Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.

OBJECTIVE: To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain. DESIGN: A double-blind prospective randomized controlled trial. SETTING: Physical therapy outpatient department, tertiary care. PATIENTS: Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44). INTERVENTIONS: Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months. MAIN OUTCOME MEASURES: Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance. RESULTS: The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program. CONCLUSION: The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.

The standard of care is not so standard.

Malpractice lawsuits affect most physicians at some point in their career. Proving that malpractice has been committed is based on substantiation of a variety of elements, including that the patient was rendered care that was "below the standard" of care. While many physicians believe that the "standard" will be judged objectively on the basis of published scientific sources and accepted conventions, the standard is established rather by the testimony of expert witness(es). It is the expert testimony that sets the standard and is proof of the standard. The testimony is open for acceptance or rejection by the judge or jury for a variety of nonscientific reasons. We review what the defendant doctor might expect regarding proof required to establish breach of the standard of care and what the prudent expert should be obliged to demonstrate.

Cortical activity of good and poor spatial test performers during spatial and verbal processing studied with Slow Potential Topography.

Whether essential processing of spatial information is lateralized asymmetrically in the human cortex is still a matter of debate. In this study, items of an Item Response Theory calibrated test for spatial ability were used to ensure stimulus homogeneity and validity. Subjects were preselected as extreme groups of good and poor spatializers. Mapping of true DC-recorded slow potential shifts (SPSs) resulted in distinctly discriminable topographies with spatial and verbal-analytic material as well as with spatial performance groups within the spatial block. Left fronto-central negativity maxima in the verbal condition clearly contrasted with occipito-parietal peak activity in the spatial condition. Poor spatializers showed higher amplitudes as well as a tendency to asymmetric activity in right parietal (parieto-temporal) areas, whereas in good spatializers the activity was localized symmetrically in occipital and occipito-parietal regions. The findings emphasize the importance of the right posterior cortex for spatial processing (negativity maxima at occipital and right parietal sites) and suggest a task-specific lower cortical efficiency or, seen from a processing perspective, a higher Investment of Cortical Effort (ICE) on the part of poor spatializers.

The elements of medical malpractice: an overview.

Most physicians will be involved in a medical malpractice case sometime in their career in one of several capacities, such as defendant, a treating physician, or an expert witness. Providing that malpractice has been committed is based on substantiation of a variety of elements and issues. This article offers an overview of the basic theories or types of claims of malpractice: 1) lack of due care; 2) lack of informed consent/battery; 3) vicarious liability/respondent superior/negligent supervision; 4) injury to third parties; and 5) abandonment. While these elements hold true in general, the laws of malpractice, the procedures involved, and the judicial process vary from state to state and from country to country.

Microparticle enzyme immunoassay (MEIA) for toxoplasma specific immunoglobulin G in comparison to the Sabin-Feldman dye test. A pilot study.

The microparticle enzyme immunoassay (MEIA) for detection of Toxoplasma specific IgG antibodies was compared to the Sabin-Feldman dye test (DT) as reference in 843 serum samples from a cohort of 757 pregnant women. The overall correlation for individual measurements was highly significant (R = 0.9446, p < 0.0001). DT and specific IgM combined allowed definition of 3 groups of patients: group 1 (no infection), group 2 (latent infection), group 3 (acute infection). A significant difference was found between the groups for the corresponding IgG values, as determined by the MEIA method, which allowed the following cut-off points to be laid down: group 1: 0-5.2 IU/ml, group 2: 5.3-187.5, and group 3: 187.6 IU/ml and higher. The validity of the cut-off points was tested in a subgroup of 57 patients who underwent serological follow-up during pregnancy. All 15 acutely- and 14 non-infected women, as well as 25 out of 28 latent infections were identified correctly. 3 latent infection were allocated falsely as acute. The threshold values presented in this report need to be confirmed in a large prospective study.

Empirical contribution to the question of sex-dependent inheritance of spatial ability.

The X-linked recessive gene hypothesis, a theory to predict the mode of genetic inheritance of spatial ability, was tested using a new Rasch-calibrated space test, the Three-dimensional Cube Test (Gittler, 1990). This allowed solving the homogeneity problem (insufficient unidimensionality of test material) by which earlier research in this field was affected. The empirical correlations from our sample of 134 families were compared with the theoretically predicted values. Present data do no corroborate the model; however, the problems of its general falsification are discussed. The fact that differences in performance in favour of males exist in the parental generation but not in the filial generation accentuates the importance of environmental factors.

[Adolescents and computers: attitude, personality and motive for interaction]. / Jugendliche und Computer: Einstellungen, Persönlichkeit und Interaktionsmotive.

This empirical study was undertaken to clarify controversial points emanating from previous theoretical and empirical papers dealing with apparently negative consequences on the personality development of young people who have at least a causal working-acquaintance with computers. We tested 174 persons of both sexes (age: 14-18 years) with a "Computer-Attitude-Questionnaire" and the "Mehrdimensionaler Persönlichkeitstest für Jugendliche" (Schmidt, 1981; "Multidimensional-Personality-Test"). A subgroup of 63 persons who have access to and do avail themselves of computers on a regular basis (as leisure-time activity) also answered the "Computer-Motive-Questionnaire". Statistical analyses revealed that the personality test-values of young people with a positive attitude toward computers range within the test-norm. The data for these people describe them as stress resistant, emotionally stable, well-balanced, sociable, achievement-oriented, and less aggressive.