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Using Multivariate Statistics

▪ Abstract We review empirical and conceptual developments over the past four years (1992–1995) on attitudes and persuasion. A voluminous amount of material was produced concerning attitude structure, attitude change, and the consequences of holding attitudes. In the structure area, particular attention is paid to work on attitude accessiblity, ambivalence, and the affective versus cognitive bases of attitudes. In persuasion, our review examines research that has focused on high effort cognitive processes (central route), low effort processes (peripheral route), and the multiple roles by which variables can have an impact on attitudes. Special emphasis is given to work on cognitive dissonance and other biases in message processing, and on the multiple processes by which mood influences evaluations. Work on the consequences of attitudes focuses on the impact of attitudes on behavior and social judgments.

Attitudes and attitude change

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations

Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with selfcare options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).

/pdf/diagnosis-and-treatment-of-low-back-pain-a-joint-clinical-wx8jag77hu.pdf

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

Objectives. The Well-Being Questionnaire, originally developed in groups with diabetes, is recommended by the World Health Organization for widespread use. This study investigates the validity of the WBQ in patients with rheumatoid arthritis (RA) using structural equation modelling.



Design. Two case-control studies, comprising postal questionnaires are described.



Method. Questionnaires completed by RA patients (377) and matched controls (282) were analysed using structural equation modelling.



Results. The findings suggest that the full version of the WBQ is not suitable for use in RA populations. A shorter version, measuring positive and negative well-being fits the data better. Comparisons with matched controls and against the Hospital Anxiety and Depression Scale scores suggest that anxiety is measured well, but that the depression factor does not perform well. Positive well-being appears to be measured well.



Conclusion. Further research is necessary before the WBQ can be utilized in groups with RA.

The Well-Being Questionnaire: Testing the structure in groups with rheumatoid arthritis

Objectives: Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients’ psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow-up, in people with and without psychological risk. Methods: We tested the associations between specific reassurance components (data gathering, relationship building, generic reassurance, and cognitive reassurance), patients’ psychological risk (the presence of depression, anxiety, catastrophizing, or fear-avoidance), and postconsultation outcomes including, satisfaction and enablement, disability, pain, and mood at 3-month follow-up. Results: Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, whereas generic reassurance was significantly associated with postconsultation enablement. Generic reassurance was also associated with lower pain at 3 months, whereas cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at 3 months: high rates of generic reassurance were associated with lower depression in low-risk patients, but with higher rates of depression for high-risk groups. Discussion: The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Clinicians reassuring behaviors might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.

Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator: A Prospective Cohort Study.

The Attitudes and Beliefs of Clinicians Treating Back Pain: Do They Affect Patients’ Outcome?

Low back pain patients' responses to videos of avoided movements.

Introduction:This study aims to explore the relationships between beliefs about emotions, emotional suppression, distress and global impact (i.e. the extent to which a patient’s symptoms impact the...

Tamar Pincus

Papers

The Well-Being Questionnaire: Testing the structure in groups with rheumatoid arthritis

Testing a Model of Consultation-based Reassurance and Back Pain Outcomes With Psychological Risk as Moderator: A Prospective Cohort Study.

The Attitudes and Beliefs of Clinicians Treating Back Pain: Do They Affect Patients’ Outcome?

Low back pain patients' responses to videos of avoided movements.

Investigating the role of beliefs about emotions, emotional suppression and distress within a pain management programme for fibromyalgia.