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Rehabilitation Psychology - Vol 62, Iss 3

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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 2017 American Psychological Association
  • Pediatric rehabilitation psychology: Rehabilitating a moving target.
    The current special section includes manuscripts focusing on four aspects of pediatric rehabilitation psychology that are unique to this practice area. The first domain addressed is natural developmental progression in the context of a disability (i.e., habilitation). The next domain addressed in this special section is pediatric rehabilitation; pediatric rehabilitation psychology addresses the reacquisition of previously attained skills and abilities within the context of the natural developmental milieu. This special section also highlights the inherently interdisciplinary and transdisciplinary nature of pediatric rehabilitation psychology given the complex environment in which children exist. Finally, the special section includes illustrations of the crucial role pediatric rehabilitation psychologists play in facilitating transitions through major milestones, particularly from pediatrics to adulthood when living with a disability. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Conducting preference assessments for youth with disorders of consciousness during rehabilitation.
    Purpose: Care and rehabilitation for individuals with disorders of consciousness (DOC) can be challenging; the use of observational data collection, individualized treatment programs, and incorporation of preferred, personally meaningful and salient items may be helpful in addressing such challenges during assessment and intervention. In this article, we extend the predominantly adult literature on use of salient items to promote differential responding by describing our methodology to identify preferred items across sensory domains for application during inpatient rehabilitation with children with DOC. Method: Details on the indirect and direct preference assessment procedures rooted in applied behavior analysis that we have tailored for this population are provided. We describe steps of the procedures, including structured caregiver interview, staff survey, item inclusion, in vivo single-item stimulus preference assessment, and treatment. Clinical case examples further illustrate implementation of our methodology, observed response topographies, individually identified preferred items, and their application for 3 children in a minimally conscious state. In addition, we introduce a new structured caregiver interview, the Preference Assessment for Youth with Disorders of Consciousness (PAYDOC), modeled on the Reinforcer Assessment for Individuals with Severe Disabilities (RAISD; Fisher, Piazza, Bowman, & Amari, 1996) and modified to be appropriate for future use as a clinical tool to enhance assessment of preferences with this pediatric brain injury population. Implications: This methodology can be used to identify highly idiosyncratic stimuli that can be incorporated in multiple ways throughout rehabilitation to optimize care for youth with DOC. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The role of the psychologist with disorders of consciousness in inpatient pediatric neurorehabilitation: A case series.
    Purpose/Objective: The psychologist in an inpatient pediatric neurorehabilitation setting provides a vital role in the assessment, treatment, and management of pediatric patients with disorders of consciousness (DoC). Competencies are drawn from several specialty areas of professional psychology, including rehabilitation psychology, pediatric neuropsychology, and pediatric psychology. This specialized knowledge forms the basis for tailoring assessment and treatment plans specific to the individual brain injury profile, with the goals of enhancing diagnosis, prognosis, and care transition decision. Aim: To describe the role of the psychologist in the differential diagnosis and treatment of pediatric patients with severe brain injury and DoC during inpatient rehabilitation. Research Method/Design: Three pediatric cases admitted to inpatient rehabilitation with suspected DoC illustrate the psychologist’s role in diagnostics, case conceptualization, assessment design, and data collection based on patient-specific brain injury profiles. Customized data collection informs diagnostic decisions and treatment planning, with the goal of improved of care and resource utilization. The psychologist also provides ongoing psychoeducation, psychotherapy, and supportive interventions to the patient’s family and caregivers to facilitate family adjustment to disability and promote long-term adaptation and adjustment. Conclusions/Implications: This case series illustrates the role of the psychologist in the use of individual brain injury profiles to coordinate assessment, diagnosis, and care for children with severe brain injury. Implications include the need for focused research to demonstrate the value-added role of the psychologist on the interdisciplinary team working in the neurorehabilitation of this complex patient population. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The Kennedy Krieger Independence Scales-Sickle Cell Disease: Executive components of transition readiness.
