Relationship of falls and fear of falling to activity limitations and physical inactivity in Parkinson's disease.

AIM: To investigate the relationships between falls, fear of falling, and activity limitations in individuals with Parkinson's disease (PD). DESIGN/METHODS: Cross-sectional study of individuals with mild to moderate PD (N = 83). Associations among demographic data, fall frequency, disease severity, motor impairment, ability to perform activities of daily living (ADL), Activities Balance Confidence Scale, Iowa Fatigue Scale, Comorbidity Index, and Physical Activity Scale for Elders were studied. RESULTS: Frequent fallers had more ADL limitations than nonfallers (p < .001) and rare fallers (p = .004). Frequent fallers reported a lower percentage of ability to perform ADL than nonfallers (p = .003). Frequent fallers and rare fallers were less physically active than nonfallers (p = .015 and p = .040, respectively). Frequent fallers and rare fallers reported a higher level of fear of falling than nonfallers (p = .031 and p = .009, respectively). CONCLUSIONS: Falls and fear of falling were associated with more ADL limitations and less physical activity after adjusting for physical impairments.

Determinants of use of a walking device in persons with Parkinson's disease.

OBJECTIVE: To identify determinants for the use of a walking device in persons with Parkinson's disease (PD). DESIGN: Cross-sectional study of participants with PD. SETTING: Laboratory. PARTICIPANTS: Persons with PD (N=85; 60 men) were studied. Their mean age was 69.4±8.9 years. The average time since diagnosis was 7.9±5.3 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Age, sex, disease duration, disease severity, and motor impairment were recorded. Participants were asked whether they usually used any walking device (eg, cane or walker) and were categorized as either an "independent walker" or a "device walker." Clinical balance measures including functional reach, turn duration, 5-meter timed Up and Go (5m-TUG) test, and Activities-specific Balance Confidence (ABC) scale were investigated for their contribution to the prediction of walking with a device. RESULTS: Thirty-one participants (36.5%) reported that they usually used a walking device. Classification and regression tree analysis determined that the 5m-TUG test and the ABC scale were important factors in differentiating participants who used a walking device from those who did not. Critical thresholds included 13 seconds for the 5m-TUG test and a score of 75 for the ABC scale in determining device walking. Using only these 2 determinants, the classification and regression tree model correctly classified 81% of the patients as either independent or needing a walking device. CONCLUSION: The 5m-TUG test and the ABC scale may be useful in clinical assessments of the need for a walking device in persons with PD.

Influence of fear of falling on gait and balance in Parkinson's disease.

PURPOSE: To study the relationship of fear of falling (FoF) with gait characteristics and balance in individuals with Parkinson's disease (PD). METHOD: Seventy-nine non-demented individuals (62 males) with PD were studied. Their mean age was 69.22 ± 8.93 years. The average time since diagnosis was 8.27 ± 5.31 years. FoF was assessed by the Activities-specific Balance Confidence (ABC) Scale in which high scores indicate less FoF. Gait was measured using a computerized walkway. Balance was measured by timed tests including the 5-step test, 360 degree turn, timed sideways walk, and timed up and go test. Participants were divided into two groups based on their ABC score (high FoF, ABC score <69; low FoF, ABC score ≥69). Gait characteristics and balance measures of the two groups were compared. RESULTS: Gait speed and stride length for forward walking (p < 0.0005 for both) and backward walking (p = 0.001 and 0.002, respectively) were lower for those with a high level of FoF compared to those with a low level of FoF. The time to take five steps (p = 0.025), time to turn (p < 0.0005), time to walk sideways (p = 0.001), and time to complete the up and go test (p = 0.003) were longer in those with a high level of FoF than in those with a low level of FoF. Number of steps to complete the turn (p = 0.001) and steps to walk sideways (p = 0.002) were greater in those with a high level of FoF than in those with a low level FoF. CONCLUSIONS: Gait and balance of individuals with PD with a high level of FoF were poorer than those with a low level of FoF, regardless of previous fall history. Implications for Rehabilitation The results demonstrates that fear of falling (FoF) is related to gait and balance in individuals with PD. Clinicians should be aware that FoF has a negative impact on gait and balance in individuals with PD.

