[Show abstract][Hide abstract] ABSTRACT: The precise relationship between sleep and physical and mental functioning in chronic fatigue syndrome (CFS) has not been examined directly, nor has the impact of daytime napping. This study aimed to examine self-reported sleep in patients with CFS and explore whether sleep quality and daytime napping, specific patient characteristics (gender, illness length) and levels of anxiety and depression, predicted daytime fatigue severity, levels of daytime sleepiness and cognitive functioning, all key dimensions of the illness experience.
118 adults meeting the 1994 CDC case criteria for CFS completed a standardised sleep diary over 14 days. Momentary functional assessments of fatigue, sleepiness, cognition and mood were completed by patients as part of usual care. Levels of daytime functioning and disability were quantified using symptom assessment tools, measuring fatigue (Chalder Fatigue Scale), sleepiness (Epworth Sleepiness Scale), cognitive functioning (Trail Making Test, Cognitive Failures Questionnaire), and mood (Hospital Anxiety and Depression Scale).
Hierarchical Regressions demonstrated that a shorter time since diagnosis, higher depression and longer wake time after sleep onset predicted 23.4% of the variance in fatigue severity (p <.001). Being male, higher depression and more afternoon naps predicted 25.6% of the variance in objective cognitive dysfunction (p <.001). Higher anxiety and depression and morning napping predicted 32.2% of the variance in subjective cognitive dysfunction (p <.001). When patients were classified into groups of mild and moderate sleepiness, those with longer daytime naps, those who mainly napped in the afternoon, and those with higher levels of anxiety, were more likely to be in the moderately sleepy group.
Napping, particularly in the afternoon is associated with poorer cognitive functioning and more daytime sleepiness in CFS. These findings have clinical implications for symptom management strategies.
PLoS ONE 01/2015; 10(1):e0117136. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Context: It is well established that subclinical hypothyroidism (SCH) is associated with mild cardiac dysfunction, but it is unknown if there is an underlying impairment of cardiac bio-energetic function. Objective: To quantify the cardiac phosphocreatine/adenosine triphosphate ratio (PCr/ATP) in SCH, compare with healthy controls and to measure the effect of 6 months of levothyroxine treatment. Design and Setting: A 6 month prospective case-controlled interventional study. Participants: and main outcome measures: PCr/ATP ratio was measured using phosphorus-31 magnetic resonance spectroscopy in subjects with SCH at baseline and after levothyroxine therapy (1.6 mcg/kg/day) and compared with age and gender matched euthyroid controls. All subjects were free of overt heart disease. Results: 21 subjects with SCH (normal free T4 and serum TSH between 4.1 and 10 mIU/L) and 17 controls were matched for age (mean age 40.5 vs. 43.3 years), sex (females 81% vs. 82%), but differed in mean TSH (6.5 vs. 2.1 mIU/L, p<0.001). At baseline mean (±SD) PCr/ATP ratio in SCH was lower than in controls (1.80±0.26 vs. 2.07±0.20, p=0.001). In the 16 subjects studied after levothyroxine treatment PCr/ATP ratio improved (from 1.74±0.24 to 1.91±0.26, p=0.004) and approached controls (borderline loss of significance (p=0.051). On multivariate analysis, SCH was independently associated with reduced PCr/ATP ratio even after adjusting for confounding variables (BMI and fasting glucose) (p=0.001). Conclusion: Our results demonstrate early cardiac bio-energetic impairment in SCH which is reversible with levothyroxine therapy. This mechanistic insight provides justification for longitudinal trials to determine whether improvement in bio-energetic function improves cardiovascular outcome.
