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Rehabilitation Psychology - Vol 59, Iss 1

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Rehabilitation Psychology 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 rehabilitation psychology.
Copyright 2014 American Psychological Association
  • Counselor-assisted problem solving improves caregiver efficacy following adolescent brain injury.
    Purpose: The purpose of the current study is to examine the efficacy of Counselor-Assisted Problem Solving (CAPS) in improving caregiver adaptation following traumatic brain injury (TBI). Research Method/Design: In a randomized clinical trial comparing CAPS (n = 65), an online problem-solving intervention with accompanying Web-based counseling sessions, with an information-based Internet Resource Comparison (IRC; n = 67) program, participants included families of 12- to17-year-olds who had sustained a TBI in the past 6 months. Linear regression analyses were used to identify main effects and to examine whether caregiver education, race, or prior computer use moderated treatment efficacy. Results: Computer experience moderated postintervention improvements in caregiving self-efficacy following CAPS, Specifically, parents in CAPS with low levels of prior use reporting the greatest improvements. CAPS participants who completed 5 or more sessions reported greater reductions in depression than did the IRC; however, the groups did not differ on global distress. Conclusions/Implications: Findings support the potential utility of counselor-supported Web-based interventions particularly for individuals with limited computer expertise following adolescent TBI. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • The Posttraumatic Growth Inventory: Factor structure and invariance among persons with chronic diseases.
    Objective: The Posttraumatic Growth Inventory (PTGI) assesses positive changes after a traumatic or serious life crisis. However, there are differing views regarding its factor structure and little understanding if it captures the positive changes experienced among individuals diagnosed with a chronic disease. Using confirmatory factor analysis (CFA), the proposed five-factor structure and measurement invariance of the PTGI was examined using two chronic illness samples: arthritis and inflammatory bowel disease (IBD). Method: Individuals diagnosed with arthritis (n = 301) or IBD (n = 544) recruited from the community and the Internet completed the PTGI. Using a pooled sample, CFA tested five hypothesized models of the underlying factors structure of the PTGI. A stepwise procedure for testing the measurement invariance across the two groups evaluated the factor structure, factorial invariance, and latent mean invariance. Results: Using the pooled sample, the CFA supported the hypothesized five-factor model, revealing the PTGI is multidimensional. Multigroup CFA supported invariance of the PTGI across the two groups although there were significant differences in latent means. Conclusions: The findings support that the PTGI assesses five related dimensions of PTG and that different chronic disease groups experience different types of positive changes. PTG may therefore be relevant as a meaningful treatment goal for people with chronic diseases as it is for people affected by other traumatic events. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Social support as a moderator of functional disability’s effect on depressive feelings in early rheumatoid arthritis: A four-year prospective study.
    Objective: To examine associations of depressive feelings with disease-related variables and explore the moderating effect of social support on depressive feelings in individuals with early rheumatoid arthritis (RA) prospectively over 4 years. Method: Data were collected annually over 4 years. The sample consisted of 124 individuals with diagnosed RA (85.5% women; mean age 47.9 years; mean disease duration 22.2 months). The strength of cross-sectional and prospective associations of sociodemographic, disease-related variables and the direct and moderating effects of social support on depression were tested using correlations, multilevel models, and hierarchical linear regressions. Results: The study showed that emotional support moderated the influence of functional disability on depressive feelings in individuals with RA. This was not detected for instrumental support. Further prospective associations between functional status, marital status, and depressive feelings were also found. Overall, the strongest association was found between initial depressive feelings and depressive feelings over time. Conclusions: Initial depression seemed to be a risk factor in explaining later depressive feelings, but emotional support might be prospectively beneficial, especially for individuals with higher levels of disability. Early detection of individuals at risk for depression and providing interventions aimed at the specific functions of social support might help to decrease mental health problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Self-efficacy as a predictor of self-reported physical, cognitive, and social functioning in multiple sclerosis.