    Purpose/Objective: Youth with sickle cell disease (SCD) are at an increased risk for executive dysfunction and simultaneously have increased self-management needs compared to typical adolescents. This unique combination may contribute, in part, to difficulties during transition to young adulthood. Current measures assessing adaptive skills do not assess the executive components (e.g., initiation, prospective memory) of SCD-related self-care tasks. Modeled on the KKIS-Spina Bifida (Jacobson et al., 2013), the Kennedy Krieger Independence Scales-Sickle Cell Disease (KKIS-SCD) is a new caregiver-report measure that assesses independence with self-management of SCD-specific demands as well as routine daily activities in adolescents with SCD. Research Method/Design: Thirty-three youth with SCD and their caregivers participated in this preliminary validation study examining the construct validity of the KKIS-SCD total and composite scores (Initiation of Routines, Prospective Memory) and exploring relationships of this measure with intellectual functioning, demographic factors, illness severity, and age. Results: The KKIS-SCD exhibited generally good internal consistency (Cronbach’s alpha = .733 to .803), and demonstrated evidence for construct and discriminant validity when compared to an existing measure of adaptive function. The KKIS-SCD was significantly associated with caregiver-report of executive behaviors but not with intellectual functioning, demographic factors, illness severity, or age. Conclusions/Implications: Results provide preliminary support for the KKIS-SCD as a reliable and valid tool for the assessment of executive components of self-care management skills for youth with SCD. Identifying specific weaknesses in executive function related to self-care management skills might assist in guiding intervention and individualizing transition planning in these at-risk youth. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Mastery motivation and executive functions as predictors of adaptive behavior in adolescents and young adults with cerebral palsy or myelomeningocele.
    Purpose/Objective: To examine mastery motivation and executive functions or behaviors as predictors of adaptive behavior in adolescents and young adults with congenital neurodevelopmental conditions. Method: Participants were 2 groups of adolescents and young adults, ages 13–29, including 43 with cerebral palsy and 36 with myelomeningocele living with a parent or caregiver. Participants completed measures of mastery motivation, executive functions or behaviors, and a measure of adaptive behavior. Results: Group differences in mastery motivation, executive functions and executive behaviors, and adaptive behavior profiles were not significant. Mastery motivation, executive functions, and executive behaviors explained a significant portion of variance in adaptive behavior. Conclusions: Findings highlight the importance of assessing and addressing motivational and executive needs in developing interventions to promote independence. Findings also suggest the need for more comprehensive assessment of adaptive behaviors that include the ability to self-direct others in the completion of tasks necessary for successful daily functioning. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Health self-management, transition readiness and adaptive behavior in persons with cerebral palsy or myelomeningocele.
    Purpose/Objective: This study was conducted to examine the associations between generic and condition-specific health self-management and levels of adaptive behavior in 2 groups of transition-age youth with congenital neurodevelopmental conditions. Method: The sample included 43 adolescents/young adults diagnosed with cerebral palsy (CP) and 36 with spina bifida/myelomeningocele (SBM), ages 13–29, mean age 18.96 (4.77), 51.9% female. Health self-management was assessed with the Transition Readiness Assessment Questionnaire (TRAQ) completed by the child, and the Kennedy Krieger Independence Scales–Spina Bifida (KKIS-SB) completed by the parent/guardian. The Adaptive Behavior Assessment System (ABAS-II) completed by the parent/guardian was used to assess levels of adaptive behavior. Results: There were significant group differences in condition-specific health self-management, including lower KKIS-SB Initiation of Routines and KKIS-SB Prospective Memory scores in the group with SBM. Those differences were no longer significant when scoring was modified to account for item applicability. Group differences in generic health self-management and adaptive behavior were not significant. There were significant differences in the correlations between health self-management instruments and ABAS-II composite scores. Conclusions: For youth with congenital neurodevelopmental conditions who are in the transition to adulthood, there are important condition-specific self-management needs that are not captured by measuring generic transition readiness or adaptive behavior. Findings highlight the need for clinicians to assess health self-management needs from multiple perspectives, utilizing generic and condition-specific measures that can inform targeted interventions and supports for optimal independence. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Social-cognitive predictors of vocational outcomes in transition youth with epilepsy: Application of social cognitive career theory.