[Show abstract][Hide abstract] ABSTRACT: Background & AimsPatients with primary sclerosing cholangitis (PSC) frequently highlight the impact of fatigue on their life quality. The study aims were to evaluate fatigue and its associations in PSC and investigate whether overt autonomic dysfunction contributes to the expression of fatigue.Methods
All PSC patients under active follow-up at a regional liver centre were sent disease- and symptom-assessment tools. Three control groups were utilised; unselected community controls, patients with inflammatory bowel disease (IBD) without PSC, and cholestatic controls with primary biliary cirrhosis (PBC). A representative subgroup of PSC patients and normal controls underwent formal autonomic assessment.ResultsSymptom-assessment tools were returned by 40 non-transplanted patients. PSC patients had significantly worse fatigue than population controls (p=0.005). Fatigue was significant compared to population controls whether or not patients had accompanying IBD, although was more marked in those with both PSC and IBD. In patients with PSC and IBD, fatigue severity and autonomic symptoms were significantly increased in those with prior significant surgical intervention. Clinically significant autonomic dysfunction was seen in 22.5% of PSC patients, and of those, 78% had significant fatigue. Neurally-mediated hypotension was found in 60% of PSC patients compared to 8% in the control group. The PSC group had increased sympathetic activity and reduced parasympathetic activity.Conclusion
Fatigue is a significant problem in a minority of PSC patients and appears to be associated with autonomic dysfunction. Fatigued PSC patients should be screened for autonomic dysfunction and targeting such dysfunction represents a potential approach to treatment which warrants further exploration.This article is protected by copyright. All rights reserved.
Liver international: official journal of the International Association for the Study of the Liver 11/2014; · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dry-sauna is a strong thermal stimulus and is commonly used all over the world. The aim of this experiment was to comprehensively analyse cardiovascular and autonomic changes that result from an increase in core body temperature during sauna bath. The study included 9 healthy men with mean age 26.7 ± 3.0 years and comparable anthropomorphical characteristics. Each subject was exposed to one 15-minute session of dry-sauna treatment at 100 ∘ C and 30–40% humidity. The autonomic and baseline cardiovascular (i.e., hemodynamic and contractility) parameters were measured noninvasively with Task Force Monitor. Cardiovascular autonomic functions were assessed using baroreceptor reflex sensitivity (BRS) and spectral analysis of heart rate (HRV) and blood pressure (BPV) variability. Measurements were performed four times, at the following stages "before sauna, " "after sauna, " "sauna + 3 h, " and "sauna + 6 h. " The first recording constituted a baseline for the subsequent three measurements. The changes in core body temperature were determined with the Vital Sense telemetric measurement system. Results show that exposure to the extreme external environmental conditions of dry-sauna does not compromise homeostasis in healthy persons. The hemodynamic changes induced by heating are efficiently compensated by the cardiovascular system and do not exert negative effects upon its short-term regulatory potential.
[Show abstract][Hide abstract] ABSTRACT: The cardiovascular, autonomic and thermal response to whole-body cryostimulation exposure are not completely known. Thus the aim of this study was to evaluate objectively and noninvasively autonomic and thermal reactions observed after short exposure to very low temperatures. We examined 25 healthy men with mean age 30.1±3.7 years and comparable anthropomorphical characteristic. Each subject was exposed to cryotherapeutic temperatures in a cryogenic chamber for 3 minutes (approx. - 120oC). The cardiovascular and autonomic parameters were measured noninvasively with Task Force® Monitor. The changes in core body temperature were determined with the Vital Sense® telemetric measurement system. Results show that 3 minutes to cryotherapeutic temperatures causes significant changes in autonomic balance which are induced by peripheral and central blood volume changes. Cryostimulation also induced changes in core body temperature, maximum drop of core temperature was observed 50–60 min after the stimulation. Autonomic and thermal reactions to cryostimulation were observed up to 6 hours after the exposure and were not harmful for examined subjects.
Journal of Thermal Biology 10/2014; · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: As services are commissioned based on effectiveness, occupational therapists are
under pressure to demonstrate the efficacy of their interventions. Occupational
therapists also need to know that the interventions they are providing are effective.