    Objective: The objective of this study was to investigate whether self-efficacy is associated with physical, cognitive, and social functioning in individuals with multiple sclerosis (MS) when controlling for disease-related characteristics and depressive symptomatology. Method: Study subjects were 81 individuals between the ages of 29 and 67 with a diagnosis of clinically definite MS. Hierarchical regression analysis was used to examine the relationships between self-efficacy and self-reported physical, cognitive, and social functioning. Results: Self-efficacy is a significant predictor of self-reported physical, cognitive, and social functioning in MS after controlling for variance due to disease-related factors and depressive symptomatology. Conclusions: Self-efficacy plays a significant role in individual adjustment to MS across multiple areas of functional outcome beyond that which is accounted for by disease-related variables and symptoms of depression. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • The personal importance of being independent: Associations with changes in disability and depressive symptoms.
    Objective: This study examined the role of independence centrality (the personal importance of being functionally independent) in adapting to functional disability in persons with spinal cord injury (SCI). We assessed how changes in disability related to changes in depressive symptoms, the association between independence centrality and depressive symptoms, and the role of independence centrality in moderating the association between changes in disability and changes in depressive symptoms. Method: Using data from a randomized controlled trial, we focused on 173 survivors of SCI who completed baseline and 12-month follow-up measures of independence centrality, disability (activities of daily living and instrumental activities of daily living needs), and depressive symptoms. Results: Consistent with our predictions, increased disability was related to increased depressive symptoms, and higher independence centrality was associated with more depressive symptoms at baseline. Consistent with the life span theory of control, SCI survivors with high independence centrality experienced more depressive symptoms when disability increased, but less depressive symptoms when disability decreased. Survivors of SCI with low independence centrality were less affected by changing levels of disability. Conclusion: Persons with SCI with high independence centrality have higher levels of depressive symptoms and are more responsive to changes in functional status. Given the functional status trajectories of survivors of SCI, having low independence centrality may be adaptive because it facilitates disengagement from unattainable goals. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Physical activity among adults with obesity: Testing the health action process approach.
    Objective: This study tested the applicability of the Health Action Process Approach (HAPA) in a sample of obese adults in the context of physical activity. Method: Physical activity was assessed along with motivational and volitional variables specified in the HAPA (motivational self-efficacy, outcome expectancies, risk perception, intention, maintenance self-efficacy, action planning, coping planning, recovery self-efficacy, social support) in a sample of 484 obese men and women (body mass index ≥30 kg/m2). Results: Applying structural equation modeling, the fit of the HAPA model was satisfactory—χ²(191) = 569.93, p <.05, χ²/df = 2.98, comparative fit index = .91, normed-fit index = .87, and root mean square error of approximation = .06 (90% CI = .06, .07)—explaining 30% of the variance in intention and 18% of the variance in physical activity. Motivational self-efficacy, outcome expectancies, and social support were related to intention. An association between maintenance self-efficacy and coping planning was found. Recovery self-efficacy and social support were associated with physical activity. No relationships were found between risk perception and intention and between planning and physical activity. The assumptions derived from the HAPA were partly confirmed and the HAPA may, therefore, constitute a theoretical backdrop for intervention designs to promote physical activity in adults with obesity. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Identifying depression severity risk factors in persons with traumatic spinal cord injury.
    Purpose/Objective: Examine the relationship between demographic characteristics, health-, and injury-related characteristics, and substance misuse across multiple levels of depression severity. Research Method/Design: 204 persons with traumatic spinal cord injury (SCI) volunteered as part of screening efforts for a randomized controlled trial of venlafaxine extended release for major depressive disorder (MDD). Instruments included the Patient Health Questionnaire-9 (PHQ-9) depression scale, the Alcohol Use Disorders Identification Test (AUDIT), and the Substance Abuse in Vocational Rehabilitation-Screener (SAVR-S), which contains 3 subscales: drug misuse, alcohol misuse, and a subtle items scale. Each of the SAVR-S subscales contributes to an overall substance use disorder (SUD) outcome. Three proportional odds models were specified, varying the substance misuse measure included in each model. Results: 44% individuals had no depression symptoms, 31% had mild symptoms, 16% had moderate symptoms, 6% had moderately severe symptoms, and 3% had severe depression symptoms. Alcohol misuse, as indicated by the AUDIT and the SAVR-S drug misuse subscale scores were significant predictors of depression symptom severity. The SAVR-S substance use disorder (SUD) screening outcome was the most predictive variable. Level of education was only significantly predictive of depression severity in the model using the AUDIT alcohol misuse indicator. Conclusions/Implications: Likely SUD as measured by the SAVR-S was most predictive of depression symptom severity in this sample of persons with traumatic SCI. Drug and alcohol screening are important for identifying individuals at risk for depression, but screening for both may be optimal. Further research is needed on risk and protective factors for depression, including psychosocial characteristics. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Affective mediators of a physical activity intervention for depression in multiple sclerosis.
