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Rehabilitation Psychology - Vol 59, Iss 2

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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
  • The World Report on Disability and its implications for rehabilitation psychology.
    Objective: This study reviewed the World Report on Disability (World Health Organization & World Bank, 2011) and explored its implications for rehabilitation psychology. Method: Key findings and recommendations were identified within the World Report and issues that are salient to the profession, practice and research within rehabilitation psychology were highlighted. Results: The World Report has a particular emphasis on disability in low-income countries, where the majority of people with disabilities live. Despite the origins and development of rehabilitation psychology within high-income countries, the profession has much to contribute to addressing many of the challenges identified in the World Report. Specific targeted contributions might include addressing the human resources for health crisis in rehabilitation; developing prosocial and community-based interventions and programs; helping to identify and overcome difficulties to accessing health care; refining the measurement and classification of disability; and strengthening research, policy and advocacy for and with people with disabilities. Implications: The World Report on Disability presents exciting and challenging opportunities that exist for rehabilitation psychology practitioners and researchers, and for the profession itself. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Evaluation of an online health promotion program for vocational rehabilitation consumers.
    Purpose/Objective: The purpose of this study was to test the comparative effectiveness of three variations of an online-based health promotion program for improving health and employment outcomes in a sample of Vocational Rehabilitation consumers. Research Method/Design: A total of 222 VR consumers participated in a randomized trial of three health promotion variations and provided baseline, 2-, 4-, and 6-month data. Data were analyzed using repeated measures ANOVA. The three health promotion variations included (a) FACTSHEETS—a series of four electronic factsheets; (b) HPE—an online interactive health promotion website that included health behavior content and tailored action planning, and (c) HPE + MI—the online health promotion website plus two 30-minute calls with a trained motivational interviewer. Results: Contrary to expectations, evidence did not support between-group differences based on intervention intensity. In fact, the Factsheet, HPE, and HPE + MI participants all experienced significant reductions in secondary conditions, F(2.85, 489) = 7.808, p F(2.7, 495) = 4.795, p = .004; and significant improvements in healthy lifestyle behaviors, F(2.6, 495) = 3.66, p = .017 over the 6-month study period. Although this study did not include a control group, a control group from another study with a similar population did not experience similar outcomes. Conclusion/Implications: People with disabilities experience significantly higher rates of secondary health conditions and lower employment rates than people without disabilities. The combination of these factors signifies the need for health promotion programming outside the work setting. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Telephone counseling and home telehealth monitoring to improve medication adherence: Results of a pilot trial among individuals with multiple sclerosis.
    Objective: To evaluate the impact upon medication adherence of brief telephone-based counseling using principles of motivational interviewing and telehealth home monitoring. Design: Randomized controlled pilot trial of 19 veterans with multiple sclerosis (MS) currently prescribed disease modifying therapy (DMT) who endorsed missing doses. Follow-up was conducted at 1, 3, and 6 months. Results: Participants in the intervention condition reported better adherence relative to controls at 6-month follow-up [M (SD) = 1.3 (2.1) vs. 8.2 (12.3) past month missed doses]. All participants in the intervention condition completed all 3 telephone counseling sessions and 90% or greater rated the program as highly successful. Conclusion: Brief telephone counseling represents a promising mechanism for improving medication adherence. The primary components, motivational interviewing and home telehealth monitoring, provided complementary mechanisms for initiating and sustaining behavior change over time. The intervention was well tolerated and provided an opportunity to extend access and reduce barriers to care by bringing it into the homes of participants. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • A comparison of visual inspection time measures in children with cerebral palsy.