Robertson et al (2013) demonstrated that the occupational therapy literature is
important for clinicians and is an essential part of their practice. However, as
more research is published, it can be increasingly time-consuming and confusing
for clinicians to keep abreast of the current literature. Occupational therapy-related
research may be published in different forms, in a range of locations, and be of
varying methodological quality. Furthermore, readily available published studies
that investigate occupational therapy efficacy may not be sufficiently powered, or
lack external validity, when applied to different clinical settings. Well-conducted,
systematic reviews provide a useful way of synthesizing and evaluating the evidence
on a particular topic and, to some extent, provide a solution to this problem. This
paper focuses upon reviews of randomized controlled trials, as these provide the
highest quality of evidence on the question of a particular intervention’s effectiveness.
The merits of reviews of qualitative studies are also considered, together with the
possibility of combining more than one type of review.
British Journal of Occupational Therapy 09/2014; 77(9):479.
[Show abstract][Hide abstract] ABSTRACT: With a rapidly expanding older population and increased survival of older people with chronic disease, we can expect to see increasing numbers of people with orthostatic hypotension (OH). Unfortunately the evidence base for people with OH, with particular relevance to older people, has not kept up and has resulted in a real lack of progress and little good evidence. There are several areas of research that could potentially benefit patients but establishing which ones are priority areas requires public and patient involvement (PPI). This process includes people/patients in the research team to maximise the relevance, success and translation of the research. This brief report describes the early involvement of older people in prioritising the research question, methods to improve adherence during a trial and the preferred methods to disseminate research output. The individuals' priority was to research non-pharmacological treatment strategies and to improve the education of patients about their condition. Education was felt to be the best strategy to promote adherence during a trial, with change in symptoms and quality of life felt to be the most important outcome measures as opposed to blood pressure. This report offers guidance for academics that are undertaking OH-related research and how they can improve its relevance and increase its translation into clinical practice.
[Show abstract][Hide abstract] ABSTRACT: Over recent years, a considerable increase in the popularity of cryostimulation and whole body cryotherapy (WBC) procedures has occurred both among healthy individuals and in various groups of patients, including those with primary untreated hypertension. The aim of this study was to compare the effects of WBC on the functional parameters of cardiovascular system in normotensive and primarily hypertensive individuals. The study included 26 young male volunteers with normal blood pressure range (NormoBP) and 13 with essential arterial hypertension (HyperBP). Each subject was exposed to cryotherapeutic factor (whole-body cryotherapy/cryostimulation, WBC) at a temperature of approximately - 115°C to -125°C for a peroid of 3 minutes. The cardiovascular and autonomatic paramaters were measured noninvasively with Task Force® Monitor. Measurements in a supine position and tilt test were performed "before WBC" and "after WBC". Our study revealed that cryogenic temperatures exert strong modulatory effect on the cardiovascular system. Both groups showed adaptive changes of myocardial and vascular parameters in response to rapid cooling of virtually the whole body surface. While the profiles of some of these changes were similar in both the groups, also several considerable intergroup differences were documented. Consequently, the cryostimulation and cryotherapy treatment should be prescribed carefully to individuals who present with cardiovascular failure of any degree.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION
A significant proportion of patients with primary Sjӧgren’s syndrome (PSS) are functionally impaired and experience difficulties participating in many various aspects of everyday life. There is currently no evidence of efficacy for non-pharmacological interventions aimed specifically at supporting them to improve participation and their ability to perform daily activities. This paper describes a research protocol for a mixed methods study to develop an intervention to improve these outcomes. The protocol follows the MRC Framework for
METHODS AND ANALYSIS:
We will use group concept mapping with patients, adults who live with them and health care professionals to identify factors which prevent people with PSS from participating in daily life and performing daily activities. The factors will be prioritised by the participants for importance and feasibility and will inform an intervention to be delivered within an NHS setting. Evidence based intervention techniques will be identified for the prioritised factors and combined into a deliverable intervention package. Key stakeholders will comment on the intervention content and mode of delivery through focus groups, and the data will be used to
refine the intervention. The acceptability and feasibility of the refined intervention will be evaluated in a future study.
ETHICS AND DISSEMINATION:
The study has been approved by an NHS Research Ethics Committee, REC Reference: 13/NI/0190. The findings of this study will be disseminated in peer reviewed journals and through presentation at national and international conferences.
