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Rehabilitation Psychology is a quarterly peer-reviewed journal that publishes articles in furtherance of the mission of Division 22 (Rehabilitation Psychology) of the American Psychological Association and to advance the science and practice of rehabilita



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Telephone-delivered problem-solving training after mild traumatic brain injury: Qualitative analysis of service members’ perceptions.

2016-01-21

Objective: The purpose of this study was to identify the specific reasons for service members’ satisfaction or dissatisfaction with problem-solving training (PST), telephone delivery, and other aspects of a telephone-delivered PST intervention in order to determine what might enhance this approach for future clinical use. Method: Standard qualitative methods were employed, using a “process” coding strategy to explore the conceptual perceptions of the intervention experience as suggested by the data recorded from final telephone interviews of 80 service members who participated in a randomized controlled trial evaluating the efficacy of telephone-delivered PST after having sustained concussions or mild traumatic brain injuries during recent (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Neuropsychological functioning, coping, and quality of life among returning war veterans.

2016-02-18

Purpose: The present research tested the hypothesis that action- and emotion-focused coping strategies would mediate the relationship between neuropsychological functioning and quality of life among a sample of returning Iraq/Afghanistan veterans. Method: Veterans (N = 130) who served as part of the wars in Iraq and Afghanistan completed a diagnostic assessment of PTSD, a battery of questionnaires assessing coping style, traumatic brain injury (TBI), and quality of life, and neuropsychological tests measuring attention, learning and memory, working memory, inhibition, executive control, and visual motor coordination. Results: Executive control, immediate and delayed verbal recall, and visual motor coordination were associated with quality of life. However, after controlling for the effects of combat exposure, PTSD, and probable TBI, no measure of neuropsychological functioning was directly associated with quality of life. Mediation analyses indicated that delayed verbal recall influenced quality of life through its effect on action-focused coping. Conclusions: Although replication is needed, these findings indicate that delayed verbal recall may indirectly influence quality of life among Iraq/Afghanistan veterans through its association with action-focused coping strategies. Psychologists who are working with veterans that are experiencing memory difficulties and poor quality of life may consider focusing on improving coping skills prior to rehabilitation of memory deficits. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Depression and health-related quality of life among persons with sensory disabilities in a health professional shortage area.

2016-02-18

Objective: The authors examined depression and health-related quality of life among individuals with self-reported sensory impairments living in a health professional shortage area. Research Method: Health surveys of residents were conducted in 2006 and 2010. Responses were analyzed by groups of residents reporting vision loss, hearing loss, dual hearing and vision loss, and no sensory loss. In 2006, the total sample size was n = 2,591, and in 2010, it was n = 3,955. Main Outcome Measures: The CESD-5 scale (Shrout & Yager, 1989) was included in 2006, and the PHQ-9 (Kroenke, Spitzer, & Williams, 2001) was included in 2010. Rates of depression on the CESD-5 were determined by the recommended cut-off scores and on the PHQ-9 by the recommended algorithm. The Centers for Disease Control (CDC) Healthy Days instrument (Moriarty, Zack, & Kobau, 2003) was used in both surveys to assess health-related quality of life. Results: In both surveys, individuals who reported sensory loss had higher rates of depression and lower health-related quality of life than individuals with no reported sensory loss. Conclusions: Individuals reporting sensory loss had high rates of depression and a compromised quality of life compared to respondents without these impairments. These data imply strategic community-based health care services, including mental health initiatives, may be indicated for individuals with sensory loss living in underserved regions. Implications for rehabilitation psychology research, service, and policy are discussed as innovations in these areas are needed to better understand and address the disparities that may compromise the overall well-being of residents of underserved communities. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Subjective health among LGBT persons living with disabilities: A qualitative content analysis.

2016-03-07

Objective: There exist significant health disparities among both lesbian, gay, bisexual, transexual (LGBT) and disability persons; however, there is a dearth of information regarding the subjective health experiences of LGBT persons living with disabilities (LGBTPWD). As such, the purpose of this study was to understand how LGBTPWD subjectively defined and characterized the meaning of health in their lives. Method: Using qualitative content analyses procedures outlined by Elo and Kyngäs (2008), we conducted a secondary data analysis using a larger questionnaire study that was administered via the Internet. Participants were originally asked to answer the following prompt, “Describe what it personally means to you to be healthy?” Open-ended responses from 79 participants were thematically analyzed over several inductive and comparative coding iterations by a 3-person research team. Trustworthiness of data analysis was ensured via researcher triangulation, negative case analyses, and researcher reflexivity. Results: Four dimensions of subjective health emerged during the qualitative analytic process: physical wellness, emotional vitality, functionality, and social engagement. Conclusions/implications: There are contextually nuanced characteristics that constitute subjective health for LGBTPWD. These findings could help rehabilitation professionals provide culturally competent interventions. Implications for future research and limitations are provided in the discussion section. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Sexual activity after dysvascular lower extremity amputation.