Predictive validity of social support relative to psychological well-being in men with spinal cord injury.

PURPOSE: Compare predictive validity (relative to psychological well-being) of long and short versions of 2 measures of social support for persons with spinal cord injury (SCI). RESEARCH METHOD: Sixty-nine men with SCI completed (a) a long and short version of the Interpersonal Support Evaluation List (ISEL), (b) a structured interview regarding the frequency with which a person receives 11 kinds of support from each of their most important supporters (maximum of 5), and (c) a global measure of the same 11 kinds of support. Approximately 3 years later they completed 4 measures of psychological well-being--the Center for Epidemiologic Studies Depression scale (CESD), the Life Satisfaction Index A (LSIA), the Perceived Stress Scale (PSS), and the Rosenberg Self-Esteem Scale (RSES). Comparisons were made among the social support measures with regard to their ability to predict each of the 4 measures of psychological well-being at a later point in time. RESULTS: The long version of the ISEL had more predictive power than the long version of the structured interview. CONCLUSIONS: The long version of the ISEL is a good choice for measuring social support in persons with SCI and the short ISEL may be an acceptable choice when minimizing respondent burden is critical if the number of response options is increased to 4.

Reliability of the non-instrumented walk test in persons with Parkinson's disease.

PURPOSE: To study the reliability of a Non-Instrumented Walk Test in individuals with Parkinson's disease (PD). METHOD: Thirty individuals (21 Males) with PD were studied. Their mean age was 68.90 ± 9.28 years. The average time since diagnosis was 8.75 ± 5.68 years. The reliability of the manual Non-Instrumented Walk Test was studied while "OFF" and "ON" dopaminergic medication. Subjects walked at their self-selected, usual speed during a Non-Instrumented Walk Test and while walking on a computerized instrumented walkway. Intraclass correlation coefficients (ICCs) were calculated and means were compared for three gait parameters as measured by the two methods. RESULTS: During "OFF" medication testing, ICCs between the Non-Instrumented Walk Test and the instrumented measures for gait speed, cadence and stride length were 0.96 (p < 0.0005), 0.72 (p = 0.001) and 0.97 (p < 0.0005), respectively. During "ON" medication testing, the ICCs were 0.96 (p < 0.0005), 0.86 (p < 0.0005) and 0.96 (p < 0.0005), respectively. The means of the non-instrumented measures tended to be lower than those obtained on the instrumented walkway. CONCLUSIONS: The Non-Instrumented Walk Test is a quick, simple and inexpensive gait evaluation for individuals with PD. The method is sufficiently reliable to be used clinically in this population during different medication cycles. IMPLICATIONS FOR REHABILITATION: • The Non-Instrumented Walk Test in individuals with PD is reliable. • Results supported the use of the measure. This simple walk test is quick and easy to administer in both clinical and community settings.

Gait variability in Parkinson's disease: influence of walking speed and dopaminergic treatment.

OBJECTIVES: To study the effects of levodopa and walking speed on gait variability in individuals with Parkinson's disease (PD). METHODS: Thirty-three individuals with PD were studied. Their mean age was 70.61±9.23 year. The average time since diagnosis was 9.65±5.80 year. Gait variability was studied while 'OFF' and 'ON' dopaminergic medication when the subjects walked at their usual and fastest speeds. RESULTS: Variability of step time, double support time, stride length and stride velocity decreased significantly (P=0.037; P=0.037; P=0.022; P=0.043, respectively) after dopaminergic treatment. When subjects increased walking speed, the variability of stride length and stride velocity decreased significantly (P=0.038 and P=0.004, respectively) both while 'OFF' and 'ON' levodopa. Increasing walking speed did not change the variability of step time and double support time regardless of medication status. CONCLUSIONS: Levodopa decreased gait variability in persons with PD. Stride length and stride velocity variability appeared to be speed dependent parameters, whereas, the variability of step time and double support time appeared to be speed independent measures. Levodopa had positive effects on gait stability in PD.

Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi-site randomized controlled trial with a secondary 6-month open-label phase.

