As long as geriatric patients are able to communicate verbally, they are most likely to profit from the structured pain interview in spite of existing cognitive impairment. A MMSE score <10 indicates that the interpretation of the data obtained may be difficult, especially due to a high frequency of missing values.
Sixteen experienced and 15 inexperienced observers watched videotapes showing participants of a back school program perform simple tasks to assess the functional adequacy of their posture. They had received basis or more extensive observer training. Intraclass correlation coefficients were computed as a measure of intra-and interobserver reliability. When individual judgments were compared, it was found that the judgments of the experienced observers were more reliable than those of the inexperienced observers. The additional observers training did not lead to a significant augmentation of reliability. By selecting the most reliable items two alternative measures of overall posture were constructured whose reliability coefficients ranged fromr=0.89 to 0.93 for the group of experienced observers. The reliability of the judgments by the more extensively trained inexperienced observers was also satisfactory. The observation method presented here can thus be regarded as a reliable and potentially valid instrument for assessing the outcome of back school programs.
Es wird ein statistisches Prüfverfahren für den Vergleich von Verteilungen vorgestellt, die am angemessensten auf einer Ordinalskala abgebildet werden können. Nach einer ausführlichen Darstellung des Rechenverfahrens wird auf Möglichkeiten der Interpretation der Ergebnisse, Vorund Nachteile der Methode sowie auf den Einsatz der Methode als Standardisierungsverfahren eingegangen.
A primary goal of pain treatment in geriatric patients is the maintenance of physical and mental functions. This is a precondition for activity and participation. In patients with chronic pain, multidisciplinary treatment, without excluding invasive procedures, is the most effective approach. The medication ladder, initially suggested by the WHO for cancer pain, provides a guideline for pharmacological treatment. Due to age-dependent alterations in the kinetics and dynamics of pharmaceuticals, the titration of the medication follows the rule "start low-go slow". The same principle holds true for the maintenance or augmentation of physical activity in order to escape from the activity-deconditioning cycle. Training should be based on learning theories, include pain management strategies, and incorporate psychological approaches to facilitate the active participation of the patient in the treatment program. In hospitals and nursing homes, nurses play an important role in defining the need for pain treatment and in supervising the patient in the treatment process. Despite these endeavours, a significant number of patients remain whose pain cannot be controlled sufficiently. Euthanasia on demand for a patient with untreatable pain is not admitted in Germany.
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