol (9.5%, p=0.002), LDL (11.2%, p=0.007) and fasting glucose (8.2%, p=0.028). Triglycerides (TG) did not significantly change. Physical activity (22.7%, p=0.016) and consumption of whole plant-foods (13.9%, p=0.003) significantly increased, while nonplant (energy and animal) foods decreased (43.1%, p=0.009). Large-, intermediate- and small-HDL decreased (-10.0%, p=0.003; -8.3%, p=0.013 and 22%, p=0.005, respectively). CONCLUSIONS: This paper discusses specific changes in HDL subfractions when overall-HDL decreases as a response to low fat, whole-food, plant-based eating and exercise. Additional research is required to elucidate the reasons through which behavioural therapies remodel the HDL particle and how this impacts the functional properties of HDL and CVD risk.

The association between self-rated health and social environments, health behaviors and health outcomes: a structural equation analysis.

BACKGROUND: The factors shaping the health of the current generation of adolescents are multi-dimensional and complex. The purpose of this study was to explore the determinants of self-rated health (SRH) of adolescents attending a faith-based school system in Australia. METHODS: A total of 788 students attending 21 Seventh-day Adventist schools in Australia responded to a health and lifestyle survey that assessed SRH as well as potential determinants of SRH including the health outcomes mental health, vitality, body mass index (BMI), select health behaviors, social factors and personal demographics. Structural equation modeling was used to analyze the data and examine the direct and indirect effects of these factors on SRH. RESULTS: The structural model developed was a good fit with the data. The health outcome mental health had the strongest association with SRH (ß = 0.17). Several upstream variables were also associated with higher SRH ratings. The health behavior sleep hours had the strongest association with SRH (ßtotal = 0.178) followed by fruit/vegetable consumption (ßtotal = 0.144), physical activity (ßtotal = 0.135) and a vegetarian diet (ßtotal = 0.103). Of the demographic and social variables measured, adverse childhood experiences (ACEs) had the strongest association with SRH (ßtotal = - 0.125), negatively influencing SRH, and gender also associated with an increase in SRH (ßtotal = 0.092), with the influence of these factors being mediated through other variables in the model. CONCLUSIONS: This study presents a conceptual model that illustrates the complex network of factors concomitantly associated with SRH in adolescents. The outcomes of the study provide insights into the determinants of adolescent SRH which may inform priority areas for improving this construct.

Religious Affiliation Influences on the Health Status and Behaviours of Students Attending Seventh-Day Adventist Schools in Australia.

Students attending Seventh-day Adventist (Adventist) schools in Australia have been shown to have better health status and behaviours compared to secular norms, yet these schools cater for a high percentage of non-Adventist students. The purpose of this study was to investigate the influence of religious affiliation (Adventist/non-Adventist) on the health status and behaviours of students attending Adventist secondary schools in Australia. The sample included 1734 students who responded to a health and lifestyle survey that captured demographic details, self-reported height and weight, self-reported health status, mental health and select health behaviours. Students who identified themselves as Adventist reported significantly better health behaviours than the non-Adventist students in several behavioural domains, especially among the male students. However, this did not translate to a difference in health status. Further research is needed to understand the causal mechanisms responsible for the potential health advantage of Adventist students, which may include family or church religious influences.

The Body Mass Index of Adolescents Attending Seventh-Day Adventist Schools in Australia: 2001-2012.

BACKGROUND: We examined the body mass index (BMI) of students attending Seventh-day Adventist (Adventist) schools in Australia in 2001 and 2012. METHODS: A total of 3069 students attending Adventist schools in Australia responded to a health and lifestyle survey in 2001 (N = 1335) and 2012 (N = 1734). The survey captured self-reported height and weight, demographics (age, sex, year level, religion), and select health behaviors. RESULTS: Compared with national norms, lower rates of overweight and obesity were observed in the study cohort, but higher rates of underweight. There was no change in the mean BMI of the students attending Adventist schools in Australia from 2001 to 2012. Regression analyses indicated that a lower BMI was associated with age, sex, more regularly eating breakfast, consuming less soft drink, and having a regular exercise program. The students reported a high consumption of fruits, vegetables, and whole grains compared with Australian national norms, and 29% claimed to be vegetarian. CONCLUSIONS: Students attending Adventist schools appear to have a lower prevalence of overweight and obesity than the secular population, but a higher prevalence of underweight. The mechanisms through which Adventist schools may influence student's BMI warrants further investigation.