BACKGROUND: Chronic pain is a significant problem for many individuals following spinal cord injury (SCI). Unfortunately, SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments. Cranial electrotherapy stimulation (CES) has been effective in managing some types of pain. It involves the application of a small amount of current through the head via ear clip electrodes. OBJECTIVE: Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain. STUDY DESIGN: Multi-site, double-blind, sham-controlled study. PARTICIPANTS: Adults with SCI and chronic neuropathic pain at or below the level of injury were randomized to receive active or sham CES. INTERVENTION: Application of active CES or sham CES 1 hour daily for 21 days. Six-month open-label phase to assess 'as-needed' CES use. OUTCOME MEASURES: Change in pre- to post-session pain ratings as well as change in pain intensity, pain interference, pain quality, pain beliefs and coping strategies, general physical and mental health status, depressive symptomatology, perceived stress, and anxiety pre- to post-treatment. RESULTS: The active group reported a significantly greater average decrease in pain during daily treatments than the sham group (Kruskal-Wallis chi-square = 4.70, P < 0.05). During the 21-day trial, there was a significant group × time interaction for only one outcome variable; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did (F = 8.50, P < 0.01, d = 0.59). CONCLUSIONS: On average, CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects. Individual results varied from no pain relief to a great deal of relief.

Feasibility of using cranial electrotherapy stimulation for pain in persons with Parkinson's disease.

Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinson's disease (PD) with cranial electrotherapy stimulation (CES). Design. Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants. Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention. Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure. Average daily change in pain intensity. Results. Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon Z = -2.20, P = .028). Conclusion. Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided.

Effect of dronabinol on central neuropathic pain after spinal cord injury: a pilot study.

OBJECTIVE: To test the efficacy and safety of a cannabinoid, dronabinol, compared with an active control, diphenhydramine, in relieving neuropathic pain in persons with spinal cord injury. DESIGN: A randomized, controlled, double-blind, crossover pilot study. RESULTS: Seven adults with spinal cord injury and neuropathic pain below the level of injury participated. Two participants withdrew while receiving dronabinol, their first medication. For the remaining five participants, change in pain on a scale of 0-10 from baseline to the end of the maintenance phase did not differ significantly between the two medications (mean change, dronabinol: 0.20 ± 0.837, range = -1.00 to 1.00; diphenhydramine: -1.80 ± 2.490, range = -6.00 to 0; Wilcoxon Z = 1.63, P = 0.102). Similar results were found when the average of the two ratings during the maintenance phase was used (dronabinol: -0.20 ± 0.671, range = -0.50 to 1.00; diphenhydramine: -1.40 ± 1.245, range = -3.50 to -0.50; Wilcoxon Z = 1.60, P = 0.109). The most common side effects were dry mouth, constipation, fatigue, and drowsiness for both medications. CONCLUSIONS: On average, dronabinol was no more effective than diphenhydramine for relieving chronic neuropathic pain below the level of injury.

A pilot study: influence of visual cue color on freezing of gait in persons with Parkinson's disease.

PURPOSE: To investigate the effect of red and green light beams on gait and freezing of gait (FOG) in persons with Parkinson's disease (PD). METHODS: Seven persons with PD who experienced FOG participated in the study. Gait and turning performances were studied while walking with canes with red, green, and no light beams while "off" and "on" anti-Parkinsonian medications. Gait speed, cadence, and stride were recorded. Time and number of freezing episodes were recorded during a 50-foot walk and a 360° turn. RESULTS: During 'off' medication, compared to no light, stride length improved when using the green light, but not the red. During the 50-foot walk, freezing episodes were reduced when using the green light compared to both the red and no light. During the 360° turn, time, number of steps and number of freezing episodes were reduced using the green light compared to the red and no light. During 'on' medication, gait speed and stride length improved more with the green light compared to the red. Neither color showed any effect on cadence during either medication state. CONCLUSION: A green light improved gait and alleviate FOG in persons with PD better than a red light or no light.

Evaluation of a new device to prevent falls in persons with Parkinson's disease.