[Show abstract][Hide abstract] ABSTRACT: Background: Chronic Fatigue Syndrome (CFS) affects 0.23–2.6% of the adult population. Sleep-related complaints are amongst the most frequently reported symptoms in these patients. Although a biopsychosocial model of CFS offers a plausible framework for understanding the condition, the role of sleep and how it functions within this model remains unclear. Purpose: This narrative review describes the findings of studies of sleep in CFS and considers the reasons behind the diversity of results. The review also discusses the difficulties that exist in establishing relationships between sleep, behaviour, cognition, physiology, and the physical symptoms of CFS. Methods: A search of Medline for the terms “CFS,” “chronic fatigue syndrome,” AND “sleep” was performed to identify articles concerning sleep and CFS from 1988 to the present. Results: Subjective sleep dysfunction was frequently reported in the CFS sleep studies. However, objective sleep research in CFS has shown no consistent picture of sleep disturbance, particularly with regard to polysomnography. This may be attributable to the heterogeneity of sleep phenotypes in the CFS population as well as the variability in sleep assessment protocols, case definitions, and exclusion criteria used across studies. Conclusions: Given the high prevalence of disturbed sleep in this population in combination with inconsistent findings, exploration of new protocols for the objective assessment of sleep in CFS (e.g., three-night PSG protocol) is recommended. Understanding the distinct sleep characteristics in this population could serve to improve insight into perpetuating factors of CFS symptoms which is relevant for diagnosis and therapy.
Fatigue: Biomedicine, Health & Behavior. 07/2014; 2(3):163-184.
[Show abstract][Hide abstract] ABSTRACT: Cirrhosis has a long natural history with considerable symptomatic impacts, particularly in advancing disease. Measuring Health Related Quality of Life (HRQOL) in liver disease provides detail about the nature and extent of its effects on individuals. Understanding the drivers of impaired HRQOL can help identify targets for improvement through new treatments or systems of care delivery. Evaluation of novel therapies which target symptomatic improvement should be done with suitable outcome measures, including HRQOL assessment. In this article, we provide an overview of HRQOL in advanced liver disease for the clinician. A clear description of the important HRQOL tools is given alongside a discussion of the factors which are known to contribute to impaired HRQOL in advanced liver disease.
Journal of Hepatology 07/2014; · 10.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background Symptoms of primary Sjögren's syndrome are varied and impact on quality of life. Non pharmacological interventions such as complimentary therapies, psychotherapy and medical devices aim to relieve symptoms and improve function. We pre-registered a protocol with PROSPERO (CRD42013004997), then conducted a systematic review.
Objectives To determine the efficacy of non pharmacological interventions on all outcomes in primary Sjogren's syndrome.
Methods A predefined list of databases were searched from inception to July 2013 with a list of search terms. Randomised controlled trials (RCTs) of any non-pharmacological interventions for adults with PSS were included. Any comparator was allowed. Titles and abstracts of studies were considered according to the inclusion/exclusion criteria. Full texts were reviewed for inclusion independently by two authors.
Two review authors separately extracted the data of included studies onto standardised forms. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes fell within the main domains addressed by the World Health Organisation International Classification of Functioning.
Results 996 studies were identified of which 17 full text articles were screened and 5 studies were included in this review with a total of 130 participants randomised. The included studies investigated effectiveness of an oral lubricating device for dry mouth, acupuncture for dry mouth, lacrimal punctum plugs for dry eyes and psychodynamic group therapy for coping with symptoms. One study showed improvement in salivary flow and speed of speech with an oral lubricating device but was at high risk of bias. One study of punctum plugs had no extractable data and another comparing punctum plugs to artificial tears reported improvements on tear volume and film with punctum plugs, but this study was small (n=42). No benefits were reported on psychodynamic therapy in a small, poor quality study.
Conclusions We identified no evidence that any non-pharmacological interventions improved symptoms of PSS.
