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Objective: This systematic review aimed to determine the effectiveness of psychoeducation, cognitive behavioural therapy (CBT) and social support interventions used in the rehabilitation of breast cancer (BC) patients.Methods: We conducted a systematic literature search to identify randomised controlled trials of female BC patients who underwent different psychosocial interventions during or after primary cancer treatment. The methodological quality of all studies was independently assessed by two reviewers. Studies with low quality, less than 20 participants in each group, patients with metastatic cancer, data not presented separately for BC and studies that included other cancer types were excluded.Results: Among 9617 identified studies, only 18 RCTs published between 1999 and 2008, including 3272 patients were finally included in this systematic evaluation. Outcome measures were categorised into quality of life (QoL), fatigue, mood, health behaviour and social function. Six trials examined psychoeducation had inconsistent results, both during and after the primary treatment. Seven trials examined the effect of CBT, four of which given after primary treatment (range 6-12 weeks) demonstrated improvements in QoL; the other three CBT studies given during primary treatment (range 9-20 weeks) had inconsistencies. Five studies addressed social support and showed no conclusive impacts of this intervention.Conclusions: Limited documentation exists on the efficacy of psychosocial rehabilitation interventions among BC patients. However, we found that patients might have QoL benefits from CBT given after primary BC treatment. More documentation is needed regarding the effects of CBT during primary treatment and the effects of psychoeducation and social support.

BackgroundThe need for cost effectiveness analyses in randomized controlled trials that compare treatment options is increasing. The selection of the optimal utility measure is important, and a central question is whether the two most commonly used indexes - the EuroQuol 5D (EQ5D) and the Short Form 6D (SF6D) – can be used interchangeably. The aim of the present study was to compare change scores of the EQ5D and SF6D utility indexes in terms of some important measurement properties. The psychometric properties of the two utility indexes were compared to a disease-specific instrument, the Oswestry Disability Index (ODI), in the setting of a randomized controlled trial for degenerative disc disease.MethodsIn a randomized controlled multicentre trial, 172 patients who had experienced low back pain for an average of 6 years were randomized to either treatment with an intensive back rehabilitation program or surgery to insert disc prostheses. Patients filled out the ODI, EQ5D, and SF-36 at baseline and two-year follow up. The utility indexes was compared with respect to measurement error, structural validity, criterion validity, responsiveness, and interpretability according to the COSMIN taxonomy.ResultsAt follow up, 113 patients had change score values for all three instruments. The SF6D had better similarity with the disease-specific instrument (ODI) regarding sensitivity, specificity, and responsiveness. Measurement error was lower for the SF6D (0.056) compared to the EQ5D (0.155). The minimal important change score value was 0.031 for SF6D and 0.173 for EQ5D. The minimal detectable change score value at a 95% confidence level were 0.157 for SF6D and 0.429 for EQ5D, and the difference in mean change score values (SD) between them was 0.23 (0.29) and so exceeded the clinical significant change score value for both instruments. Analysis of psychometric properties indicated that the indexes are unidimensional when considered separately, but that they do not exactly measure the same underlying construct.ConclusionsThis study indicates that the difference in important measurement properties between EQ5D and SF6D is too large to consider them interchangeable. Since the similarity with the “gold standard” (the disease-specific instrument) was quite different, this could indicate that the choice of index should be determined by the diagnosis.

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Multiple sclerosis (MS) patients suffer from impaired muscle activation and lower limb strength. Strength training enhances muscle activation and muscle strength, but neural adaptations to strength training remain unexplored in MS patients. The hypothesis was that maximal strength training (MST) using high loads and few repetitions would improve central neural drive and thus strength capacity of MS patients. 14 MS patients staying at a national MS rehabilitation center were randomly assigned to a MST group or a control group (CG). Both groups received "today's treatment". In addition, the MST group trained 4 x 4 repetitions of unilateral dynamic leg press and plantar flexion 5 days a week for 3 weeks. Neural adaptations of the soleus muscle were assessed by surface electromyography (EMG) activity, and by superimposed H-reflexes and V-waves obtained during maximum voluntary isometric plantar flexor contractions (MVCs). H-reflexes and V-waves were normalized by the M-wave (H(SUP)/M(SUP), V/M(SUP), respectively). In the MST group, MVC increased by 20 +/- 9% (P < 0.05). Soleus EMG activity and V/M(SUP) ratio increased by 40 and 55%, respectively, in the MST group compared to the CG (P

The purpose of this study was to investigate the effects of 4-week (16 sessions) unilateral, maximal isometric strength training on contralateral neural adaptations. Subjects were randomised to a strength training group (TG, n = 15) or to a control group (CG, n = 11). Both legs of both groups were tested for plantar flexion maximum voluntary isometric contractions (MVCs), surface electromyogram (EMG), H-reflexes and V-waves in the soleus (SOL) and gastrocnemius medialis (GM) superimposed during MVC and normalised by the M-wave (EMG/M(SUP), H(SUP)/M(SUP), V/M(SUP), respectively), before and after the training period. For the untrained leg, the TG increased compared to the CG for MVC torque (33%, P < 0.01), SOL EMG/M(SUP) (32%, P < 0.05) and SOL V/M(SUP) (24%, P < 0.05). For the trained leg, the TG increased compared to the CG for MVC torque (40%, P < 0.01), EMG/M(SUP) (SOL: 38%, P < 0.05; GM: 60%, P < 0.05) and SOL V/M(SUP) (72%, P < 0.01). H(SUP)/M(SUP) remained unchanged for both limbs. No changes occurred in the CG. These results reinforce the concept that enhanced neural drive to the contralateral agonist muscles contributes to cross-education of strength.