Hoofdstuk 28 in Werken in gedwongen kader 28.1 Onvrijwillige cliënten 28.2 Onvrijwilligheid en de reacties daarop 28.3 Reactance en weerstand tegen verandering 28.4 Reactance en handelen van de professional 28.5 Motivational congruence
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The body of evidence that the working alliance is associated with positive outcomes for mandated clients is growing. The aim of this research was to investigate the influence of several characteristics of probation officers (POs) and offenders on the course of the working alliance during probation supervision. This study examined the patterns on the four alliance subscales: Trust, Bond, Goals-Restrictions, and Reactance of the Working Alliance With Mandated Clients Inventory (WAMCI) in 201 offenders and their 137 POs. Three patterns on each alliance subscale were found: deteriorating, improving, and stable. Multinomial logistic analysis revealed that change of POs and the preference of the PO to maintain rules were associated with a deteriorating Trust pattern. From the perspective of the offenders, being motivated to take part in supervision was associated with a stable pattern on every alliance subscale, but having problems with substance use increased the likelihood of a deteriorating pattern on every alliance subscale.
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Background & aims: Low muscle mass and -quality on ICU admission, as assessed by muscle area and -density on CT-scanning at lumbar level 3 (L3), are associated with increased mortality. However, CT-scan analysis is not feasible for standard care. Bioelectrical impedance analysis (BIA) assesses body composition by incorporating the raw measurements resistance, reactance, and phase angle in equations. Our purpose was to compare BIA- and CT-derived muscle mass, to determine whether BIA identified the patients with low skeletal muscle area on CT-scan, and to determine the relation between raw BIA and raw CT measurements. Methods: This prospective observational study included adult intensive care patients with an abdominal CT-scan. CT-scans were analysed at L3 level for skeletal muscle area (cm2) and skeletal muscle density (Hounsfield Units). Muscle area was converted to muscle mass (kg) using the Shen equation (MMCT). BIA was performed within 72 h of the CT-scan. BIA-derived muscle mass was calculated by three equations: Talluri (MMTalluri), Janssen (MMJanssen), and Kyle (MMKyle). To compare BIA- and CT-derived muscle mass correlations, bias, and limits of agreement were calculated. To test whether BIA identifies low skeletal muscle area on CT-scan, ROC-curves were constructed. Furthermore, raw BIA and CT measurements, were correlated and raw CT-measurements were compared between groups with normal and low phase angle. Results: 110 patients were included. Mean age 59 ± 17 years, mean APACHE II score 17 (11–25); 68% male. MMTalluri and MMJanssen were significantly higher (36.0 ± 9.9 kg and 31.5 ± 7.8 kg, respectively) and MMKyle significantly lower (25.2 ± 5.6 kg) than MMCT (29.2 ± 6.7 kg). For all BIA-derived muscle mass equations, a proportional bias was apparent with increasing disagreement at higher muscle mass. MMTalluri correlated strongest with CT-derived muscle mass (r = 0.834, p < 0.001) and had good discriminative capacity to identify patients with low skeletal muscle area on CT-scan (AUC: 0.919 for males; 0.912 for females). Of the raw measurements, phase angle and skeletal muscle density correlated best (r = 0.701, p < 0.001). CT-derived skeletal muscle area and -density were significantly lower in patients with low compared to normal phase angle. Conclusions: Although correlated, absolute values of BIA- and CT-derived muscle mass disagree, especially in the high muscle mass range. However, BIA and CT identified the same critically ill population with low skeletal muscle area on CT-scan. Furthermore, low phase angle corresponded to low skeletal muscle area and -density. Trial registration: ClinicalTrials.gov (NCT02555670).
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