Optimizing the Intensity of Lifestyle Medicine Interventions: Similar Outcomes for Half the Sessions.

Lifestyle medicine interventions are typically intensive by design. This study explored the optimal "dosage" of a well-known lifestyle medicine intervention-the Complete Health Improvement Program (CHIP). A total of 2383 individuals (mean age = 61.0 ± 9.2 years; 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P < .01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P < .01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective.

The Complete Health Improvement Program (CHIP): History, Evaluation, and Outcomes.

The Complete Health Improvement Program (CHIP) is a premier lifestyle intervention targeting chronic disease that has been offered for more than 25 years. The intervention has been used in clinical, corporate, and community settings, and the short-term and long-term clinical benefits of the intervention, as well as its cost-effectiveness, have been documented in more than 25 peer-reviewed publications. Being an easily administered intervention, CHIP has been presented not only by health professionals but also by non-health-trained volunteers. The benefits of the program have been extensively studied under these 2 delivery channels, consistently demonstrating positive outcomes. This article provides a brief history of CHIP and describes the content and structure of the intervention. The published evaluations and outcomes of the intervention are presented and discussed and future directions are highlighted.

Gender differences in effectiveness of the Complete Health Improvement Program (CHIP).

OBJECTIVE: To determine the differential effect of gender on outcomes of the Complete Health Improvement Program, a chronic disease lifestyle intervention program. DESIGN: Thirty-day cohort study. SETTING: One hundred thirty-six venues around North America, 2006 to 2009. PARTICIPANTS: A total of 5,046 participants (33.5% men, aged 57.9 ± 13.0 years; 66.5% women, aged 57.0 ± 12.9 years). INTERVENTION: Diet, exercise, and stress management. MAIN OUTCOME MEASURES: Body mass index, diastolic blood pressure, systolic blood pressure, lipids, and fasting plasma glucose (FPG). ANALYSIS: The researchers used t test and McNemar chi-square test of proportions, at P < .05. RESULTS: Reductions were significantly greater for women for high-density lipoprotein (9.1% vs 7.6%) but greater for men for low-density lipoprotein cholesterol (16.3% vs 11.5%), total cholesterol (TC) (13.2% vs 10.1%), triglycerides (11.4% vs 5.6%), FPG (8.2% vs 5.3%), body mass index (3.5% vs 3%), diastolic blood pressure (5.5% vs 5.1%), and TC/high-density lipoprotein (6.3% vs 1.4%) but not different for systolic blood pressure (6% vs 5%). The greatest reductions were in participants with the highest baseline TC, low-density lipoprotein, triglycerides, and FPG classifications. CONCLUSIONS AND IMPLICATIONS: The Complete Health Improvement Program effectively reduced chronic disease risk factors among both genders, but particularly men, with the largest reductions occurring in individuals at greatest risk. Physiological or behavioral factor explanations, including differences in adiposity and hormones, dietary intake, commitment and social support, are explored. Researchers should consider addressing gender differences in food preferences and eliciting commitment and differential support modes in the development of lifestyle interventions such as the Complete Health Improvement Program.

Gender differences in effectiveness of the Complete Health Improvement Program (CHIP) lifestyle intervention: an Australasian study.

