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Rehabilitation Psychology - Vol 62, 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 2017 American Psychological Association
  • Family caregiver adjustment and stroke survivor impairment: A path analytic model.
    Objective: Depressive symptoms are a common problem among family caregivers of stroke survivors. The purpose of this study was to examine the association between care recipient’s impairment and caregiver depression, and determine the possible mediating effects of caregiver negative problem-orientation, mastery, and leisure time satisfaction. The evaluated model was derived from Pearlin’s stress process model of caregiver adjustment. Method: We analyzed baseline data from 122 strained family members who were assisting stroke survivors in Germany for a minimum of 6 months and who consented to participate in a randomized clinical trial. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. The cross-sectional data were analyzed using path analysis. Results: The results show an adequate fit of the model to the data, χ2(1, N = 122) = 0.17, p = .68; comparative fit index = 1.00; root mean square error of approximation: p <.01; standardized root mean square residual = 0.01. The model explained 49% of the variance in the caregiver depressive symptoms. Results indicate that caregivers at risk for depression reported a negative problem orientation, low caregiving mastery, and low leisure time satisfaction. The situation is particularly affected by the frequency of stroke survivor problematic behavior, and by the degree of their impairments in activities of daily living. Conclusion: The findings provide empirical support for the Pearlin’s stress model and emphasize how important it is to target these mediators in health promotion interventions for family caregivers of stroke survivors. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Social-cognitive factors of long-term physical exercise 7 years after orthopedic treatment.
    Objective: Although it has been confirmed that physical exercise improves orthopedic conditions, many individuals fail to maintain a regular exercise regimen after being discharged from medical rehabilitation. The present study examines the role of intention, social support, self-determination, planning, and self-efficacy in facilitating strength and endurance training. Design: In a 7-year observational study, intention, received social support and self-determination were assessed at baseline, self-efficacy and planning at 6-month follow-up, and physical exercise at 1-year, 3-year, and 7-year follow-up. Study participants were recruited from an orthopedic rehabilitation center, N = 641 participated in the survey at baseline, n = 495 at 6-month follow-up, n = 373 at 1-year follow-up, n = 330 at 3-year follow-up, and n = 191at 7-year follow-up. Path analyses were applied to investigate whether personal and social resources contribute to long-term physical activity. Results: Self-determination and planning mediated the link from intention and from social support to physical exercise at 1-, 3- and 7-year follow-ups. Self-efficacy facilitated planning and bridged the intention-behavior relationship in the domain of strength training after 1 year. An inverse direct relationship between social support and strength training was also found for all follow-ups. Conclusions: Findings indicate that intention, received social support and self-determination act as crucial resources in the long-term management of exercise. Planning can bridge the intention-behavior gap on a long-term basis. Behavior change interventions should replenish personal and social resources to empower individuals to maintain a healthy lifestyle (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • College-age adults’ religiosity, family functioning and values, and willingness to provide care for a relative with a chronic health condition.
    Purpose/Objective: The population of adults age 65 and older is increasing at a faster rate than the rest of the U.S. population. As such, older adults, particularly those with chronic health conditions and disabilities, will require informal care from today’s college-age adults. At present, there is no research examining factors predicting college-age individuals’ willingness to provide care for a family member with a chronic condition. The purpose of this study was to examine the pattern of associations among college-age adults’ religiosity, family functioning, family values, and willingness to provide care for a family member with a chronic health condition. Research Method/Design: A sample of 330 undergraduate students from a major public research university completed an online survey with measures assessing these constructs. Four different structural equation models were tested. Results: The fourth model revealed good fit indices and was therefore retained. This model found that religiosity and family values were positively and uniquely associated with willingness to provide care. Family functioning yielded a significant indirect effect through family values. Conclusions/Implications: The current study findings suggest religiosity, family functioning, and family values play a role in willingness to provide care, and thus, future researchers should target these constructs for intervention-based studies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Understanding self-report Multidimensional Attitudes Scale Toward People with Disabilities: An exploratory analysis.