PURPOSE: To compare walking characteristics of individuals with Parkinson's disease (PD) using a new walking aid, the WalkAbout, with usual walking. METHOD: Fifteen subjects with PD were recruited. Subjects walked in their usual fashion and then walked again in the WalkAbout. Gait parameters, 5-min walk, and oxygen consumption were recorded. RESULTS: Stride lengths were shorter when using the WalkAbout. On an average, the distance walked in 5 min and the oxygen uptake was not different when walking with the WalkAbout compared with the usual walk. Eight subjects (responders) walked further with the WalkAbout compared to their usual walk (164.90 +/- 55.72 m vs. 140.82 +/- 55.94 m). Seven subjects (non-responders) walked a shorter distance while using the WalkAbout compared to their usual walk (241.79 +/- 73.06 m vs. 281.24 +/- 82.83 m). Compared to non-responders, responders were older, had more severe disability, and were more likely to use an assistive device for walking. Responders walked more slowly, had a shorter stride length, and walked shorter distances in 5 min than non-responders. CONCLUSION: The WalkAbout may help persons with PD who have more severe disability to walk farther. These data could be beneficial in selecting a helpful walking aid for persons with PD.

Effects of assistance dogs on persons with mobility or hearing impairments: a pilot study.

Service dogs help persons with mobility impairments by retrieving items and performing other tasks. Hearing dogs alert persons with hearing impairments to environmental sounds. We conducted a pre-post, wait list-controlled pilot study to assess the impact of the dogs on the lives of recipients. Participants were recruited through two assistance dog training organizations and completed an initial questionnaire packet. The Experimental group completed another packet 6 months after receiving a dog. The Control group completed a second packet 6 months after the initial data collection. On average, dog recipients were very satisfied with their assistance dogs. Both service and hearing dog recipients reduced their dependence on other persons. Service dog recipients reduced hours of paid assistance. No other significant change occurred in various standardized outcome measures. Assistance dogs had a major positive impact on the lives of recipients. More appropriate measurement instruments are needed to capture the impact of these dogs.

Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention.

OBJECTIVE: To test the hypothesis that enhanced education and structured follow-up after pressure ulcer surgery will result in fewer recurrences. DESIGN: Randomized controlled trial. SETTING: Veterans Affairs medical center. PARTICIPANTS: Forty-nine veteran men with spinal cord injury or dysfunction were approached on admission for pressure ulcer surgery. Five never had surgery, 2 refused to participate, and one withdrew. Forty-one were randomized into 3 groups. Three participants' ulcers did not heal, so follow-up could not begin. INTERVENTIONS: Group 1 received individualized pressure ulcer education and monthly structured telephone follow-up (n=20); group 2 received monthly mail or telephone follow-up without educational content (n=11); and group 3 received quarterly mail or telephone follow-up without educational content (n=10). Follow-up continued until recurrence, death, or 24 months. MAIN OUTCOME MEASURE: Time to pressure ulcer recurrence. RESULTS: Group 1 had a longer average time to ulcer recurrence or end of study than groups 2 and 3 (19.6 mo, 10.1 mo, 10.3 mo; P=.002) and had a smaller rate of recurrence (33%, 60%, 90%; P=.007). Survival analysis confirmed these findings (P=.009). CONCLUSIONS: Individualized education and structured monthly contacts may be effective in reducing the frequency of or delaying pressure ulcer recurrence after surgical repair of an ulcer.

Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury.

