Anchor-and distribution-based methods were combined to evaluate and establish minimally important differences (MIDs) for two Patient-Reported Outcomes Measurement Information System (PROMIS) measures in an outpatient chronic pain population. These included the computer-adaptive test (CAT) versions of two PROMIS measures: Depressive Symptoms and Anxiety-Related Symptoms (PROMIS; Cella, Gershon, Lai & Choi). Participants (n = 170) undergoing a behavioral medicine evaluation in an interdisciplinary pain management clinic completed two PROMIS CATs and multiple clinical anchor measures/ questions. Modeled after similar analyses (Yost, Eton, Garcia, & Cella), three a priori criteria were used to select usable cross-sectional anchor-based MID estimates; these included a minimum Spearman correlation of .3 between the PROMIS measure and anchor item/categories, a minimum comparison group sample size of 10 within each anchor, and an effect size between .2 and .8 for each anchor-based estimate. For each PROMIS measure, the mean standard error of measurement was calculated and incorporated into MID analyses. Using a large sample (n = 170), a number of the cross-sectional T-score anchorbased MID estimates (57%) were not included due to failure to meet a priori criteria. Based on the analyses, the following T-score MID ranges are recommended: Depression CAT (3.5-5.5) and Anxiety CAT (3.0-5.5). The average effect sizes for MID estimates ranged from .32 to .57. This study is among the first to address MIDs for PROMIS measures; it is the first study to establish usable MIDs for psychological symptoms on outpatients with chronic/persistent pain. The results may be used to gauge minimally important clinical difference and/or treatment response for individuals within this patient population. MIDs for PROs are particularly useful when treatment responses are significant to the patient but are difficult to evaluate during the clinical visit.
Objective: To explain variance in depression in students (N = 648) using a model incorporating sexual trauma, pessimism, and risky sex. Method: Survey data collected from undergraduate students receiving credit for participation. Results: Controlling for demographics, a hierarchical linear regression analysis [Adjusted R²= .34, F(5,642)=67.38, P<.001] suggests that higher pessimism (t = 16.05, P<.001), more sexual trauma (t= 3.76, P<.001), and more risky sex (t=3.40, P<.001) were associated with increased depression. Not being in a relationship (t = 3.54, P<.001) and being unemployed (t=3.10, P<.01) also predicted more depression in students. Conclusions: Results identify key access points for the treatment of depression in students.
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Temporomandibular disorder-relaTed oral surgery sarah e. Fraley, eric swanholm, anna w. sTowell, and roberT J. gaTchelThe symptoms of temporomandibular disorders (Tmds) include pain and limited jaw opening of the temporomandibular joint (TmJ) and masticatory musculature pain. other common Tmd symptoms include orofacial pain, joint grinding, clicks or popping, pain on masticatory muscle palpation, and limited mandibular movement. diagnosis of Tmd typically involves the identification of degenerative changes of the TmJ and disc displacements, muscle disorders, or internal derangements. although the etiology of Tmd is not yet clear, proposed causal factors may include the physical structure of the mouth and musculature, and psychosocial factors (wright et al., 2004). additionally, stress-related clenching and grinding, poor muscle discrimination, and unconscious bracing of the orofacial musculature may also contribute to the etiology of Tmd. other potential contributors include functional and structural issues in the TmJ, such as trauma, internal derangement, mechanical displacement, or osteoarthritis (gatchel, potter, hinds, & ingram, 2011).
Effective pain management techniques are essential, particularly given the suffering and ever‐increasing costs associated with pain. Pain management techniques exclusively based on the biomedical model are insufficient to alleviate pain. Instead, pain management techniques should address biological, psychological, and social factors to treat the pain patient, as exemplified by the biopsychosocial model. One component of this model—cognitive behavioral therapy ( CBT )—has proven effective in managing pain. Techniques that fall within the scope of CBT include psychoeducation, symptom monitoring, exercise, thought monitoring, communication skills training, pacing, relaxation, distraction techniques, problem‐solving skills, and self‐monitoring. These techniques can be used in conjunction with one another, and they are tailored to the individual needs of each patient. It is also important that individuals suffering from pain are educated about effective pain management techniques, relative to treatment modalities that have no empirical research support, so that pain sufferers can make the most educated decisions regarding their treatment.
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