Felix Angst

Therapists can use horticultural therapy as an adjuvant therapy in a non threatening context, with the intent of bringing about positive effects in physical health, mental health, and social interaction. Very few experimental studies exist that test its clinical effectiveness. To determine whether the addition of horticultural therapy to a pain-management program improved physical function, mental health, and ability to cope with pain. The research team designed a prospective, nonrandomized, controlled cohort study, enrolling all patients consecutively referred to the Zurzach Interdisciplinary Pain Program (ZISP) who met the studys criteria. The team divided them into two cohorts based on when medical professionals referred them: before (control group) or after (intervention group) introduction of a horticultural therapy program. The setting was the rehabilitation clinic (RehaClinic) in Bad Zurzach, Switzerland. Seventy-nine patients with chronic musculoskeletal pain (fibromyalgia or chronic, nonspecific back pain) participated in the study. The research team compared a 4-week, inpatient, interdisciplinary pain-management program with horticultural therapy (intervention, n = 37) with a pain-management program without horticultural therapy (control, n = 42). The horticultural therapy program consisted of seven sessions of group therapy, each of 1-hour duration. The research team assessed the outcome using the Medical Outcome Study Short Form-36 (SF-36), the West Haven-Yale Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), the Coping Strategies Questionnaire (CSQ ), and two functional performance tests. The team tested participants on entry to and discharge from the 4-week pain-management program. Between-group differences in sociodemographic and outcome variables were not significant on participants entry to the pain-management program. On discharge, the research team measured small to moderate outcome effects (effect size [ES] up to 0.71) within both groups. The study found significantly larger improvements for the horticultural therapy group vs the control group in SF-36 role physical (ES = 0.71 vs 0.22; P = .018); SF-36 mental health (ES = 0.46 vs 0.16; P = .027); HADS anxiety (ES = 0.26 vs 0.03; P = .043); and CSQ pain behavior (ES = 0.30 vs -0.05; P = .032). The addition of horticultural therapy to a pain management program improved participants' physical and mental health and their coping ability with respect to chronic musculoskeletal pain.

The relationship between chronic pain and depression is controversial and the data on association show strong variation. This study aimed to provide refined correlation and regression data on the basis of categorical and continuous measures. Cross-sectional assessment was based on standardized instruments that measure on a quasi-continuous scale, the Short Form-36, the Hospital Anxiety and Depression Scale, and the Multidimensional Pain Inventory. Correlations between depression and pain were determined by the instruments' scales, with and without correction for confounders, and within chronic pain subgroups using multivariate regression analysis. In 273 chronic pain patients participating in an inpatient pain rehabilitation program, the Multidimensional Pain Inventory pain severity scale and the Hospital Anxiety and Depression Scale showed maximum overall correlations of 0.27 to 0.29 (bivariate) and 0.30 (partial). The odds ratios for depression varied between 1.72 and 2.10 for different pain levels. Distinguishing 3 subtypes of pain patients, the pain-depression correlation was moderate in the "interpersonally distressed" subgroup (up to 0.57) (characterized by relatively low support, high punishing, low solicitous, and low distracting responses), weak in the "dysfunctional" subgroup (up to 0.26), and absent in the "adaptive copers/minimizers" subgroup (up to -0.09). The strengths of the pain-depression association and the "dose-response" relationship were both weak-weaker than to be expected if the hypothesis of a causal relationship were true. In the interpersonally distressed subgroup, the moderate association may have an impact on pain management, that is, pain could be treated by treatment of depression and vice versa.

Changes of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments. The aim of this study was to determine and compare responsiveness, i.e. the sensitivity to change of five outcome instruments for effect measurement in chronic pain.

Objective: To assess the responsiveness (sensitivity to change) of 6 shoulder outcome instruments.Methods: In a prospective cohort study of 153 total shoulder arthroplasties, outcome was measured by the Short Form 36 (SF‐36); Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH); Shoulder Pain and Disability Index (SPADI); American Shoulder and Elbow Surgeons questionnaire for the shoulder (ASES); and the Constant (Murley) Score (CS). Responsiveness was mainly quantified by effect sizes before and 6 months after operation. Sensitivity analysis of the effects by receiver operating characteristic (ROC) curves was performed to determine the instruments' ability to classify effects into global health change assessment categories.Results: Effect sizes of the self‐assessment total scores were 0.71, 1.19, 2.10, and 2.13 for the SF‐36, DASH, SPADI, and ASES, respectively. The clinical ASES and the CS had effect sizes of 1.87 and 2.23, respectively. The SPADI (effect size 2.12) and the CS (effect size 2.72) were most responsive for pain. For functioning, the patient ASES (effect size 2.10), the CS (effect size 1.82), and the clinical ASES (effect size 1.85) were almost equal. The SF‐36 bodily pain scale and most scores of the condition‐specific instruments showed a significant area under the ROC of up to 0.77.Conclusion: The SPADI and/or the CS are the most suitable for short, responsive, shoulder‐specific assessment. The more expensive patient ASES can be used for most responsive shoulder‐function assessment. For a comprehensive measurement of health and quality of life, the DASH and/or the SF‐36 should be added to the set.

Objective. To cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) from English into German, and to test the reliability and validity of the German version.

To determine whether it is possible to specify different score patterns for hip and knee osteoarthritis (OA), and to identify the degree of responsiveness and the validity of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) factors, which are alternative health dimensions obtained by factor analysis of the WOMAC items. WOMAC scales and WOMAC factors were compared in a prospective setting examining patients with hip and knee OA before and after rehabilitative inpatient intervention (n = 317). In a partial sample (n = 103), the validity of the WOMAC factors was determined by a global rating of their activities. The WOMAC factor "ascending/descending" was significantly different for hip and knee OA in the health state before therapy (score in hip 5.09, in knee 6.59; p < 0.001); this was also true of the effect size after therapy (hip 0.39, knee 0.65; p = 0.012). The WOMAC scales did not differ for the 2 conditions. The WOMAC factor "ascending/descending" was the most responsive dimension in knee OA (effect size 0.65), but in hip OA the WOMAC pain scale was most responsive (effect size 0.55). Most of the WOMAC factors correlated moderately (r = 0.52-0.69) with the patient's self-rating on the validation questionnaire. The WOMAC factors are valid measures. Analyzing the WOMAC by the WOMAC factors facilitates and improves the differential relevance and accuracy of the WOMAC for specific conditions such as hip and knee OA.