    Purpose/Objective: This study examined the performance of children with and without cerebral palsy on two inspection time (IT) tests, as accessible nonspeeded response measures of cognitive processing speed. Research Method/Design: Participants, ages 8 to 16, included 66 children with congenital CP and 119 typically developing peers. Measures were two visual IT tasks with identical target stimuli but differential response strategies either via a traditional dual-key method or with an assistive technology pressure switch interface and response option scanning. Results: The CP group had slower IT than the control group independent of test version. Log transformations were used to address skew, and transformed mean intraclass correlations showed moderate agreement between test versions for both participant groups. Bland-Altman plots showed that at higher mean IT thresholds, greater discrepancies between test version scores were observed. Conclusions/Implications: Findings support the feasibility of developing tests that reduce speeded motor response demands. Future test development should incorporate increased gradations of difficulty at the extremes of neuropsychological functioning to more accurately assess the performance of individuals whose conditions are associated with atypical performance levels. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Gender and nurturance in families of children with neurodevelopmental conditions.
    Objective: This study tested the hypothesis that gender differences in parent-reported nurturance of children would be attenuated in families of children with neurodevelopmental conditions (NDCs). Method: In this cross-sectional study, participants included 49 (29 male) children diagnosed with an NDC and 60 (30 male) typically developing (TD) children. Children in the NDC group had a diagnosis of cerebral palsy (CP; n = 41) or spina bifida (SB; n = 8). Parental nurturance was measured using the nurturance subscale of the Parenting Dimensions Inventory (PDI; Power, 1991). Data were analyzed using a 2 × 2 (gender × diagnosis) analysis of covariance (ANCOVA) with child age as the covariate. Results: As a simple main effect, parents reported more nurturing behavior toward TD girls than TD boys. However, girls with an NDC received less nurturance, thereby eliminating the gender difference in parental nurturance in the NDC sample. This pattern was reflected in the larger ANCOVA as a 2-way interaction between diagnosis and gender. Group differences in other PDI subscales were not statistically significant. Conclusions and Significance: This pattern of results suggests that the parents of girls with NDCs may be less nurturing toward them, thereby attenuating gender differences observed in families with TD children. Findings highlight the need for more research on the gendered dynamics in families with a child with an NDC to develop systemic models of family functioning and targeted parenting interventions for this group. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Attractiveness, diagnostic ambiguity, and disability cues impact perceptions of women with pain.
    Purpose/Objective: This experimental study investigated how physical attractiveness, disability cue, and diagnostic ambiguity stereotypes impact perceptions of a patient’s pain/disability and personality. Research Method/Design: After viewing photographs of women pictured with or without a cane, accompanied by descriptions of the women’s diagnosis (fibromyalgia or rheumatoid arthritis), 147 university students rated the women’s pain/disability and personality. Results: Analyses revealed that more attractive women received lower ratings on pain/disability and higher ratings (more positive) on personality. Moreover, those pictured with a disability cue got higher ratings on both pain/disability and personality, and those with medical evidence of pathology (less ambiguity) got higher ratings on pain/disability and lower ratings on personality. Examination of the 3 stereotypes in a single study enabled an evaluation of their interactions. An Attractiveness × Disability Cue × Diagnostic Ambiguity interaction for ratings of pain/disability revealed that the presence of both medical evidence and a disability cue were needed to override the strong “beautiful is healthy” stereotype. Significant 2-way interactions for ratings of personality indicated that the impact of the disability stereotype tends to be overshadowed by the attractiveness stereotype. Conclusion/Implications: The results indicate that these stereotypes have a large effect on perceptions of women with chronic pain and that attractiveness, a contextual variable unrelated to the pain experience, exerts an even stronger effect when there is less objective information available. This could have clinical ramifications for assessment and treatment of patients with chronic pain, which often occurs in the absence of “objective” medical evidence or any external cues of disability. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Thought intrusion among adults living with complex regional pain syndrome.
    Purpose: This study investigated the presence and influence of intrusive thoughts among adults previously diagnosed with complex regional pain syndrome. Method: The present study used an Internet-based survey completed by a sample (N = 326) from two national organizations. Results: After controlling for age, gender, and pain level, intrusive thoughts were significantly related to disability and health-related quality of life. Conclusions/Implications: Intrusive thoughts about the inciting event that caused CRPS uniquely influenced pain and quality of life, suggesting a potential mechanism to target for intervention. Understanding factors that relate to maintenance of CRPS and its resulting disability will help in the development of treatments to improve quality of life. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Injury perceptions, hope for recovery, and psychological status after spinal cord injury.