    Objective: Previous analyses showed that a telephone-based intervention to increase physical activity in individuals with multiple sclerosis (MS) and depression resulted in significantly improved depressive symptoms compared to a wait-list control group. The aim of this study was to test positive affect and negative affect as mediators of the effect of the physical activity counseling on depressive symptoms. Method: Ninety-two adults with MS, who met diagnostic criteria for either major depression or dysthymia and who reported low levels of physical activity, were randomized 1:1 to a 12-week telephone-based motivational interviewing (MI) intervention to improve physical activity (n = 44) or to a 12-week wait-list control group (n = 48). Self-reported positive and negative affect, physical activity, and depressive symptoms were gathered at baseline and postintervention. Path-analysis was used to test whether positive affect and negative affect mediated the positive effects of the intervention on depressive symptoms. Results: Both positive and negative affect were significant mediators of the effects of the intervention on depressive symptoms; however, only positive affect mediated the association between changes in physical activity and improved depressive symptoms. Conclusions: Findings support physical activity and positive affect as key mediators of the MI treatment effect on improved mood. Decreases in negative affect were also evident in the treatment group, but were not related to improved physical activity. Findings may suggest the use of exercise-based interventions in conjunction with treatments that specifically target negative affective mechanisms for depression. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Traumatic brain injury and PTSD screening efforts evaluated using latent class analysis.
    Objective: To empirically identify latent classes of service members according to persistent postconcussive symptom patterns and to characterize the identified classes relative to other postdeployment variables including posttraumatic stress disorder (PTSD) and mild traumatic brain injury (TBI) screening results. Such comparisons may directly inform policy regarding these routine assessments and translate to improved treatment decisions. Method: Self-report data were obtained for 12,581 combat-exposed male U.S. Navy and Marine Corps personnel who returned from deployment in 2008–2009 and completed a Post-Deployment Health Assessment (PDHA) and an associated Post-Deployment Health Reassessment (PDHRA). Persistent postconcussive symptoms indicated on the PDHRA were used as manifest variables in a latent class analysis yielding 4 distinct classes: systemic, cognitive/behavioral, comorbid, and nonpresenting. Results: Although the nonpresenting class endorsed few or no postconcussive symptoms, the systemic and cognitive/behavioral classes displayed elevated likelihoods of neurological and mental health symptoms, respectively. Members of the comorbid class had an increased probability of reporting a wide range of symptoms across both domains. Characterization of identified classes suggested that class membership may indicate the presence or absence of persistent conditions resulting from head injury and/or mental health issues. Under this assumption, estimated class membership probabilities implied a rate of probable neurological injury among this sample to be 17.9%, whereas the standard assessments aimed at identifying repercussions of mild TBI reported a positive screening rate of only 13.1%. Conclusions: Findings suggest that the routinely administered PDHA and PDHRA appear to underestimate the true prevalence of service members experiencing postdeployment health problems. Supplemental items or an alternative screening algorithm incorporating persistent postconcussive symptoms may enable identification of additional cases requiring treatment following return from deployment. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Exploring the longitudinal stability of the CSQ24 in a back pain population.
    Objective: The CSQ24 is a shortened version of the Coping Strategies Questionnaire and includes 24 items and four factors—Catastrophizing, Diversion, Reinterpreting, and Cognitive Coping. The factor structure of the CSQ has been a matter for debate for some time. This study aimed to explore the stability of the factor structure of the CSQ24 using repeated measurements in a back pain population at assessment, after physiotherapy treatment, and at 6 and 12 months after treatment. Method: A consecutive sample of 194 adults with chronic low back pain was recruited over 24 months. They completed the CSQ24, with other measures of pain, disability and mood, on 4 occasions. Ninety-six participants satisfactorily completed and returned both 6- and 12-month longitudinal follow-up questionnaires. Results: Exploratory Factor Analysis showed, at each time point, a 4-factor structure of Catastrophizing, Cognitive Coping, Diversion, and Reinterpreting. Within each factor, the factor scores at each time point were significantly correlated and showed good internal reliability. This stability was demonstrated against a background of significant change in measures of pain, disability, and mood. Conclusions: These results provide support for the 4-factor structure of the CSQ24 and its longitudinal stability. Argument is provided for the need to explore the longitudinal stability of related tools in populations that undergo change as a result of treatment. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • The rational patient and beyond: Implications for treatment adherence in people with psychiatric disabilities.