    Objective: This study examined the utility of social–cognitive career theory (SCCT; Lent, Brown, & Hackett, 1994) as a framework to investigate career self-efficacy, outcome expectations, goals, and contextual supports and barriers as predictors of choice actions among transition-age individuals with epilepsy. Moreover, these SCCT constructs are offered as an operational definition of work participation in this population. Method: Using a quantitative descriptive research design and hierarchical regression analysis (HRA), 90 transition-age individuals with epilepsy, age 18–25, were recruited from affiliates of the Epilepsy Foundation and invited to complete an online survey comprised of a series of self-report social–cognitive measures. Results: The HRA findings indicated that self-efficacy, outcome expectations, and environmental supports were significant predictors of work participation in youth and young adults with epilepsy. The final model accounted for 58% of the variance in work participation, which is considered a large effect size. Conclusions: The research findings provide support for the use of the SCCT framework to identify predictors of work participation and to provide guidance for designing customized vocational rehabilitation services and career development interventions for individuals with epilepsy in the transition from adolescence to adulthood. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Teen online problem solving for teens with traumatic brain injury: Rationale, methods, and preliminary feasibility of a teen only intervention.
    Purpose/Objective: To describe the Teen Online Problem Solving—Teen Only (TOPS-TO) intervention relative to the original Teen Online Problem Solving—Family (TOPS-F) intervention, to describe a randomized controlled trial to assess intervention efficacy, and to report feasibility and acceptability of the TOPS-TO intervention. Research method and design: This is a multisite randomized controlled trial, including 152 teens (49 TOPS-F, 51 TOPS-TO, 52 IRC) between the ages of 11–18 who were hospitalized for a moderate to severe traumatic brain injury in the previous 18 months. Assessments were completed at baseline, 6-months post baseline, and 12-months post baseline. Data discussed include adherence and satisfaction data collected at the 6-month assessment (treatment completion) for TOPS-F and TOPS-TO. Results: Adherence measures (sessions completed, dropout rates, duration of treatment engagement, and rates of program completion) were similar across treatment groups. Overall, teen and parent reported satisfaction was high and similar across groups. Teens spent a similar amount of time on the TOPS website across groups, and parents in the TOPS-F spent more time on the TOPS website than those in the TOPS-TO group (p = .002). Parents in the TOPS-F group rated the TOPS website as more helpful than those in the TOPS-TO group (p = .05). Conclusions/Implications: TOPS-TO intervention is a feasible and acceptable intervention approach. Parents may perceive greater benefit from the family based intervention. Further examination is required to understand the comparative efficacy in improving child and family outcomes, and who is likely to benefit from each approach. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • A review of the literature on pediatric concussions and return-to-learn (RTL): Implications for RTL policy, research, and practice.
    Objective: While reintegration of concussed youth back into sports has been increasingly studied over the past decade, a noticeably lacking yet growing body of research has begun to focus on issues surrounding return to academics or “return-to-learn” (RTL). The objective of this article was to conduct a comprehensive literature review to identify the full range of themes and gaps in the current body of RTL research. Study design: Researchers analyzed PubMed, PsycINFO, and ERIC databases to identify all recent (January 2000 through May 2016) empirical publications on the RTL process following youth concussions. In addition to the database searches, bibliographies of selected manuscripts were hand-searched for additional sources. Results: A total of 35 articles met inclusion criteria. Key themes identified from the RTL literature centered on academic outcomes, physician recommendations, length of time to complete RTL, concussion-related symptom difficulties, and academic accommodations/guidelines. Across these areas, the research was fairly inconsistent in terms of providing clear conclusions, likely because of the small number of studies conducted within these areas as well as variability in methodology and terminology. Gaps in the research include a lack of the following: consensus on RTL protocols, agreement on prescription of cognitive rest, guidance for RTL legislation, understanding of communication between systems of care, concussion-related education for systems of care, evidence-based programs or interventions for RTL, and the impact on RTL outcomes. Conclusions: Given the inconsistencies in RTL literature, more rigorous research is needed to inform concussion policy and practice to assist with pediatric concussion management. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Crip for a day: The unintended negative consequences of disability simulations.