2016-06-02

Objective: This study examined the prevalence and correlates of sexual activity among individuals experiencing their first dysvascular lower extremity amputation. Design: A prospective cohort was recruited from 4 Veterans Affairs Medical Centers. Of 198 potential participants who met inclusion criteria, 113 (57%) agreed to participate within 7 days of amputation (baseline) and 6 weeks, 4 months, and 12 months post-amputation; 105 completed the sexual activity items at baseline. Measures included self-reported frequency of sexual activity; desire for more or less sexual activity; importance of sexual activity to satisfaction with life; Patient Health Questionnaire—9; Locomotor Capability Index—5; pain intensity/frequency; quality of life. Results: Depending on the time period post-amputation, 11%–24% reported engaging in any sexual activity, although a majority indicated that sexual activity is very important to their satisfaction with life. Frequency of sexual activity increased between 6 weeks and 4 and 12 months post-amputation. In univariate analyses, older age was associated with decreased sexual activity at all time points; at 4 and 12 months, greater mobility was associated with increased sexual activity. In multivariable models, mobility was associated with sexual activity at 4 and 12 months; age and race remained associated with sexual activity at 4 and 12 months, respectively. At all time points, frequency and importance of sexual activity were significantly associated with one another. Conclusions: Although a minority of individuals engaged in any sexual activity during the study period, it remained an important factor in overall satisfaction with life. Younger age and improved mobility were associated with increased sexual activity. Rehabilitation specialists are encouraged to address sexuality and, if relevant, incorporate it into rehabilitation goals. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Correlates of resilience in the first 5 years after traumatic brain injury.

2016-02-08

Purpose/Objective: To examine resilience in the context of adjustment to traumatic brain injury (TBI), including the relative roles of demographic and theoretically related constructs such as coping, social support, and positive affectivity on resilience within the first 5 years postinjury. Research Method/Design: This was a cross-sectional, observational study of 67 persons with medically documented mild complicated to severe TBI. Participants completed a battery of measures including cognitive tests; questionnaires assessing self-report of emotional symptoms, perceived social support, and coping style; and a measure of resilience. Results: Approximately 60% of the sample endorsed moderate to high levels of resilience during the first 5 years postinjury. Brain injury severity, premorbid intelligence, and cognitive flexibility did not predict resilience, as measured by the Connor-Davidson Resilience Scale. By contrast, task-oriented coping and perceived social support were strong and unique covariates of resilience. Positive and negative affectivity were related to resilience but were not unique covariates of it in the presence of task-oriented coping and perceived social support. Discriminant validity of resilience as a concept and the means of assessing it was supported by findings that emotion-oriented and avoidance coping were not meaningfully related to resilience. Conclusions/Implications: Overall, the findings indicate that the majority of individuals in this sample reported high levels of resilience after brain injury and that correlates of resilience in adults with TBI is similar to that observed in adults without the history of cognitive impairment. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



The role of psychological facilitators and barriers to therapeutic engagement in acute, inpatient rehabilitation.

2016-05-12

Objective: Lequerica and Kortte (2010) proposed a model of therapeutic engagement in rehabilitation that indicates there are facilitators and barriers to an individual’s engagement in rehabilitation. The current study examines potential personal variables that may play a role in rehabilitation engagement. Design: In this prospective cohort design, 206 adults from 3 inpatient acute rehabilitation hospitals completed the Hopkins Rehabilitation Engagement Rating Scale, Hope Scale, Benefit Finding Scale, Positive and Negative Affect Schedule, Brief Symptom Inventory, and Denial of Illness Scale. Results: Among potential facilitators (hope, benefit-finding, positive affect), positive affect was the only variable that accounted for a significant variance (β = .24, p < .01) in rehabilitation engagement. Among potential barriers (depressive symptoms, negative affect, denial of illness), only denial of illness accounted for a significant variance (β = −.24, p < .01) in rehabilitation engagement. Conclusions: The present findings suggest that specific facilitators (positive affect) and barriers (denial of illness) relate to therapeutic engagement in rehabilitation. Interventions that increase positive affect and address denial of illness may provide novel avenues to increase therapeutic engagement. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Mental health and professional help-seeking among college students with disabilities.