    Objective: The purpose of this study was to investigate the relationship of injury perceptions and hope for recovery with life satisfaction, purpose in life, and depressive symptoms measured during inpatient rehabilitation after spinal cord injury (SCI). Method: Participants included adults hospitalized for SCI inpatient rehabilitation (N = 208), each of whom completed a modified version of the Illness Perception Questionnaire and three outcome measures: the Purpose in Life Scale, the Satisfaction with Life Scale, and the abbreviated version of the Patient Health Questionnaire. Results: Principal components analysis indicated an SCI perceptions factor regarding severity, permanence, and cure control of SCI, and a second factor related to hope for recovery. Whereas hope for recovery was nearly universal, injury perceptions were more varied. Favorable injury perceptions of SCI were predictive of purpose in life, whereas hope for recovery was predictive of life satisfaction. Conclusions: Hope for recovery and favorable SCI perceptions were related to positive psychological outcomes during inpatient rehabilitation, although the strength of the relationship was limited. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Trajectories of life satisfaction five years after medical discharge for traumatically acquired disability.
    Objectives: We studied the predictive impact of family satisfaction, marital status, and functional impairment on the trajectories of life satisfaction over the first 5 years following medical treatment for traumatic spinal cord injury, burns, or interarticular fractures (total N = 662). It was anticipated that fewer functional impairments, being married, and greater family satisfaction would predict higher life satisfaction trajectories. Method: The Functional Independence Measure, the Family Satisfaction Scale, and the Life Satisfaction Index were administered 12, 24, 48, and 60 months postdischarge. Results: Trajectory modeling revealed that greater functional impairment significantly predicted lower life satisfaction, regardless of injury type. However, this association diminished when marital status and family satisfaction were entered into the models. Greater family satisfaction and being married predicted greater life satisfaction across time. Moreover, there was no evidence for increases in life satisfaction trajectories over time: Trajectories were stable across time for all injury groups. Conclusions: Results suggest that being married and greater family satisfaction promote life satisfaction among those who traumatically acquire disability, and these beneficial effects may be more salient than the degree of functional impairment imposed by the condition. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Positive aspects of caregiving in Spanish caregivers of individuals with acquired brain injury.
    Objective: Taking care of a person with acquired brain injury (ABI) is often associated with symptoms of stress and psychological distress. However, caregiving can also be a source of satisfaction and can contribute toward an improvement in the quality of life both of the caregiver and the person with ABI. The aim of this study is to assess and adapt the Positive Aspects of Caregiving Scale (PACS) to Spanish. Method: The PACS was completed by a sample of 141 family members who are the primary caregivers of relatives with ABI (mean age = 58.3 years, SD = 12.2; 78% women). The caregivers also responded to questions evaluating quality of life, burden, and posttraumatic growth. Results: The results confirm the original structure of the PACS, which consists of 2 correlated factors: Self-Affirmation and Outlook on Life. Furthermore, these factors demonstrated adequate indices for internal consistency. The scores obtained from the PACS are positively associated with quality of psychological life, quality of social life, and posttraumatic growth and negatively associated with the perception of burden. Conclusions: The results highlight how important it is for interventions to emphasize the positive aspects of caregiving in caregivers of people affected by ABI. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • The development and validation of the Readiness to Engage in Self-Management after Acute Traumatic Injury Questionnaire.