    Objective: To investigate the impact of disability simulations on mood, self-ascribed disability stereotypes, attitudes about interacting with disabled individuals, and behavioral intentions for improving campus accessibility. Design: Experiment 1 evaluated disability-awareness simulations by randomly assigning undergraduates (N = 60) with and without disabilities to stations simulating either dyslexia, hearing or mobility impairments. Experiment 2 extended the field study into the lab where undergraduates (N = 50) with and without disabilities each completed low vision, hearing impairment, and dyslexia simulations. Both studies incorporated pretest–posttest measures of mood, self-ascribed disability stereotypes, and attitudinal measures. Results: In both experiments, disability simulations made participants feel more confused, embarrassed, helpless, and more vulnerable to becoming disabled themselves compared to baseline. Following the simulations, empathetic concern (warmth) toward disabled people increased in both studies, but attitudes about interacting did not improve. In Experiment 1, postsimulation anxiety, embarrassment, and helplessness were highest for those who used wheelchairs or simulated dyslexia. In Experiment 2, participants judged themselves less competent, expressed more pity, expressed more interaction discomfort, and were not more willing to interview disabled students for an accessibility project following the simulations compared to baseline. In addition, Experiment 2 found frustration, guilt, anxiety, and depression were most pronounced among those who interacted with disabled people less than once per month. Conclusions: Simulating disabilities promotes distress and fails to improve attitudes toward disabled people, undermining efforts to improve integration even while participants report more empathetic concern and “understanding of what the disability experience is like.” (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Effect of the environment on participation in spinal cord injuries/disorders: The mediating impact of resilience, grief, and self-efficacy.
    Objective: The objective of the study was to test the hypothesis that the influence of environmental barriers on participation will be fully mediated by psychosocial factors (resilience, grief or loss, and self-efficacy) among individuals with spinal cord injuries and disorders. Method: This was a cross-sectional mailed survey with a national sample of veterans with spinal cord injuries and disorders (n = 565), which included measures of demographics, perceived environmental barriers, participation, resilience, grief or loss, and self-efficacy. Data were analyzed using a latent variable path analysis; the model fit was assessed using χ2, normed χ2, root mean square error of approximation (RMSEA;
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  • Examination of traumatic brain injury exposure among veterans with spinal cord injury.
    Objective: The authors investigated lifetime exposure to traumatic brain injury (TBI) among veterans with spinal cord injury (SCI) in order to describe outcome differences as a function of self-reported TBI history. Design: Cross sectional study, veterans with SCI (N = 857) completed the Ohio State University TBI Identification interview method (OSU-TBI); Veterans RAND 36-Item Health Survey (VR-36); Quick Inventory for Depressive Symptomatology, Self-Report (QIDS-SR); Patient Health Questionnaire-9; Satisfaction with Life Scale; Craig Handicap Assessment and Reporting Technique (CHART; along with clinician-rated Functional Independence Measure (FIM) Total, Motor, and Cognitive scores. Results: Probable TBI exposure was described by 77.6% of participants, with 38% reporting sustaining more than one injury. Self-reported TBIs classified as moderate/severe comprised 49.5% of injuries. Participants with self-reported TBI obtained significantly lower scores on the FIM-Cognitive and CHART Cognitive Independence scales and reported more alcohol use. A history of multiple TBIs was additionally associated with lower mental well-being on the VR-36. Conclusions: These findings highlight the need to consider more than co-occurring injuries and the potential utility of the OSU-TBI for this purpose. Recognizing lifetime exposure to TBI among veterans with SCI may help identify those with broader impairments and enhance the rehabilitation process. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Blame, coping, and psychosocial outcomes in caregivers of individuals with brain injury.
