Social Work in Health Care, 53(5), 2014, pp.435-445.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Several studies demonstrated the importance of psychosocial factors, like social support, for understanding the experience of people with Systemic Lupus Erythematosus (SLE). Less information is available on “problematic support”; that is, instances of support that are perceived as non-supportive, even though the provider’s actions may be well intended. Aim of this qualitative study was to explore the experiences of problematic support from SLE patients’ perspective. Nine women with SLE were interviewed and transcripts were analysed through qualitative content analysis. Three main types of problematic social support were indentified. Oppressive support describes social support offers characterised by excessive worries and unwanted advices. Support denying the illness is characterised by a neglect of the disease or of its consequences. Support based on divergent illness representations is perceived as not punctual and not in line with patients’ actual clinical condition. This study confirms the complexity of providing useful support to SLE patients and suggest that also people living close to patients should represent a target of interventions.
(Edited publisher abstract)
Several studies demonstrated the importance of psychosocial factors, like social support, for understanding the experience of people with Systemic Lupus Erythematosus (SLE). Less information is available on “problematic support”; that is, instances of support that are perceived as non-supportive, even though the provider’s actions may be well intended. Aim of this qualitative study was to explore the experiences of problematic support from SLE patients’ perspective. Nine women with SLE were interviewed and transcripts were analysed through qualitative content analysis. Three main types of problematic social support were indentified. Oppressive support describes social support offers characterised by excessive worries and unwanted advices. Support denying the illness is characterised by a neglect of the disease or of its consequences. Support based on divergent illness representations is perceived as not punctual and not in line with patients’ actual clinical condition. This study confirms the complexity of providing useful support to SLE patients and suggest that also people living close to patients should represent a target of interventions.
(Edited publisher abstract)
Subject terms:
quality of life, patients, intervention, physical illness;
Social Science and Medicine, 68(9), May 2009, pp.1700-1710.
Publisher:
Elsevier
From a systematic search of six electronic databases, 56 original studies were extracted, reporting on 7937 sick and well people. A meta-analysis was conducted on change in Quality of Life (QoL) from pre- to post-intervention compared with outcomes from a no-exercise control group, using weighted (by the study's sample size) pooled mean effect sizes and a fixed-effects model. Significant differences in outcome were found when treatment purpose was compared; prevention/promotion (well populations), rehabilitation, or disease management. Three to 6 months post-baseline, a moderate positive effect of exercise interventions was found for overall QoL in rehabilitation patients, but no significant effect for well or disease management groups. However, physical and psychological QoL domains improved significantly relative to controls in well participants. Psychological QoL was significantly poorer relative to controls in the disease management group. This pattern of results persisted over 1 year. With some exceptions, better overall QoL was reported for light intensity exercise undertaken in group settings, with greater improvement in physical QoL following moderate intensity exercise. The implications for future health care practice and research are discussed.
From a systematic search of six electronic databases, 56 original studies were extracted, reporting on 7937 sick and well people. A meta-analysis was conducted on change in Quality of Life (QoL) from pre- to post-intervention compared with outcomes from a no-exercise control group, using weighted (by the study's sample size) pooled mean effect sizes and a fixed-effects model. Significant differences in outcome were found when treatment purpose was compared; prevention/promotion (well populations), rehabilitation, or disease management. Three to 6 months post-baseline, a moderate positive effect of exercise interventions was found for overall QoL in rehabilitation patients, but no significant effect for well or disease management groups. However, physical and psychological QoL domains improved significantly relative to controls in well participants. Psychological QoL was significantly poorer relative to controls in the disease management group. This pattern of results persisted over 1 year. With some exceptions, better overall QoL was reported for light intensity exercise undertaken in group settings, with greater improvement in physical QoL following moderate intensity exercise. The implications for future health care practice and research are discussed.
Extended abstract:
Author
GILLISON Fiona B.; et al.;
The effects of exercise interventions on quality of life in clinical and healthy populations: a meta-analysis.
Journal citation/publication details
Social Science & Medicine, 68(9), May 2009, pp.1700-1710.