ISSUE ADDRESSED: Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Among US CHIP participants, differences in gender responsiveness to improvements in chronic disease risk factors were demonstrated. This study examined gender differences in outcomes to the CHIP intervention in Australasia. METHODS: Changes in body weight, blood pressure (BP), blood lipid profile and fasting plasma glucose (FPG) were assessed in 925 participants (34.3% men, mean age=56.0±12.5 years; 65.7% women, mean age=54.4±13.5 years) 30 days after program commencement. RESULTS: Significant reductions (P<0.001) in all biometrics measured were found for men and women but were greater among men for total (TC) and low-density lipoprotein cholesterol (LDL), triglycerides (TG), FPG, body mass index (BMI) and TC/high-density lipoprotein cholesterol (HDL) ratio. Participants with highest baseline classifications of BMI, systolic BP, blood lipids and FPG showed greatest reductions in 30 days. CONCLUSIONS: CHIP more effectively reduced chronic disease risk factors among men than women. All participants, but particularly men, entering the program with the greatest risk achieved the largest reductions. Possible physiological or behavioural factors include food preferences, making commitments and differential support modes. SO WHAT?: Developers of lifestyle intervention programs should consider gender differences in physiological and behavioural factors when planning interventions. In particular, developers should manage expectations of people entering lifestyle interventions to increase awareness that men tend to respond better than women. In addition, this is a call for further research to identify the underlying mechanisms responsible for the disproportionate responsiveness of males.

The Complete Health Improvement Program (CHIP) and reduction of chronic disease risk factors in Canada.

PURPOSE: The short-term effectiveness of the nutrition-centred Complete Health Improvement Program (CHIP) lifestyle intervention for improving selected chronic disease risk factors was examined in the Canadian setting. METHODS: A total of 1003 people (aged 56.3 ± 12.1 years, 68% female) were self-selected to participate in one of 27 CHIP interventions hosted in community settings by Seventh-day Adventist churches throughout Canada, between 2005 and 2011. The program centred on the promotion of a whole-food, plant-based eating pattern, and daily physical activity was also encouraged. Biometric measures, including body mass index (BMI), blood pressure (BP), blood lipid profile, and fasting blood sugar (FBS), were determined at program entry and 30 days into the intervention. RESULTS: Over 30 days, significant overall reductions (P<0.001) were recorded in the participants' BMI (-3.1%), systolic BP (-7.3%), diastolic BP (-4.3%), total cholesterol ([TC] -11.3%), low-density lipoprotein cholesterol ([LDL-C] -12.9%), triglycerides ([TG] -8.2%), and FBS (-7.0%). Participants with the highest classifications of TC, LDL-C, TG, and FBS at program entry experienced approximately 20% reductions in these measures in 30 days. CONCLUSIONS: The CHIP intervention, which centres on a whole-food, plant-based eating pattern, can lead to rapid and meaningful reductions in chronic disease risk factors in the Canadian context.

The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL levels and the implications for metabolic syndrome status - a cohort study.

BACKGROUND: Low levels of high-density lipoproteins (HDL) are considered an important risk factor for cardiovascular disease and constitute one of the criteria for the Metabolic Syndrome (MetS). Lifestyle interventions promoting a low-fat, plant-based eating pattern appear to paradoxically reduce cardiovascular risk but also HDL levels. This study examined the changes in MetS risk factors, in particular HDL, in a large cohort participating in a 30-day lifestyle intervention that promoted a low-fat, plant-based eating pattern. METHODS: Individuals (n = 5,046; mean age = 57.3 ± 12.9 years; 33.5% men, 66.5% women) participating in a in a Complete Health Improvement Program (CHIP) lifestyle intervention within the United States were assessed at baseline and 30 days for changes in body mass index (BMI), blood pressure (BP), lipid profile and fasting plasma glucose (FPG). RESULTS: HDL levels decreased by 8.7% (p<0.001) despite significant reductions (p<0.001) in BMI (-3.2%), systolic BP (-5.2%), diastolic BP (-5.2%), triglycerides (TG; -7.7%), FPG (-6.3%), LDL (-13.0%), total cholesterol (TC, -11.1%), TC: HDL ratio (-3.2%), and LDL: HDL ratio (-5.3%). While 323 participants classified as having MetS at program entry no longer had this status after the 30 days, 112 participants acquired the MetS classification as a result of reduction in their HDL levels. CONCLUSIONS: When people move towards a low-fat, plant-based diet, HDL levels decrease while other indicators of cardiovascular risk improve. This observation raises questions regarding the value of using HDL levels as a predictor of cardiovascular risk in populations who do not consume a typical western diet. As HDL is part of the assemblage of risk factors that constitute MetS, classifying individuals with MetS may not be appropriate in clinical practice or research when applying lifestyle interventions that promote a plant-based eating pattern.

Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort study.

OBJECTIVE: To examine the long-term (three or more years) effectiveness of the volunteer-delivered Complete Health Improvement Program (CHIP) intervention. DESIGN: Cohort study. SETTING: Hawera, New Zealand. PARTICIPANTS: Of the total cohort of 284 individuals who self-selected to complete the CHIP lifestyle intervention between 2007 and 2009, 106 (37% of the original cohort, mean age=64.9±7.4 years, range 42-87 years; 35% males, 65% female) returned in 2012 for a complimentary follow-up health assessment (mean follow-up duration=49.2+10.4 months). INTERVENTION: 30-day lifestyle modification programme (diet, physical activity, substance use and stress management) delivered by volunteers in a community setting. MAIN OUTCOME MEASURES: Changes in body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG). RESULTS: After approximately 4 years, participants with elevated biometrics at programme entry maintained significantly lowered BMI (-3.2%; 34.8±5.4 vs 33.7±5.3 kg/m(2), p=0.02), DBP (-9.4%; 89.1±4.1 vs 80.8±12.6 mm Hg, p=0.005), TC (-5.5%; 6.1±0.7 vs 5.8±1.0 mmol/L, p=0.04) and TG (-27.5%; 2.4±0.8 vs 1.7±0.7 mmol/L, p=0.002). SBP, HDL, LDL and FPG were not significantly different from baseline. Participants with elevated baseline biometrics who reported being compliant to the lifestyle principles promoted in the intervention (N=71, 67% of follow-up participants) recorded further reductions in BMI (-4.2%; 34.8±4.5 vs 33.4±4.8 kg/m(2), p=0.02), DBP (-13.3%; 88.3±3.2 vs 77.1±12.1 mm Hg, p=0.005) and FPG (-10.4%; 7.0±1.5 vs 6.3±1.3 mmol/L, p=0.02). CONCLUSIONS: Individuals who returned for follow-up assessment and entered the CHIP lifestyle intervention with elevated risk factors were able to maintain improvements in most biometrics for more than 3 years. The results suggest that the community-based CHIP lifestyle intervention can be effective in the longer term, even when delivered by volunteers.

The effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for reducing selected chronic disease risk factors: a feasibility study.

AIM: To examine the effectiveness within the Australasian context of the Complete Health Improvement Program (CHIP) lifestyle intervention, which has been shown to produce meaningful reductions in selected chronic disease risk factors in the United States. METHODS: Changes in body weight, blood pressure, blood lipid profile and fasting plasma glucose were assessed in 836 self-selected participants (age=55.9 plus or minus 12.7 yrs, 35% male/65% female) from 18 sites throughout New Zealand (N=731) and Australia (N=105). RESULTS: In the 30 days of the program, significant overall reductions (p<0.001) were recorded in the participants' body mass (-3.8%; 87.1 plus or minus 22.4 versus 83.9 plus or minus 21.5 kg), systolic blood pressure (-5.6%; 135 plus or minus 19 versus 127 plus or minus 17 mmHg), diastolic blood pressure (-4.6%; 80 plus or minus 12 versus 76 plus or minus 12 mmHg), total cholesterol (-14.7%; 5.17 plus or minus 1.08 versus 4.41 plus or minus 0.96 mmol/L), low-density lipoprotein cholesterol (-17.9%; 3.17 plus or minus 0.95 versus 2.60 plus or minus 0.83 mmol/L), triglycerides (-12.5%; 1.51 plus or minus 0.98 versus 1.32 plus or minus 0.71 mmol/L) and fasting plasma glucose (-5.6%; 5.55 plus or minus 1.49 versus 5.24 plus or minus 1.11 mmol/L). Participants at program entry with the highest classifications of total cholesterol, low-density lipoprotein, triglycerides and fasting plasma glucose experienced over 20% reductions in these measures in 30 days. CONCLUSIONS: Significant reductions in selected chronic disease risk factors were observed in 30 days using the CHIP intervention and the improvements were comparable to that observed in cohorts from the United States. The results of this feasibility study indicate that lifestyle interventions like CHIP may be useful for combating the burgeoning epidemic of chronic disease and further research is warranted.