    Objective: Acquired brain injury (ABI) is associated with many physical and psychiatric conditions. Oftentimes, the individual’s family members are responsible for providing long-term care, leaving caregivers vulnerable to negative effects of caregiving including stress, depression, and decreased quality of life. Attribution theory suggests that caregivers may blame the individual with the ABI for their injury as a way to understand their own circumstances. The objective of this study was to investigate caregiver coping strategies as possible mediators between caregiver family member blame and caregiver psychosocial outcomes among caregivers of individuals with ABI. Method: Caregivers of individuals with ABI (n = 94) completed an online survey of self-report measures regarding coping (emotion-focused, problem-focused, and dysfunctional strategies), blame (direct, indirect, and preoccupation with blame), depressive symptoms, and quality of life (QOL). Bootstrapping mediation analyses were conducted to investigate the mediating role of caregiver coping strategies between blame attributions, and either depressive symptoms or QOL. Results: Results demonstrated that the use of more dysfunctional coping strategies significantly mediated the relationship between indirect blame, and depressive symptoms and QOL. Furthermore, using more dysfunctional coping strategies also significantly mediated the relationship between preoccupation with blame and depressive symptoms. Conclusions: Results of this study point to the important role blame attributions play in the use of coping strategies and subsequent psychosocial outcomes. By understanding the relationships between blame attributions, coping behavior, and psychosocial outcomes, clinicians may better tailor treatments to optimize QOL and promote the psychological well being of caregivers and care recipients. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Exercise motivation and nonspecific back pain: A comparison of patients and nonpatients.
    Objective: Motivation is a key variable to consider during exercise or exercise therapy of individuals with back pain. Based on organismic integration theory, this study aims to improve the understanding of exercise motivation in patients and nonpatients by evaluating the relationships between typical motivational profiles and personal characteristics, therapy parameters and pain related variables. Method: One hundred nine women and 145 men with back pain (mean age 33.3 years; 31.9% currently under the care of a physician) involved in some kind of exercise for current nonspecific back pain voluntarily participated in this study. An adapted version of the Behavioral Regulation in Sport Questionnaire was used to measure exercise motivation. Furthermore, data on pain, disability status, level of sport activity, body concept, and the type of treatment or exercise were gathered. Results: Autonomous forms of regulation were most prevalent among subjects. Of 4 motivational profiles found, 2 showed a positive pattern (29.1% highly motivated individuals, 21.7% autonomously convinced individuals), and 2 showed a more negative pattern (19.7% controlled convinced individuals, 29.5% less motivated individuals). Relationships between profiles and age, body concept, involvement in sport competition, and type of exercise were found. Conclusions: The different motivational profiles respectively reveal specific practical relevance. In particular, the controlled convinced pattern is supposed to be more maladaptive than all other profiles. The insights provided by this study supports the development of motivation-oriented treatments based on the assessment of individuals’ motivational profiles. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Adjustment between work demands and health needs: Development of the Work–Health Balance Questionnaire.
    Purpose: This study presented the construct of Work–Health Balance (WHB) and the design and validation of the Work–Health Balance Questionnaire (WHBq). More and more workers have a long-standing health problem or disability (LSHPD). The management of health needs and work demands is crucial for the quality of working life and work retention of these workers. However, no instrument exists measuring this process. The WHBq assesses key factors in the process of adjusting between health needs and work demands. Method: We tested the reliability and validity of 38 items with cross-sectional data from a sample of 321 Italian workers (mean age = 45 ± 11 years) using exploratory factor analysis (EFA), Rasch analyses, and the correlations with other relevant variables. Results: The instrument ultimately consisted of 17 items that reliably measured three factors: work–health incompatibility, health climate, and external support. These dimensions were associated with well-being in the workplace, dysfunctional behaviors at work, and general psychological health. A higher level on the WHB index was associated with lower levels of presenteeism, emotional exhaustion, workaholism, and psychological distress and with higher levels of job satisfaction and work engagement, supporting the construct validity of the instrument. Conclusion: The WHBq shows good psychometric characteristics and strong and theoretically consistent relationships with important and well-known variables. These results make the WHBq a promising tool in the study and management of health of employees, especially for the work continuation of employees returning to work with LSHPD. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Rehabilitation research at the National Institutes of Health moving the field forward (executive summary).