OBJECTIVE: To test the hypotheses that both amitriptyline and gabapentin are more effective in relieving neuropathic pain than an active placebo, diphenhydramine. DESIGN: Randomized, controlled, double blind, triple crossover 8-week trial. SETTING: Veterans Affairs medical center. PARTICIPANTS: Community dwelling adults with spinal cord injury (N=38) were recruited by telephone, letters, and flyers. INTERVENTION: Eight-week trial each of amitriptyline, gabapentin, and diphenhydramine. MAIN OUTCOME MEASURES: Pain intensity measured with a 10-cm visual analog scale (VAS) and an 11-point (0-10) numeric rating scale (NRS) and depressive symptomatology measured with the Center for Epidemiologic Studies Depression Scale-Short Form (CESD-SF). RESULTS: Baseline VAS scores for participants with low (< 10) CESD-SF scores was 4.61 and for those with high scores (> or = 10) it was 7.41. At week 8, in participants with high baseline CESD-SF scores, amitriptyline (mean, 4.21) was more effective than diphenhydramine (mean, 6.67; P=.035), and there was a nonsignificant trend suggesting that amitriptyline may be more effective than gabapentin (mean, 6.68; P=.061). Gabapentin was no more effective than diphenhydramine (P=.97). There was no significant difference among the medications for those with lower CESD-SF scores. Results could not be attributed to dropout rates, order or dose of medications, amount of medication taken for breakthrough pain, or side effects. CONCLUSIONS: Amitriptyline is more efficacious in relieving neuropathic pain than diphenhydramine at or below the level of spinal cord injury in people who have considerable depressive symptomatology.

Gender differences regarding career issues and promotion in academic physical medicine and rehabilitation.

OBJECTIVE: To assess gender differences in academic progress and attitudes toward promotion in academic physical medicine and rehabilitation (PM&R). DESIGN: A survey was sent to members of the Association of Academic Physiatrists (AAP). Questions addressed demographics, job description, hours worked, childcare responsibilities, publications, career aspirations, mentoring, and familiarity with promotion and tenure policies. Respondents were also asked about the relative importance of career aspects including the perceived benefits of and obstacles to promotion. Responses were anonymous. RESULTS: Women spent less time on scholarly activities. Women considered the fact that they disliked writing and did not know how to do research to be more important obstacles to promotion than did men. Women were more likely to have part-time appointments and lower academic rank. They had fewer children at home but greater responsibility for child care. Women were less likely to aspire to become full professor, they met less often with their department chair/supervisor, and they published fewer papers. Men and women reported equal career satisfaction. CONCLUSIONS: There are several gender differences in the values, attitudes, and priorities in academic PM&R. Women respondents were generally less interested in traditional academic pursuits than were their male counterparts.

Pain after spinal cord injury: an evidence-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures meeting.

BACKGROUND/OBJECTIVES: To examine the reliability, validity, sensitivity, and practicality of various outcome measures for pain after spinal cord injury (SCI), and to provide recommendations for specific measures for use in clinical trials. DATA SOURCES: Relevant articles were obtained through a search of MEDLINE, EMBASE, CINAHL, and PubMed databases from inception through 2006. STUDY SELECTION: The authors performed literature searches to find articles containing data relevant to the reliability and validity of each pain outcome measure in SCI and selected non-SCI populations. DATA EXTRACTION: After reviewing the articles, an investigator extracted information utilizing a standard template. A second investigator reviewed the chosen articles and the extracted pertinent information to confirm the findings of the first investigator. DATA SYNTHESIS: Taking into consideration both the quantity and quality of the studies analyzed, judgments on reliability and validity of the measures were made by the two investigators. Based upon these judgments, recommendations were formulated for use of specific measures in future clinical trials. In addition, for a subset of measures a voting process by a larger group of SCI experts allowed formulation of recommendations including determining which measures should be incorporated into a minimal dataset of measures for clinical trials and which ones need revision and further validity and reliability testing before use. CONCLUSIONS: A 0-10 Point Numerical Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI, while the 7-Point Guy/Farrar Patient Global Impression of Change (PGIC) scale is recommended as the outcome measure for global improvement in pain. The SF-36 single pain interference question and the Multidimensional Pain Inventory (MPI) or Brief Pain Inventory (BPI) pain interference items are recommended as the outcome measures for pain interference after SCI. Brush or cotton wool and at least one high-threshold von Frey filament are recommended to test mechanical allodynia/hyperalgesia while a Peltier-type thermotester is recommended to test thermal allodynia/hyperalgesia. The International Association for the Study of Pain (IASP) or Bryce-Ragnarsson pain taxonomies are recommended for classification of pain after SCI, while the Neuropathic Pain Scale (NPS) is recommended for measuring change in neuropathic pain and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) for quantitating neuropathic and nociceptive pain discrimination.