    Purpose/Objective: This study aimed to explore the factor structure of the Multidimensional Attitudes Scale Toward People With Disabilities (MAS) using participants from South Korea and assess the impact of participants’ social desirability on this South Korean version of the MAS (MAS-K). Research Method/Design: One hundred eighty-nine college students without disabilities from 4 universities in South Korea completed an online survey. Among them, 75 were females. Participants completed the MAS-K and a social desirability scale. We used principal axis factoring with promax rotation to examine the factor structure of the MAS-K, and correlations between factors and social desirability measure. Results: We obtained a 27-item 4-factor MAS-K. Four factors were negative affect (α = .89), ease-unease (α = .75), positive cognition (α = .86), and avoidant behavior (α = .88). The interfactor correlations ranged from .18 to .61. The correlations between the social desirability measure and the 4 factors in the MAS-K ranged from −.23 to −.33. Conclusions/Implications: The MAS-K retrieved from this study may help researchers identify unique attitudinal factors that need to be addressed to promote social inclusion of PWD in South Korea. Moreover, the emergence of the MAS-K highlights the necessity to develop culturally relevant versions of the MAS. This line of research will facilitate researchers’ worldwide investigations regarding attitudes toward PWD and discussions about the rights of PWD. Finally, this study also pointed out the potential impact of social desirability on attitude measurement using the MAS. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Change in explicit and implicit motivation toward physical activity and sedentary behavior in pulmonary rehabilitation and associations with postrehabilitation behaviors.
    Objective: The aim of this study was twofold: (a) to determine whether Theory of Planned Behavior (TPB) variables and implicit attitudes toward physical activity and sedentary behavior would change during a 5-week pulmonary rehabilitation (PR) program, and (b) to investigate the relationships between behavioral intentions, implicit attitudes, physical activity, and sedentary behavior in postrehabilitation. Design: Out of 142 patients with respiratory disease included in this study, 119 completed 2 questionnaires measuring TPB variables with regard to physical activity and sedentary behavior, and an Implicit Association Test (IAT) measuring implicit attitudes toward physical activity in contrast to sedentary behavior. The TPB questionnaires and the IAT were administered at the beginning (Time 1) and the end of the program (Time 2). Six months after the program (Time 3), 62 patients provided self-reported measures of their recreational physical activity and screen-based, leisure-time sedentary behavior. Results: Over the course of pulmonary rehabilitation, perceived behavioral control and intentions toward physical activity increased, as did social norms and perceived behavioral control toward sedentary behavior; implicit attitudes were also more positive toward physical activity. Implicit attitudes at the end of PR (Time 2) were significantly associated with postrehabilitation physical activity (Time 3). Conclusions: TPB variables toward physical activity and sedentary behavior as well as implicit attitudes were enhanced during PR. At 6 months, implicit attitudes were significantly associated with physical activity. These results suggest that motivation, particularly implicit attitudes, should be targeted in future behavioral interventions in order to optimize the effects of rehabilitation on physical activity maintenance. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Factors impacting sense of community among adults with brain injury.
    Purpose: Despite increasing interest in examining community outcomes following disability, sense of community (SOC) has received relatively no attention in the rehabilitation literature. SOC refers to feelings of belonging and attachment one has for a community and is of particular relevance for people with brain injury who are at increased risk of social isolation. The aim of this study was to investigate factors contributing to SOC for individuals with brain injury. Method: Members from 2 brain injury associations (n = 98) participated in this survey-based study. Hierarchical regression analysis was used to explore demographic, disability-related, community and social participation variables’ impact on SOC with regard to one’s town or city. Follow-up mediation analyses were conducted to explore relationships among social self-efficacy, support network, neighboring behavior, and SOC. Results: Findings indicated that disability-related and community variables accounted for over 40% of the variance in SOC. Size of social support network was the only significant independent contributor to SOC variance. Follow-up analyses provided support for (a) the partial mediating effect of social support network size on the relationship between social self-efficacy and SOC, and (b) the mediating effect of neighboring behavior on the relationship between social self-efficacy and social support network size. Conclusions: Findings from this study highlight the particular importance of self-efficacy, social support, and neighboring behaviors in promoting SOC for people with brain injury. Recommendations are provided to advance research efforts and inform intervention approaches to improve the felt experience of community among people with brain injury. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Utilizing the ICF to understand depressive symptomology in multiple sclerosis: An exploratory systematic review.