    Approximately 53 million Americans live with a disability. For decades, the National Institutes of Health (NIH) has been conducting and supporting research to discover new ways to minimize disability and enhance the quality of life of people with disabilities. After the passage of the Americans With Disabilities Act, NIH established the National Center for Medical Rehabilitation Research, with the goal of developing and implementing a rehabilitation research agenda. Currently, 17 institutes and centers at NIH invest more than $500 million per year in rehabilitation research. Recently, the director of NIH, Francis Collins, appointed a Blue Ribbon Panel to evaluate the status of rehabilitation research across institutes and centers. As a follow-up to the work of that panel, NIH recently organized a conference, “Rehabilitation Research at NIH: Moving the Field Forward.” This report is a summary of the discussions and proposals that will help guide rehabilitation research at NIH in the near future. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • National Institutes of Health research plan on rehabilitation.
    One in 5 Americans experiences disability that affects daily function because of impairments in mobility, impairments in cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The National Institutes of Health (NIH) recently published a Research Plan on Rehabilitation that provides a set of priorities to guide the field over the next 5 years (Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD] & NIH Medical Rehabilitation Coordinating Committee [MRCC], 2016). The plan was developed with input from multiple institutes and centers within the NIH, the National Advisory Board for Medical Rehabilitation Research, and the public. This article provides an overview of the need for this research plan, an outline of its development, and a listing of six priority areas for research. The NIH is committed to working with all stakeholder communities engaged in rehabilitation research to track progress made on these priorities and to work to advance the science of medical rehabilitation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Does functional motor incomplete (AIS D) spinal cord injury confer unanticipated challenges?
    Purpose/Objective: Examine psychological challenges associated with Spinal Cord Injury (SCI) among a cohort of Veterans. Research Method/Design: Cross-sectional descriptive study. SCI Centers participating in a multisite evaluation of longitudinal employment, quality of life, and economic outcomes among a large cohort of veterans with SCI, the Predictive Outcome Model Over Time for Employment (PrOMOTE) project. A total of 1,047 patients from participating SCI Centers provided baseline interviews. Main outcome measures included the Veterans RAND 36-Item Health Survey (VR-36) Mental Component Score (MCS); VR-36 Mental Health Scale; VR-36 Vitality Scale; VR-36 Bodily Pain Scale; Quick Inventory for Depressive Symptomatology, Self-Report (QIDS-SR); Patient Health Questionnaire-Depression Scale (PHQ-9); and Diener Satisfaction with Life Scale (SWLS). Results: ANOVA analysis showed that persons with AIS D SCI evidenced higher self-reported depressive symptoms, higher pain, and a lower subjective quality of life. Conclusions/Implications: Individuals with functional motor incomplete spinal cord injury are more vulnerable to psychological distress and a low subjective quality of life than might be expected based on functional outcomes. Further study appears warranted to ascertain potential explanations for these findings. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Clinical utility and psychometric properties of the Disability Rating Scale with individuals with traumatic brain injury.
    This Rehabilitation Measures Database summary provides a review of the psychometric properties of the Disability Rating Scale (DRS) which is an observer-rated instrument designed to measure general functional disability in individuals with traumatic brain injury. A full review of the DRS as well as reviews of over 300 other instruments can be found at www.rehabmeasures.org. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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