Perceived preparedness for physiatric specialization and future career goals of graduating postgraduate year IV residents during the 2004-2005 academic year.

OBJECTIVE: The purpose of this study was to evaluate trends among postgraduate year (PGY) IV physiatry residents, at the time of graduation from residency, in terms of their perceived experiences in the core clinical areas, confidence with procedural subspecialization, choice in career specialization, and desire to pursue clinical fellowship. DESIGN: Surveys were distributed to 386 PGY IV residents in physiatry at the end of the 2004-2005 academic year. RESULTS: Ninety-three residents (24%) completed responses in a confidential manner. Residents who were generally more confident in core clinical areas, as defined by the Self-Assessment Examination, and specialty prescription writing also believed themselves to be more prepared to practice these topics in their careers. Overall levels of confidence and perceived preparedness correlated positively with months of training and negatively with the belief in the need for postresidency fellowship training to incorporate these areas into clinical practice. Positive correlations also existed among perceived levels of preparedness in performing various physiatric procedures. Statistically significant differences in levels of confidence and preparedness existed among geographic regions when evaluating core physiatric subject matter. Fifty-six percent of residents who responded planned to pursue fellowship training, and a majority of residents intended to perform interventional procedures and musculoskeletal medicine in their practices. CONCLUSIONS: These results provide insight into how trainees perceive their current clinical education. With validation of measures for confidence and preparedness, this survey may be useful as an adjunct resource for residency programs to evaluate their trainees.

Physical medicine and rehabilitation conditions in the Astrodome clinic after hurricane Katrina.

OBJECTIVE: To report the physical medicine and rehabilitation (PMR) conditions seen in the Astrodome Clinic after Hurricane Katrina. DESIGN: Retrospective chart analysis from the county hospital-sponsored disaster-relief clinic in large urban city, including a study of 239 patients with 292 PMR conditions. The total number of patients seen in the Astrodome Medical Clinic was 11,245. The Astrodome database was reviewed for PMR condition diagnostic codes. A retrospective chart analysis was conducted, including date of visit, age, gender, ethnicity, and PMR diagnosis category. Descriptive statistics were obtained for the entire sample. chi2 or t tests were used to determine gender, age, or date-of-service predominance for the most common diagnostic categories. RESULTS: Mean +/- SD age was 45.7 +/- 14.3 yrs; 56% were women, 43% were men (1% unspecified), and 76% were African American. The majority (75%) of PMR conditions presented in the first week. Most frequent were swollen feet and legs (22%), leg pain and cramps (17%), headache (12%), and neck and back pain (10%). Persons with headaches were younger than those without (41.3 vs. 46.3 yrs, P = 0.048). Persons with neck and/or back pain were older than those without those conditions (51.3 vs. 44.8 yrs, P = 0.004). Women had more headaches (20.9%) than did men (6.7%, P = 0.002). There were no Caucasians with leg pain/cramps, whereas 20.2% of African Americans had this condition (P = 0.028). CONCLUSIONS: This study documents the time of clinic presentation and most frequent types of PMR conditions of patients treated in the Astrodome Clinic after a historic hurricane. Most PMR conditions were treated by PMR personnel during the first week. Thus, future disaster planning should include PMR professionals as early responders.

A pilot study of healing touch and progressive relaxation for chronic neuropathic pain in persons with spinal cord injury.

This pilot study assessed the role of Healing Touch (HT), an energy-based therapy, in modulating chronic neuropathic pain and the associated psychological distress from post spinal cord injury. Twelve veterans were assigned to either HT or guided progressive relaxation for six weekly home visits. The instruments selected showed sensitivity, although there was a large variation among the groups. There was a significant difference in the composite of interference on the Brief Pain Inventory (t = -2.71, p = .035). The mean score of the fatigue subscale of the Profile of Moods decreased (ns) in the HT group and in the subscale of confusion yet remained stable in the control group. The Diener Satisfaction With Life Scale showed increased well-being in the HT group and no change in the control group. Participants reported various experiences with HT sessions indicating that it may have benefit in the complex response to chronic pain.