    Objective: Although the management of acute traumatic injury has improved, long-term functional outcomes remain poor. Data suggest major improvements in outcome will require comprehensive, self-management (SM) interventions. However, little is known about trauma survivors’ willingness to participate in such interventions. The goal of this study was to create and validate an instrument based on the stages of change (SOC) framework to assess readiness to engage in SM programs following acute traumatic injury. Method: The Readiness to Engage in Self-Management after Acute Traumatic Injury (RESMATI) was developed based on SOC theory. Participants (N = 150) were admitted to a Level I trauma center for treatment of severe trauma and completed the RESMATI 3 to 12 months postinjury. A random sample (n = 60) completed a reassessment 1 month later to determine item stability. A principal components analysis and an exploratory factor analysis were conducted. Results: The analyses of the 34 RESMATI items yielded a 5-factor model, collapsed into 3 domains based on SOC theory. Two factors were classified as “precontemplation,” 2 factors were classified as “contemplation,” and 1 factor was classified as “action/maintenance.” All 3 domains had good internal consistency reliability (.71 to .92) and moderate test–retest reliability (.56 and .73). Conclusions: The exploratory factor analysis yielded 3 domains that were consistent with the SOC model. Two notable exceptions were the lack of a “preparation” domain and lack of distinction between the action and maintenance stages. The RESMATI is a reliable instrument that requires further testing to establish validity and utility in identifying individuals’ readiness to engage in SM following acute traumatic injury. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Measuring community participation of adults with psychiatric disabilities: Reliability of two modes of data collection.
    Purpose/Objective: The Americans with Disabilities Act set in motion a series of policies and actions to promote community integration and participation, including for those individuals with psychiatric disabilities. Measuring participation in this population is in its infancy. This study examines the test–retest reliability of two modes of administration of a measure that assesses participation in four social life domains and the extent to which participation is viewed as sufficient and important. Research Method/Design: One hundred and 19 individuals with a diagnosis of schizophrenia, bipolar disorder, or major depression were randomly assigned to either an interviewer- or self-administered method of completing the measure, and filled out the measure again in the same format within 48–72 hr. Results: Correlations at the individual participation item and scale levels between the two time points were nearly all in the r = .6-.9 range. Agreement on the importance and sufficiency of their participation was also consistently high. The importance of participation in each area ranged from 36% to 95%, and among these individuals, between 18% and 71% indicated they were not participating as much as desired. Conclusions/Implications: Community participation of individuals with psychiatric disabilities can be reliably measured using 2 methods of administration as an outcome in rehabilitation research and evaluation studies with this population. These individuals are engaged to varying degrees in a wide-range of participation areas in the community that are important, but most not to the degree that they desire. More intervention efforts are needed to increase the sufficiency of community participation. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Comparing CESD-10, PHQ-9, and PROMIS depression instruments in individuals with multiple sclerosis.
    Purpose: This study evaluated psychometric properties of the Patient Health Questionnaire-9 (PHQ-9), the Center for Epidemiological Studies Depression Scale-10 (CESD-10), and the 8-item PROMIS Depression Short Form (PROMIS-D-8; 8b short form) in a sample of individuals living with multiple sclerosis (MS). Research Method: Data were collected by a self-reported mailed survey of a community sample of people living with MS (n = 455). Factor structure, interitem reliability, convergent/discriminant validity and assignment to categories of depression severity were examined. Results: A 1-factor, confirmatory factor analytic model had adequate fit for all instruments. Scores on the depression scales were more highly correlated with one another than with scores on measures of pain, sleep disturbance, and fatigue. The CESD-10 categorized about 37% of participants as having significant depressive symptoms. At least moderate depression was indicated for 24% of participants by PHQ-9. PROMIS-D-8 identified 19% of participants as having at least moderate depressive symptoms and about 7% having at least moderately severe depression. None of the examined scales had ceiling effects, but the PROMIS-D-8 had a floor effect. Conclusions: Overall, scores on all 3 scales demonstrated essential unidimensionality and had acceptable interitem reliability and convergent/discriminant validity. Researchers and clinicians can choose any of these scales to measure depressive symptoms in individuals living with MS. The PHQ-9 offers validated cutoff scores for diagnosing clinical depression. The PROMIS-D-8 measure minimizes the impact of somatic features on the assessment of depression and allows for flexible administration, including Computerize Adaptive Testing (CAT). The CESD-10 measures 2 aspects of depression, depressed mood and lack of positive affect, while still providing an interpretable total score. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Social support and depressive symptoms among caregivers of veterans with multiple sclerosis.