Summary
This meta-analysis of 56 randomised controlled trials on exercise interventions in well and clinical populations found significant effects on quality of life (QoL) when purpose of intervention was compared. A positive increase in overall QoL was found for rehabilitation patients, but not well or disease management groups at three to six months post-intervention compared to controls. The physical and psychological QoL domains improved from baseline in the well population but patients in the disease management group experienced poorer psychological QoL. Significant effects on QoL across the population groups were also seen for exercise intensity and exercise setting. Categorisation by intervention purpose may represent a more accessible proxy for assessing the appropriateness of interventions for particular populations by meta-analysis.
Context
Physical activity and/or exercise have been shown to play a role in individuals' perceptions of their QoL. The aim of this review was to conduct a meta-analysis to examine the effects of exercise interventions across clinical and non-clinical populations and to assess whether characteristics of either the exercise intervention or the QoL domain measured could account for heterogeneity across studies.
Methods
What sources were searched? The following six databases were searched from the date of inception to September 2007: PubMed, EMBASE, Cochrane Library, SCOPUS, PsycINFO, Web of Science.
What search terms/strategies were used? The keywords used were 'quality of life', 'well being' or 'wellbeing', 'exercise(s)', physical activity/ies', 'randomis(z)ed control(l)ed trial(s)' 'RCT'. No further details of the search strategy are presented.
What criteria were used to decide on which studies to include? Eligible studies were randomised controlled trials of active exercise interventions in adults in which pre- and post-test ratings of Qol were carried out in intervention and control (no exercise) groups. Only studies reported in English were included.
Who decided on their relevance and quality? Articles retrieved from the search were independently examined for eligibility by two (unnamed) authors. Disagreements were resolved by a third author. Methodological quality of the trials was not assessed.
How many studies were included and where were they from? The database searches yielded 2662 articles of which 2565 were excluded after examination of the titles and abstracts. A total of 111 papers were examined in full, including twenty four papers identified from reviews. Fifty-six studies were eligible for inclusion in the meta-analysis. There is no indication as to which countries the studies were from.
How were the study findings combined? Data was extracted separately for each QoL domain or sub-domain reported in each study and clustered into the WHOQOL higher order framework. Results for overall QoL are also reported. A meta-analysis was conducted on change in QoL from pre-to post-intervention compared with a control group using weighted pooled mean effect sizes (ES) and a fixed-effects model. The main analyses were conducted on data gathered at 3-6 months post-intervention. Study characteristics including moderating variables are presented in Table 1 and summarised according to the variables in Table 2.
Findings of the review
Most of the studies (24) were chronic disease management/treatment studies; there were also 12 rehabilitation studies and 11 prevention/health promotion studies (not all studies reported purpose of intervention). Sample sizes varied from 9 to 264 (total sample size 7937); follow-up data was reported for time points ranging from one to 26 months post-intervention.
Rehabilitation interventions were associated with greater improvements in overall QoL than in well populations, or in those exercising for disease management. In well populations exercise interventions produced significantly beneficial outcomes in psychological and physical health QoL domains. Psychological QoL was better improved with light rather than moderate intensity exercise; moderate intensity exercise improved the physical QoL.
In the disease management population, exercise produced a significant decrease in psychological QoL compared to a small increase in physical QoL. Moderate to high intensity exercise was associated with lower psychological QoL and higher physical QoL, possibly a result of patients' unrealistic expectations. In the well sample social QoL was more improved when exercise was taken in an individual setting, compared to a group setting. This may reflect the lack of impact of attending an exercise class on an individual's broader needs. Group setting was associated with an overall improvement in QoL across the three intervention groups.
Authors' conclusions
A small but meaningful improvement in QoL can be produced by exercise interventions in patients in rehabilitation and well populations compared to no-exercise controls. Patients exercising as part of disease management interventions can experience a deterioration in overall and psychological QoL. Differentiating between populations on the basis of the purpose of the intervention can provide some explanation of the heterogeneity of results and provide a basis for exploring the appropriateness of interventions for population sub-groups.
Implications for policy or practice
'Disease severity and the reason for exercise i.e. to achieve an improvement in condition rather than maintenance of a poor health state, should be considered carefully when recommending exercise interventions for clinical populations.'
