Adding the most significant chord to the song: The role of the disease paradox and the health dilemma in the rehabilitation process
Scientific Study from the year 2010 in the subject Psychology - Clinic and Health Psychology, Abnormal Psychology, grade: keine, University of Vienna, language: English, abstract: Summary. Background: This article provides an overview of studies in which assessments of specific functional capacity, made by experts on the one hand (objective) and by patients on the other (subjective) were compared in various patient groups. In essence, these data reveal marginal or insignificant associations. Methods: Based on these considerations, a theoretical differential-diagnosis model of objective findings/subjective state of health is presented. By dichotomization of specific functional capacity at these two levels, the model permits the classification of a patient cohort into four sub-groups: Patients with concurrence between subjective and objective assessments are referred to as “the fortunate” while those with a negative concurrence are termed “the unfortunate”. In case of discrepancies between these two levels, for instance when patients’ subjective assessment was good although their condition was obviously poor, they are considered to be in a so-called “disease paradox”. Alternatively, patients whose subjective assessment of their condition was poor although the objective findings were positive, were considered to be in a so-called “health dilemma”. Results: The study in a sample of patients who had received an artificial hip joint for mobility disorders revealed striking differences in health-related quality of life (HrQol). Comparisons of HrQoL data pre- and post-operatively in the whole sample demonstrated an improvement in five of six dimensions (loss of energy, pain, emotional reaction, sleeping problems, and problems in physical mobility, p
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ANOVA Asadi-Lari back pain baseline Bullinger cardiovascular disease catamnesis Changes in health-related Cieza clinical correlation current functional capacity discrepancies disease paradox dissatisfaction dilemma emotional reaction evaluation experts explained variance factors Figure 5b Filipp and Ferring fortunate four categories four groups Fritz and Piva Hannover Functional Questionnaire health dilemma health-related quality HrQoL illness behavior improvements p<0.01 inner health resources instrument Kirchberger-Blumstein Knahr Kohlmann Kryspin-Exner Lebensqualität Lindholm loss of energy low back pain meta-analysis modified Viennese model Myrtek Nottingham Health Profile objective findings objective findings/subjective Ormel Orthopedic Hospital Speising orthopedist outcome patient groups Physical Impairment Index physical mobility post-hoc Scheffé tests process of rehabilitation Psychology Raspe Ravens-Sieberer Reinhold Jagsch Adding related quality satisfaction paradox Science & Medicine self-reported Siegrist significant chord social isolation Social Science specific functional capacity Steverink subjective and objective subjective assessment subscales surgery symptoms theoretical total hip arthroplasty whole sample World Health Organization