Frost PM, Shirlaw PJ, et al. Impact of wearing an intra-oral lubricating device on oral health in dry mouth patients. Oral Dis 2006;12(1):57-62.
List T, Lundeberg T, et al. The effect of acupuncture in the treatment of patients with primary Sjogren's syndrome. A controlled study. Acta Odontol Scand 1998;56(2):95-9.
Mansour K, Leonhardt CJ, et al. Lacrimal punctum occlusion in the treatment of severe keratoconjunctivitis Sicca caused by Sjogren syndrome: a uniocular evaluation. Cornea 2007; 26(2).
Qiu WQ, Liu ZY, et al. Punctal plugs versus artificial tears for treating primary Sjogren's syndrome with keratoconjunctivitis SICCA: a comparative observation of their effects on visual function. Rheumatol Int 2013;33(10):2543-48.
Poulsen A. Psychodynamic, time-limited group therapy in rheumatic disease – a controlled study with special reference to alexithymia. Psychother Psychosom 1991;56(1-2):12-23.
Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):1211-1212. · 9.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rationale, aims and objectivesIn the context of an ageing population, increasing numbers of older people with long-term conditions are presenting to secondary health care facilities in the United Kingdom having experienced a fall or fall-related injury. Despite such observations, falls and long-term conditions have traditionally been regarded as entirely separate entities. The purpose of this study was to explore the process of behaviour change in a small sample of older people with the fall-associated chronic liver disease primary biliary cirrhosis (PBC) receiving either a standard or an enhanced programme of strength and balance training (SBT).MethodsA qualitatively driven mixed-methods approach was employed that juxtaposed semi-structured interviews with graphical representations of patient-reported outcome measures collected during the course of an experimental case series in nine older people with the fall-associated chronic liver disease PBC.ResultsParticipants receiving both the standard and enhanced intervention completed the programme of SBT as instructed throughout the course of the case series. However, only the enhanced intervention, which focused on self-determination and self-management support, was associated with continued active participation on completion of the programme.Conclusions
Longer, but not necessarily more intensive, periods of clinical intervention are necessary to support individuals at risk of falling to move through the incremental stages of behaviour change. Effective self-management support should focus on the development of a wide range of strategies and behaviours to empower older people with long-term conditions develop an ongoing active commitment to SBT.
Journal of Evaluation in Clinical Practice 05/2014; · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study objectively analyzed postural instability and cognitive function in patients with Parkinson's disease (PD) and a group of healthy elderly and middle-aged individuals.
The study included ten healthy middle-aged individuals (range 42-57 years), 14 healthy elderly individuals (range 60-90 years) and 15 PD patients (range 58-93 years). Center of pressure (COP) parameters were determined by means of computed static posturography during free standing with open and closed eyes. The level of cognitive functioning was examined with mini mental state examination (MMSE) and counting backwards test (CBT).
Parkinson's disease patients showed significantly lower MMSE scores compared to healthy middle-aged (p = 0.004) and elderly individuals (p = 0.03). Mean duration of CBT in PD patients was significantly longer than in healthy subjects. COP parameters correlated with age of subjects and cognitive function (MMSE score). No significant differences in any stabilographic parameters were observed between healthy elderly subjects and PD patients.
Age is the most significant factor impacting upon the static balance of older individuals during free standing. Compared to middle-aged and elderly individuals without central nervous system impairment, patients with PD present with significant delay in cognitive processes associated with executive function.
Aging - Clinical and Experimental Research 04/2014; · 1.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ischemic heart disease is the leading cause of mortality worldwide. Due to advances in medicine in the last few decades, life expectancy has increased resulting in an aging population in developed and developing countries. Acute coronary syndrome causes greater morbidity and mortality in this group of older patients, which appears to be due to age-related co-morbidities. This review examines the incidence and prevalence of acute coronary syndrome among older patients, examines current treatment strategies, and evaluates the predictors of adverse outcomes. In particular, the impact of frailty on outcomes and the need for frailty assessment in developing future research and management strategies among older patients are discussed.