Subject terms:
intervention, physical exercise, physical illness, quality of life;
Child: Care, Health and Development, 35(4), July 2009, pp.437-439.
Publisher:
Wiley
This editorial introduces articles in a special issue of the journal. It notes that quality of life work developed primarily from concerns about the impact of aggressive treatment on children in the early days of cancer treatment as well as premature children undergoing high-tech treatment. It outlines issues relating to the use of proxy ratings and discusses measures of quality of life PedsQL and KIDSCREEN.
This editorial introduces articles in a special issue of the journal. It notes that quality of life work developed primarily from concerns about the impact of aggressive treatment on children in the early days of cancer treatment as well as premature children undergoing high-tech treatment. It outlines issues relating to the use of proxy ratings and discusses measures of quality of life PedsQL and KIDSCREEN.
Subject terms:
instruments, physical illness, quality of life, carers, children;
Objective: Befriending is an emotional supportive relationship in which one-to-one companionship is provided on a regular basis by a volunteer. It is commonly and increasingly offered by the voluntary sector for individuals with distressing physical and mental conditions. However, the effectiveness of this intervention on health outcomes is largely unknown. This systematic review examines the benefits of befriending.
Design: Systematic review
Methods: A systematic search of electronic databases was conducted to identify randomised controlled trials and quasi-experimental trials of befriending for a range of physical and mental health indications including depression, anxiety, mental illness, cancer, physical illness and dementia. Main outcomes included patient-relevant and disease-specific outcomes, such as depression, loneliness, quality of life, self-esteem, social support and well-being.
Results: A total of 14 trials (2411 participants) were included; 7 were judged at low risk of bias. Most trials showed improvement in symptoms associated with befriending but these associations did not reach statistical significance in all trials. Befriending was significantly associated with better patient-reported outcomes across primary measures. However, there was no significant benefit on single outcomes, including depression, quality of life, loneliness ratings, self-esteem measures, social support structures and well-being.
Conclusions: There was moderate quality evidence to support the use of befriending for the treatment of individuals with different physical and mental health conditions. This evidence refers to an overall improvement benefit in patient-reported primary outcomes, although with a rather small effect size. The current evidence base does not allow for firm conclusions on more specific outcomes. Future trials should hypothesise a model for the precise effects of befriending and use specified inclusion and outcome criteria.
(Edited publisher abstract)
Objective: Befriending is an emotional supportive relationship in which one-to-one companionship is provided on a regular basis by a volunteer. It is commonly and increasingly offered by the voluntary sector for individuals with distressing physical and mental conditions. However, the effectiveness of this intervention on health outcomes is largely unknown. This systematic review examines the benefits of befriending.
Design: Systematic review
Methods: A systematic search of electronic databases was conducted to identify randomised controlled trials and quasi-experimental trials of befriending for a range of physical and mental health indications including depression, anxiety, mental illness, cancer, physical illness and dementia. Main outcomes included patient-relevant and disease-specific outcomes, such as depression, loneliness, quality of life, self-esteem, social support and well-being.
Results: A total of 14 trials (2411 participants) were included; 7 were judged at low risk of bias. Most trials showed improvement in symptoms associated with befriending but these associations did not reach statistical significance in all trials. Befriending was significantly associated with better patient-reported outcomes across primary measures. However, there was no significant benefit on single outcomes, including depression, quality of life, loneliness ratings, self-esteem measures, social support structures and well-being.
Conclusions: There was moderate quality evidence to support the use of befriending for the treatment of individuals with different physical and mental health conditions. This evidence refers to an overall improvement benefit in patient-reported primary outcomes, although with a rather small effect size. The current evidence base does not allow for firm conclusions on more specific outcomes. Future trials should hypothesise a model for the precise effects of befriending and use specified inclusion and outcome criteria.