    Purpose: Acceptance of the International Classification of Functioning, Disability and Health (ICF) in research and clinical practice has been delayed, despite its multiperspective approach to health measurement. This review utilized the ICF to examine evidence on the associations between depressive symptoms and psychosocial functioning in a patient cohort: multiple sclerosis (MS). Research Method: Forty-nine studies, involving 7,548 adults with relapsing or progressive forms of MS, were quantitatively evaluated. Data were categorized according to ICF domains: activities of individuals along with their participation in life areas and influential environmental and personal factors. Effect size estimates, in the form of Pearson’s r, 95% confidence intervals and Fail-safe Ns were calculated. Results: Depression severity was linked to reduced social activities and participation levels (29%, n = 14 studies). Limited quality and/or frequency of informal support from family and friends was also identified as an environmental barrier to participation (29%, n = 14 studies). Intrapersonal markers of depressive symptomatology (e.g., low self-efficacy, anxiety, poor coping, illness attitudes and beliefs) were routinely reported (53%, n = 29 studies). Conclusions: The ICF can help guide the selection of clinical measures to assess psychosocial functioning in adults with MS and highlight areas necessitating further research and/or intervention. For those reporting depressed mood, this might include interventions premised on supporting activity and participation in addition to reinforcing interpersonal strengths. To enhance the utility of the ICF in MS care, further research is needed to operationalize its domains and to map this framework onto existing measurement tools. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Developing a measure to assess identity reconstruction in patients with multiple sclerosis.
    Purpose/Objective: To develop and test initial validation of a theory-driven quantitative measure of identity reconstruction in patients with multiple sclerosis (MS) based upon previous qualitative research. Research Method/Design: This study uses a cross-sectional survey design, in which 137 patients living with MS were recruited from an outpatient MS Center in the Southeastern U.S. Participants completed demographic items, Identity Reconstruction Assessment Scales (IRAS), Patient Determined Disease Steps, Medical Outcomes Study Measures of Patient Adherence, Chronic Disease Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Leeds MS Quality of Life Questionnaire, MS-Related Stigma Scale, and Posttraumatic Growth Inventory—Short Form. Results: The IRAS conformed to a 3-factor solution consisting of 23 items accounting for 42.6% of the variance. The 3 factors, labeled as “sustained identity” (α = .84), “reactionary identity” (α = .74), and “integrated identity” (α = .65), were not significantly correlated with each other, necessitating and allowing for independent scoring of the scales. Higher scores on “sustained identity” scale were associated with less anxiety, depression, perceived disability, and MS-related stigma, as well as with increased self-efficacy, treatment adherence, and quality of life. “Reactionary identity” scale was positively correlated with anxiety and MS-related stigma. “Integrated identity” was significantly associated with age and perceived disability. Conclusions/Implications: Identity reconstruction provides needed context for understanding adjustment to and living with MS. Examination of the IRAS within a larger sample and in other disease groups can provide additional construct validity evidence. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Posttraumatic stress disorder after spinal cord injury.
    Objective: The objective of the study was to identify the relationships of demographics, injury-related characteristics, employment, depressive symptoms, and health events with posttraumatic stress disorder (PTSD) among participants with spinal cord injury. Research Method: A total of 1,063 participants were recruited from 3 sites in different regions (Southeastern, Mountain, and Western) of the United States. Hispanics and non-Hispanic Blacks were oversampled. Three hundred sixty-nine were non-Hispanic White, followed by 361 non-Hispanic Black, 277 Hispanic, and 56 from other racial-ethnic groups. PTSD was measured by the Purdue PTSD Scale–Revised. All variables were measured by self-report. Multivariate logistic regression models were developed to assess the association between PTSD and multiple variables. Results: The overall prevalence of PTSD across all participants was 24.9%, and the mean PTSD score of all participants was 34.7 (SD = 14.6). PTSD was associated with depression, frequency of medication use for depression or stress, number of times receiving medical care because of injury in the past year, and race-ethnicity (lower among non-Hispanic Whites). Conclusions: PTSD was relatively prevalent in this study. PTSD was highly comorbid with depressive disorders and associated with post–spinal cord injuries within the previous year. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Evaluation of a concentric biopsychosocial model of well-being in persons with spinal cord injuries.
    Objective: The objective of this study was to evaluate a concentric biopsychosocial model of well-being in individuals with spinal cord injuries (SCI). Method: Adults (N = 235) with SCI participated in this study. A cross-sectional design with hierarchical regression and Andrew Hayes’ (2013) PROCESS mediation analysis procedure was used to evaluate the model. Results: Each step of the hierarchical regression on life satisfaction, in which biological variables were entered first, social variables were entered second, and psychological variables were entered third, was significant. Examining the standardized partial coefficients, pain, interpersonal self-efficacy, social support, hope–agency, and self-esteem were all significantly associated with life satisfaction, controlling for variables in each outward ring of the concentric model. Four serial mediational analyses were also conducted in which the social and psychological variables significantly partially mediated the relationship between pain and life satisfaction. Conclusions: The results provide support for a concentric biopsychosocial model of well-being in persons with SCI. Rehabilitation interventions should focus on augmenting biopsychosocial factors to allow for maximum improvement in well-being outcomes in individuals with SCI. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Disability identity development: A systematic review of the literature.