Effectiveness of a volunteer-delivered lifestyle modification program for reducing cardiovascular disease risk factors.

Lifestyle modification has been demonstrated to effectively reduce the risk factors associated with cardiovascular disease, but there is a perception that it is costly to administer and resource. The present study examined the results achieved by a 30-day lifestyle modification program (Coronary Health Improvement Project) delivered by volunteers in a community setting. Changes in selected biometric measures of 5,070 participants in the Coronary Health Improvement Project programs delivered throughout North America (January 2006 to October 2009), were assessed. Overall, significant reductions (p < 0.001) were recorded in body mass (-3.2%), systolic and diastolic blood pressure (-4.9% and -5.3%, respectively), total cholesterol (-11.0%), low-density lipoprotein cholesterol (-13.0%), triglycerides (-7.7%), and fasting plasma glucose (-6.1%). Stratification of the data revealed more dramatic responses in those presenting with the greatest risk factor levels. Those presenting with cholesterol levels >280 mg/dl recorded an average reduction of 19.8%. A mean decrease of 16.1% in low-density lipoprotein levels was observed among those who entered the program with a low-density lipoprotein level >190 mg/dl. Individuals who presented with triglycerides >500 mg/dl recorded a mean reduction of 44.1%. The Framingham assessment forecast that approximately 70 cardiac events would be averted during the subsequent decade in the cohort because of the program. In conclusion, significant reductions in cardiovascular disease risk factors can be achieved in a 30-day lifestyle intervention delivered by volunteers, providing a cost-effective mode of administering lifestyle medicine.

The Bournemouth Questionnaire as an outcome measure in the rehabilitation of a person suffering with mechanical neck and arm pain and concurrent Charcot-Marie-Tooth disease: a case report.

OBJECTIVE: The objective of this paper was to present a report in which the Bournemouth Questionnaire was used as an outcome measure in the treatment and rehabilitation of an individual previously diagnosed with Charcot-Marie-Tooth disease and concurrently suffering with mechanical neck and arm pain. DESIGN ARCHITECTURE: This was a retrospective case report. SAMPLE PROFILE: An individual over 18 years of age previously diagnosed with Charcot-Marie-Tooth disease and now suffering with mechanical neck and arm pain. The individual is free from other illnesses and the individual is free from contra-indications to chiropractic care and rehabilitation. OUTCOME MEASURES: The outcome measures of this case report were based on the Bournemouth Neck Questionnaire. METHOD: The course of treatment involved diversified chiropractic manipulative therapy of involved joints, soft tissue therapy and specific rehabilitative postural exercises. Outcome measures were compared to pretreatment baselines. The Bournemouth Neck Questionnaire was completed at weeks 0, and 6. The length of the study was 6 weeks. Re-evaluation of treatment occurred at similar intervals. RESULTS: The Bournemouth patient raw scores pre-intervention were 6, 3, 2, 7, 2, 4, 2 with a total score of 26/70. Post intervention raw scores were 4, 2, 0, 7, 1, 2, 1 with a total score of 17/70. The percentage change score was 34.6. CONCLUSION: The change in raw scores was not clinically important. The percentage change score is considered indicative of clinically important change. The following two questions for further study are presented. Can the questions relating to depression and mood in the Bournemouth Questionnaire be used as a clinical indicator of adherence to home exercise programs? Can the Bournemouth Questionnaire be used as an appropriate outcome measure of non-specific musculoskeletal pain in individuals suffering from Charcot-Marie-Tooth disease?