(Edited publisher abstract)
Subject terms:
befriending schemes, systematic reviews, quality of life, mental health problems, intervention, physical illness, long term conditions;
The population of persons living with HIV (PLWH) is growing older and more prone to developing other chronic health conditions. Disease progression has been shown to be related to quality of life (QoL). Approximately 452 PLWH aged 50 years or older were recruited from AIDS Service Organizations in nine US states. Participants completed a telephone survey that included measures of other chronic health conditions, perceived stress, depression, and health-related quality of life. As much as 94% of the sample reported a chronic health condition in addition to HIV. The highest reported conditions were hypertension, chronic pain, hepatitis, and arthritis. Despite relatively high rates of depression, overall QoL was moderately high for the sample. Physical functioning was most impacted by the addition of other chronic health problems. Social functioning, mental health functioning, stress, and depression were also strongly associated with chronic disease burden. Additional chronic health problems are the norm for PLWH aged 50 years and older. QoL is significantly related to the addition of chronic health problems. As increasing numbers of PLWH reach older age, this raises challenges for providing comprehensive healthcare to older PLWH with multiple chronic conditions.
(Edited publisher abstract)
The population of persons living with HIV (PLWH) is growing older and more prone to developing other chronic health conditions. Disease progression has been shown to be related to quality of life (QoL). Approximately 452 PLWH aged 50 years or older were recruited from AIDS Service Organizations in nine US states. Participants completed a telephone survey that included measures of other chronic health conditions, perceived stress, depression, and health-related quality of life. As much as 94% of the sample reported a chronic health condition in addition to HIV. The highest reported conditions were hypertension, chronic pain, hepatitis, and arthritis. Despite relatively high rates of depression, overall QoL was moderately high for the sample. Physical functioning was most impacted by the addition of other chronic health problems. Social functioning, mental health functioning, stress, and depression were also strongly associated with chronic disease burden. Additional chronic health problems are the norm for PLWH aged 50 years and older. QoL is significantly related to the addition of chronic health problems. As increasing numbers of PLWH reach older age, this raises challenges for providing comprehensive healthcare to older PLWH with multiple chronic conditions.
(Edited publisher abstract)
Subject terms:
HIV AIDS, older people, quality of life, long term conditions, adults, physical illness, ageing;
This study uses Lazarus and Folkman's model of stress and coping to identify the main and interactive effects of attachment style and forgiveness on physical health quality of life in HIV + adults. It tested the following hypotheses: attachment avoidance and anxiety are inversely related to physical health quality of life and to forgiveness of self and others; and forgiveness moderates the relationships. An ethnically mixed group of participants was recruited in Dallas/Fort Worth (n=288, 49% women, average age 41.7 and average years being HIV + 7.6). Participants completed medical and demographic screening and measures assessing attachment anxiety and avoidance, forgiveness of self and others, and five quality of life scales (physical functioning, pain, role functioning, social functioning, and health perceptions). There were significant correlations. Attachment anxiety was inversely related to physical health quality of life, while forgiveness of self was associated with greater quality of life. Attachment anxiety and avoidance, forgiveness of self and others, as well as interactions between attachment style and forgiveness, were related to the physical health quality of life of HIV + adults. Interpretation of the interactions suggests that for individuals who endorsed greater attachment anxiety, forgiveness of others was associated with greater pain, while forgiveness of self was associated with a greater perception of health.
This study uses Lazarus and Folkman's model of stress and coping to identify the main and interactive effects of attachment style and forgiveness on physical health quality of life in HIV + adults. It tested the following hypotheses: attachment avoidance and anxiety are inversely related to physical health quality of life and to forgiveness of self and others; and forgiveness moderates the relationships. An ethnically mixed group of participants was recruited in Dallas/Fort Worth (n=288, 49% women, average age 41.7 and average years being HIV + 7.6). Participants completed medical and demographic screening and measures assessing attachment anxiety and avoidance, forgiveness of self and others, and five quality of life scales (physical functioning, pain, role functioning, social functioning, and health perceptions). There were significant correlations. Attachment anxiety was inversely related to physical health quality of life, while forgiveness of self was associated with greater quality of life. Attachment anxiety and avoidance, forgiveness of self and others, as well as interactions between attachment style and forgiveness, were related to the physical health quality of life of HIV + adults. Interpretation of the interactions suggests that for individuals who endorsed greater attachment anxiety, forgiveness of others was associated with greater pain, while forgiveness of self was associated with a greater perception of health.