    Purpose/Objective: The purpose of this systematic review was to synthesize existing empirical research on disability identity development. This review is organized to present the demographics of participants and types of disabilities represented in the existing data, measures of disability identity development and theoretical models of disability identity development. Method: Electronic databases (EBSCO, PsycINFO, ERIC, and Sociological Abstracts) were searched for all peer reviewed empirical studies published between 1980 and 2017. Articles were excluded if they were theoretical and/or did not include participants with disabilities, or focused on a disability-specific community identity rather than general disability identity. Results: Empirical articles (N = 41) were included in the final review. An overwhelming majority (75.6%) were qualitative in nature, with only 22% of the articles reviewed being quantitative and only 1 that utilized a mixed methods design. The results suggest that disability identity can be considered a unique phenomenon that shapes persons’ ways of seeing themselves, their bodies, and their way of interacting with the world. Conclusions/Implications: Disability identity development has the potential to become an important factor in developing effective interventions and/or therapies. Identity development is a fundamentally social process, and identities are formed through mirroring, modeling, and recognition through available identity resources, and so it is imperative that able-bodied professionals (i.e., rehabilitation professionals, therapists, teachers and caregivers) working with individuals with disabilities become aware of this developmental process to be able to better support individuals along this journey. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Family caregivers’ opinions about interaction with the environment in consciousness disorders.
    Objectives: To assess family caregivers’ opinions about level of interaction with the environment in their relatives with disorders of consciousness (DOCs) and to explore psychological features of caregivers whose opinions diverge from clinicians’ diagnosis. Method: Forty-five family caregivers of 38 DOC inpatients without communication abilities answered 2 questions assessing their opinion about level of interaction with the environment in their relatives. Self-report questionnaires were used to evaluate caregivers’ depression, anxiety, psychophysiological disturbances, prolonged grief disorder, coping strategies, quality of perceived needs and social support. Results: Fifteen caregivers (5 relatives of patients in vegetative state and 10 of patients in minimally conscious state) considered their relatives able to communicate, in contrast with clinical diagnosis. These caregivers had significantly higher depressive symptoms, and higher worries about possible death of their relatives with respect to the remaining caregivers. Conclusions: Caregivers of DOC patients detected some interaction with the environment in their relatives more often than care professionals. This is likely related to caregivers’ beliefs and expectations, but is also based on observations closer and longer than those possible for physicians. These considerations are important to build a therapeutic alliance with caregivers and to involve them in the diagnostic process and rehabilitative program. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Perceived social support moderates the relationship between activities of daily living and depression after lower limb loss.
    Objective: This study examined the moderating influence of perceived social support on the prospective relationship between baseline levels of activities of daily living (ADL) and depressive symptoms during the 1st year following amputation. Method: Participants included 73 veterans with new/first unilateral lower extremity amputation due to vascular disease or diabetes. Baseline levels of perceived social support, ADL function, and mobility were assessed by retrospective recall 6 weeks after amputation. Depressive symptoms were measured at 6 weeks and 12 months following surgery. Results: Perceived social support moderated the relationship between baseline ADL functioning and depressive symptoms at 12 months (β = −0.27, p <.001) after controlling for 6-week depressive symptoms and sociodemographic and physical/functional variables. Lower levels of baseline ADL function were associated with depressive symptoms at 12 months among those who reported lower levels of perceived social support. Conclusion: These data allowed us to identify those participants with both low ADL function at baseline and low social support as being at higher risk for depression symptoms postamputation. The findings support the stress buffering hypothesis and suggest that perceived social support may be an important modifiable target of intervention among individuals with lower levels of functioning. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • A review of the use and psychometric properties of the Cognistat/Neurobehavioral Cognitive Status Examination in adults post–cerebrovascular accident.
    This Rehabilitation Measures Database summary provides a review of the psychometric properties of the Cognistat/Neurobehavioral Cognitive Status Examination in individuals with cognitive impairment. A full review of the Cognistat/Neurobehavioral Cognitive Status Examination 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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