    Objective: Many people with psychiatric disabilities do not benefit from evidence-based practices because they often do not seek out or fully adhere to them. One way psychologists have made sense of this rehabilitation and health decision process and subsequent behaviors (of which adherence might be viewed as one) is by proposing a “rational patient”; namely, that decisions are made deliberatively by weighing perceived costs and benefits of intervention options. Social psychological research, however, suggests limitations to a rational patient theory that impact models of health decision making. Design: The research literature was reviewed for studies of rational patient models and alternative theories with empirical support. Special focus was on models specifically related to decisions about rehabilitation strategies for psychiatric disability. Results: Notions of the rational patient evolved out of several psychological models including the health belief model, protection motivation theory, and theory of planned behavior. A variety of practice strategies evolved to promote rational decision making. However, research also suggests limitations to rational deliberations of health. (1) Rather than carefully and consciously considered, many health decisions are implicit, potentially occurring outside awareness. (2) Decisions are not always planful; often it is the immediate exigencies of a context rather than an earlier balance of costs and benefits that has the greatest effects. (3) Cool cognitions often do not dictate the process; emotional factors have an important role in health decisions. Each of these limitations suggests additional practice strategies that facilitate a person’s health decisions. Conclusion: Old models of rational decision making need to be supplanted by multiprocess models that explain supradeliberative factors in health decisions and behaviors. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Review of intellectual assessment measures for children who are deaf or hard of hearing.
    Overview: Intellectual assessment of children who are deaf or hard of hearing presents unique challenges to the clinician charged with attempting to obtain an accurate representation of the child’s skills. Selection of appropriate intellectual assessment instruments requires a working knowledge of the strengths and weaknesses of the measure and what changes in standardized administration might be necessary to accommodate for the needs of children who are deaf or hard of hearing. In the case of some available instruments, there is limited guidance and objective research available examining the performance of children who are deaf or hard of hearing. This review summarizes available information on widely used and most recent editions of intellectual assessment measures with special attention to guidance on accommodations, score interpretation, subtest selection and other test-specific considerations when assessing children who are deaf or hard of hearing. Summary: There is much opportunity for further inquiry in the field of intellectual assessment as it applies to children who are deaf or hard of hearing, as many measures have not been closely scrutinized for their appropriate use with this population. Clinicians must recognize inherent difficulties with intellectual assessment measures with children who are deaf or hard of hearing and issues in providing for an accessible and accurate administration of test items. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • The role of disability self-concept in adaptation to congenital or acquired disability.
    Purpose/Objective: Current theories of adaptation to disability do not address differences in adaptation to congenital or acquired disability. Although people with congenital disabilities are generally assumed to be better adapted than people with acquired disabilities, few studies have tested this, and even fewer have attempted to explain the mechanisms behind these differences. This study tested the proposition that whether a disability is congenital or acquired plays an important role in the development of the disability self-concept (consisting of disability identity and disability self-efficacy), which in turn, affects satisfaction with life. It was predicted that disability self-concept would be better developed among people with congenital, compared with acquired disabilities, predicting greater satisfaction with life in those with acquired conditions. Research Method/Design: 226 participants with congenital and acquired mobility disabilities completed a cross-sectional online questionnaire measuring satisfaction with life, self-esteem, disability identity, disability self-efficacy, and demographic information. Results: Self-esteem, disability identity, disability self-efficacy, and income were significant predictors of satisfaction with life. Congenital onset predicted higher satisfaction with life; disability identity and disability self-efficacy, but not self-esteem, partially mediated the relationship. Conclusions/Implications: Findings highlight the distinction between adaptation to congenital versus acquired disability and the importance of disability self-concept, which are underresearched constructs. Results suggest that rather than attempting to “normalize” individuals with disabilities, health care professionals should foster their disability self-concept. Possible ways to improve disability self-concept are discussed, such as involvement in the disability community and disability pride. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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