    Purpose/Objective: The primary aim of this study was to examine the relationship between perceived social support and depressive symptoms among family caregivers of veterans with multiple sclerosis (MS). A secondary aim of this study was to examine the relationship between caregiver perceived social support and caregiver demographic variables, veteran health-related variables, and caregiver depressive symptoms. Research Method/Design: As part of a larger study, 42 family caregivers of veterans with MS completed questionnaires by telephone. Hierarchical regression was used to examine the relationship between caregiver depressive symptoms and perceived social support. Results: Greater MS disease severity and poorer overall veteran health were associated with higher levels of depressive symptoms among caregivers. Caregiver perceived social support was associated with depressive symptoms after controlling for veterans’ MS disease severity and overall physical health. Conclusions/Implications: Psychosocial interventions aimed at enhancing social support among caregivers of veterans with MS in multiple life domains, such as work, finances, housing, social life, marriage, and family, may be important for family caregiver mood management, particularly as MS disease severity increases. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Attitudes toward the sexuality of persons with physical versus psychiatric disabilities.
    Objective: Research has shown that attitudes toward different disabilities form a hierarchy, with observers exhibiting more positive attitudes toward persons with physical disabilities than toward persons with psychiatric disabilities. In addition, investigations of attitudes toward persons with a disability indicate that they are often perceived as asexual. The current study examined whether involvement of persons with either a physical or psychiatric disability in a sexual relationship moderates the relation between their type of disability and attitudes toward them. Method: After reading one of six randomly assigned vignettes, university students (N = 195) filled out a semantic differential-based attitude scale (Katz & Shurka, 1977; Kravetz, Katz, & Albez, 1994). The six vignettes consisted of a male with a physical disability/with a psychiatric disability/without a disability, who was either involved/not involved in a sexual relationship. Results: An interaction between type of disability and involvement in a sexual relationship was found for two subscales of the attitudes scale, occupation and intelligence. Involvement in a sexual relationship was found to generate more positive attitudes when the target person had a physical disability but more negative attitudes when he had a psychiatric disability. Conclusions: Involvement in a sexual relationship seems to work in favor of persons with a physical disability because of the association of such a relationship with normality and adaptation. However, attributing such a relationship to persons with a psychiatric disability seems to be stigmatic. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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  • Brief report of affective state and depression status after traumatic brain injury.
    Objective: To examine the relationship between affective state (positive and negative affect) and depression status among adults with chronic traumatic brain injury (TBI). Research Method: This is a cross-sectional cohort study of community-dwelling adults with chronic TBI (n = 64) that assesses the relationship between affective state (positive and negative affect), using the Positive and Negative Affect Schedule (PANAS), and depression status, categorized as no depression, history of depressive episode, and current depressive episode, using the Primary Care Evaluation of Mental Disorders (PRIME-MD). Results: Affective state differed significantly across depression status groups for both positive affect (F (2, 61) = 5.10, p = .009) and negative affect (F ( 2, 61) = 8.19, p = .001). Participants with no depression reported higher positive affect (M = 35.67, SD = 9.08) than those with a current depressive episode (M = 27.64, SD = 8.59, p = .007) and lower negative affect (M = 14.52, SD = 5.08) than those with a history of a depressive episode (M = 20.21, SD = 5.08, p = .006) and those with a current depressive episode (M = 22.29, SD = 6.21, p = .001). Conclusions: Poor affective state, including both low positive affect and high negative affect, is associated with depression diagnosis. High negative affect is present, even in the absence of a current depressive episode, after TBI. These data highlight the need to assess affective state in addition to screening for mood disorders among adults with chronic TBI. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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