2016-08-11

Objective: Research has demonstrated that providing appropriate supports and services on campus can improve both mental health and academic outcomes for students with disabilities (Emerson, Honey, Madden, & Llewellyn, 2009; Stumbo, Martin, & Hedrick, 2009), but little is known about the specific mental health needs of this population. The purpose of this exploratory study, therefore, was to identify the mental health needs of college students with various types of disabilities. Method: Researchers analyzed data, collected by the Center for Collegiate Mental Health, of 5,696 students with, and without, disabilities who utilized counseling services on campuses in the 2013–14 academic year. A nonclinical (students not in counseling) sample of 1,620 students with, and without, disabilities was also explored. Results: Compared to students without disabilities, students with disabilities report more anxiety and academic-related distress, as well as higher rates of suicide ideation, suicide attempts, and nonsuicidal self-injury among both students in counseling and not in counseling. Conclusions: Although in certain areas students with disabilities show similar levels of distress as students without disabilities, students with disabilities have higher levels of distress in areas which could impact their academic success. Self-harming tendencies are higher for students with disabilities overall, but more so for specific disability types. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Validation of the Social Provisions Scale in people with multiple sclerosis.

2016-04-18

Objective: This study examined the factorial and construct validity of the Social Provisions Scale (SPS) in a sample of people with multiple sclerosis (MS). Method: Participants included 292 individuals with MS (83.9% women) recruited from the Greater Illinois, Gateway, and Indiana chapters of the National Multiple Sclerosis Society. Participants completed the SPS and pain, fatigue, depression, anxiety, MS self-efficacy, quality of life, and satisfaction with life measures. Factorial validity was tested using confirmatory factor analysis (CFA), and construct validity was examined based on the strength of bivariate correlations with scores on related measures. Results: Findings from the CFA indicated that a first-order, 6-factor measurement model provided a good fit for the 24 items of the SPS (CFI = .94, TLI = .93, RMSEA = 0.07) and that the 6 factors could be described by a single, second-order factor of the overall social provisions (CFI = .93, TLI = .92, RMSEA = 0.08). Cronbach’s alpha was .89 for the global score and between .66 and .81 for the 6 subscales. The SPS global and subscale scores correlated significantly with satisfaction with life, depression, anxiety, MS self-efficacy, and quality of life measures. Conclusions: Findings from this study support the factorial validity, construct validity, and reliability of the SPS as a measure of social provisions for use with people with MS. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Initial validation of personal self-advocacy measures for individuals with acquired brain injury.

2016-05-12

Purpose/Objective: The purpose of this study was to evaluate the psychometric properties of 2 novel measures assessing personal advocacy, self-efficacy and personal advocacy activities in individuals with acquired brain injury (ABI). Design: This was an instrument development study using (a) expert panel review with a content validity index, (b) consumer survey, and (c) Rasch analysis. Participants were adults (N = 162) with ABI recruited through a community survey. Main Outcome Measure: Participants completed the Self-Advocacy Scale (SAS) and the Personal Advocacy Activity Scale (PAAS). Results: Using Rasch analysis to inform instrument development, after modification on the basis of item response theory analysis, the SAS, a measure of advocacy self-efficacy, was found to be unidimensional with an eigenvalue of 1.6, exhibited monotonicity, and had an item reliability of 0.97. Similarly, the PAAS, a measure of advocacy activity, was found to exhibit monotonicity, is unidimensional (eigenvalue of 1.7) and had an item reliability of 0.97. Both measures demonstrated concurrent validity, because they were significantly correlated with other established measures of related constructs and with each other. A separation reliability of 0.97 (real not model) for both the SAS and PAAS suggests that items will likely hold their relative positions in a similar sample. Conclusions: This study supported the PAAS and the SAS as reliable and valid measures of personal advocacy activity and associated self-efficacy in individuals post-ABI. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Assessing accident phobia in mild traumatic brain injury: The Accident Fear Questionnaire.