Subject terms:
HIV AIDS, physical illness, quality of life, stress, attachment, emotions, health;
DIEFENBACH Gretchen J., TOLIN David F., GILLIAM Christina M.
Journal article citation:
International Journal of Geriatric Psychiatry, 27(8), August 2012, pp.828-835.
Publisher:
Wiley
This study examined the independent contributions of depressive and anxiety symptoms to quality of life among older adults who were in receipt of a home care program. Participants were 66 community-dwelling older adults (ages 65 years and older), living in the northwestern United States who were experiencing chronic medical illness and concomitant functional disability. They completed self-report measures of depression, anxiety, and health-related quality of life. Additional data on cognitive, health, and functional status were collected for use as covariates. The associations of depressive symptoms with quality of life impairments in home care were substantial and pervasive. Depressive symptoms were significantly associated with quality of life impairments in nearly all domains. After controlling for depressive symptoms, anxiety symptoms accounted for additional and statistically significant variance in impaired life quality in the domains of mental health, role emotional functioning, and bodily pain. The results show that depressive and anxiety symptoms have negative associations with life quality among older adults receiving home care. The authors highlight the importance of developing community-based programs to assess and treat depressive and anxiety symptoms among home care clients.
This study examined the independent contributions of depressive and anxiety symptoms to quality of life among older adults who were in receipt of a home care program. Participants were 66 community-dwelling older adults (ages 65 years and older), living in the northwestern United States who were experiencing chronic medical illness and concomitant functional disability. They completed self-report measures of depression, anxiety, and health-related quality of life. Additional data on cognitive, health, and functional status were collected for use as covariates. The associations of depressive symptoms with quality of life impairments in home care were substantial and pervasive. Depressive symptoms were significantly associated with quality of life impairments in nearly all domains. After controlling for depressive symptoms, anxiety symptoms accounted for additional and statistically significant variance in impaired life quality in the domains of mental health, role emotional functioning, and bodily pain. The results show that depressive and anxiety symptoms have negative associations with life quality among older adults receiving home care. The authors highlight the importance of developing community-based programs to assess and treat depressive and anxiety symptoms among home care clients.
Subject terms:
home care, older people, physical illness, quality of life, anxiety, depression;
International Journal of Social Welfare, 21(3), July 2012, pp.309-318.
Publisher:
Wiley
A wide range of disciplines have produced information and research on the health-enhancing effects of nature. However, despite substantial evidence that the natural environment can enhance human wellbeing, the social work profession has maintained an almost exclusive focus on the social environment. This review article summarises the literature on the health benefits of nature, arguing for the application and positive impact of a nature-based approach in social work. It includes literature from the fields of psychology, medicine, child development, community development, and architecture as well as from social work. The literature highlights the many possibilities for integrating natural resources and settings into everyday practice. It reveals 3 broad categories of benefits; emotional, cognitive and spiritual well-being; physical health; and social interaction. The article challenges practitioners to recognise and articulate the role of the physical environment in their day-to-day practice. Implications for social work are identified in recommendations for enhancing opportunities to include non-human nature in future social work practice.
A wide range of disciplines have produced information and research on the health-enhancing effects of nature. However, despite substantial evidence that the natural environment can enhance human wellbeing, the social work profession has maintained an almost exclusive focus on the social environment. This review article summarises the literature on the health benefits of nature, arguing for the application and positive impact of a nature-based approach in social work. It includes literature from the fields of psychology, medicine, child development, community development, and architecture as well as from social work. The literature highlights the many possibilities for integrating natural resources and settings into everyday practice. It reveals 3 broad categories of benefits; emotional, cognitive and spiritual well-being; physical health; and social interaction. The article challenges practitioners to recognise and articulate the role of the physical environment in their day-to-day practice. Implications for social work are identified in recommendations for enhancing opportunities to include non-human nature in future social work practice.