2016-06-30

Purpose: Despite a documented prevalence of accident phobia in almost 40% of motor vehicle accident (MVA) survivors, the onset of accident phobia after traumatic brain injury (TBI) remains poorly understood. There is currently a body of knowledge about posttraumatic stress disorder (PTSD) in patients with TBI, but less is known about accident phobia following TBI, particularly in cases of mild TBI (mTBI). Accident phobia can impede safe return to driving or motor vehicle travel, inhibiting return to daily functioning. In addition, pain complaints have been found to correlate positively with postinjury anxiety disorders. Method: The present study sought to determine the reliability and validity of the Accident Fear Questionnaire (AFQ), a measure used to assess accident phobia, in 72 patients with mTBI using secondary data analysis and the subsequent development of accident phobia postinjury. Furthermore, we sought to examine the impact of pain, anxiety, and depression complaints on the AFQ. Results: Results reveal convergent validity and reliability in mTBI populations. Additionally, pain, anxiety, and depression measures were significantly correlated with scores on the AFQ. Conclusions: Psychometrically, the phobia avoidance subscale of the AFQ is a reliable measure for use with mTBI populations, although some limitations were found. In particular, the accident profile (AP) subscale was not found to be reliable or valid and could be eliminated from the AFQ. Collectively, the present study contributes to the small body of published literature evaluating accident phobia in patients with mTBI and the impact of pain on the development of postinjury anxiety disorders. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Psychometric properties of the Cognitive and Linguistic Scale: A follow-up study.

2016-05-19

Objective: In a pediatric rehabilitation setting, monitoring recovery of cognitive skills is challenging due to diversity in age and brain injury severity. The Cognitive and Linguistic Scale (CALS) is a measure with promising psychometric properties that was designed for inpatient pediatric rehabilitation care. This study re-examines the reliability and validity of the CALS in a larger, independent sample. Method: Two hundred fifty-eight children (2–21 years) who were consecutively admitted to an inpatient brain injury facility between 2008 and 2014 for a first inpatient rehabilitation admission following a traumatic or acquired brain injury were included. Both CALS and Functional Independence Measure for Children (WeeFIM) were examined at admission and discharge. CALS scores by age groups (preschool-aged, school-aged, adolescents, or young adults), gender, and etiology (acquired vs. traumatic brain injury) and in two subgroups. Results: The internal consistency of the CALS was high. Total CALS score and individual item scores improved significantly between admission and discharge for children of all age groups, both genders, both traumatic and acquired etiologies, and in subgroups with limited responsiveness and no change on the WeeFIM cognitive domain. No age group had a floor or ceiling effect. Correlations with the WeeFIM were high. Factor analysis revealed 2 factors (basic responding and higher-level cognitive skills). Conclusions: The CALS has strong psychometric properties across a wide range of ages, brain injury etiologies, and cognitive severity. The CALS can be used to track cognitive and linguistic recovery in children, adolescents, and young adults with brain injury during inpatient rehabilitation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Validation of the Injustice Experiences Questionnaire in a heterogeneous trauma sample.

2016-07-07

Purpose/Objective: A recent study by Trost et al. (2015) investigated the influence of perceived injustice—reflecting appraisals of the severity and irreparability of loss following injury, blame, and unfairness—on physical and psychological outcomes in a sample of patients 12 months after sustaining a traumatic injury. This brief report examines the psychometric properties of the Injustice Experiences Questionnaire (IEQ) using the previous sample from Trost et al. (2015) with added trauma patients (total N = 206). Research Method/Design: Primary analyses included confirmatory and exploratory factor analyses to validate the measurement model of the IEQ in patients 12 months after traumatic injury. Reliability analyses were conducted and construct validity was assessed by examining associations between the IEQ and other pain-related, psychological, and health-related outcome variables of interest. Results: Results replicated both one- and two-factor structures from past research, with a high factor correlation in confirmatory factor analyses and cross-loadings in exploratory factor analysis. Item characteristics analysis demonstrated overall strong internal consistency (α = .95). In addition, significant associations with psychosocial variables provide additional construct validity in regards to related outcomes. Conclusion/Implications: The IEQ shows strong psychometric properties and is suitable for use in a sample of diverse traumatic injury. However, results suggest the use of a one-factor model for the IEQ in this sample. Future trauma and rehabilitation research can use the IEQ to explore how injustice perceptions related to traumatic injury can prospectively influence physical and psychological outcomes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Clinical utility and characteristics of the brown location test for individuals with right temporal lobe epilepsy.

2016-08-11

This Rehabilitation Measures Database summary provides a review of the characteristics of the BLT for individuals with right temporal lobe epilepsy. A full review of the BLT as well as reviews of over 300 other instruments can be found at www.rehabmeasures.org. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)