Subject terms:
literature reviews, pets, physical illness, quality of life, social work, environment;
This study evaluated the relationship between employment status and health-related quality of life (HRQOL) in 361 Canadian people living with HIV/AIDS. Participants provided baseline data in the context of an ongoing cohort study examining the natural history of neurobehavioral functioning and its effects on HRQOL. Information collected included; demographic status, HIV disease markers, psychosocial symptom burden, neurocognitive function and HRQOL (MOS-HIV). Regression analyses were used to evaluate the contribution of employment status to the physical and mental health components of quality of life (QOL). Employment status was strongly related to better physical and mental health QOL after controlling for potential confounders. However employment status had a greater impact on physical health than mental health QOL. The effect of employment on physical health QOL was stronger than that observed for ethnicity, social support, or having an AIDS diagnosis and was comparable to that observed with having many HIV-related symptoms. The authors conclude there may be physical and mental health benefits associated with obtaining or keeping employment or, more likely, that there is an interactional and reinforcing process.
This study evaluated the relationship between employment status and health-related quality of life (HRQOL) in 361 Canadian people living with HIV/AIDS. Participants provided baseline data in the context of an ongoing cohort study examining the natural history of neurobehavioral functioning and its effects on HRQOL. Information collected included; demographic status, HIV disease markers, psychosocial symptom burden, neurocognitive function and HRQOL (MOS-HIV). Regression analyses were used to evaluate the contribution of employment status to the physical and mental health components of quality of life (QOL). Employment status was strongly related to better physical and mental health QOL after controlling for potential confounders. However employment status had a greater impact on physical health than mental health QOL. The effect of employment on physical health QOL was stronger than that observed for ethnicity, social support, or having an AIDS diagnosis and was comparable to that observed with having many HIV-related symptoms. The authors conclude there may be physical and mental health benefits associated with obtaining or keeping employment or, more likely, that there is an interactional and reinforcing process.
Subject terms:
HIV AIDS, mental health problems, physical illness, quality of life, unemployment, employment;
This report describes the results of a survey of 68 carers across Scotland. The survey investigated: the nature of the self-reported levels of ill health amongst carers; the prevalence of long term conditions; and the impact of primary health in supporting carers’ health and well-being. The survey found that 96% of respondents said that caring had impacted negatively on their health, with 27% rating their health as poor or very poor. The level of long term illness or disability was 57%, more than twice the level of the general population. Many respondents had more than 1 long term conditions: 45% suffered from significant illness including diabetes, depression and fibromyalgia or have had cancer; 68% experienced physical problems such as joint, hip, back or neck pain; 13% had respiratory problems including asthma and COPD; 11% had neurological problems including epilepsy, stroke or acquired brain injury; and 34% had high blood pressure or heart problems. More than half the respondents (54%) said they felt isolated and could not meet friends and family or take part in leisure or social activities. Almost half reported that their conditions had started after they began caring. Of those whose condition predated their caring role, a quarter said that their condition had worsened since they took on their caring role. Almost all (91%) said that their GP knew that they were a carer, but, despite this improved identification, 73% said that their GP had offered little or no help. A number of recommendations are provided.
This report describes the results of a survey of 68 carers across Scotland. The survey investigated: the nature of the self-reported levels of ill health amongst carers; the prevalence of long term conditions; and the impact of primary health in supporting carers’ health and well-being. The survey found that 96% of respondents said that caring had impacted negatively on their health, with 27% rating their health as poor or very poor. The level of long term illness or disability was 57%, more than twice the level of the general population. Many respondents had more than 1 long term conditions: 45% suffered from significant illness including diabetes, depression and fibromyalgia or have had cancer; 68% experienced physical problems such as joint, hip, back or neck pain; 13% had respiratory problems including asthma and COPD; 11% had neurological problems including epilepsy, stroke or acquired brain injury; and 34% had high blood pressure or heart problems. More than half the respondents (54%) said they felt isolated and could not meet friends and family or take part in leisure or social activities. Almost half reported that their conditions had started after they began caring. Of those whose condition predated their caring role, a quarter said that their condition had worsened since they took on their caring role. Almost all (91%) said that their GP knew that they were a carer, but, despite this improved identification, 73% said that their GP had offered little or no help. A number of recommendations are provided.
Subject terms:
long term conditions, physical illness, primary care, quality of life, surveys, carers, general practitioners;