Rehabilitation Psychology

Acceptance of pain in neurological disorders: Associations with functioning and psychosocial well-being.
Objective: Chronic pain acceptance has been shown to be related to positive adjustment to chronic pain in patients presenting with pain as a primary problem. However, the role of pain acceptance in adjustment to chronic pain secondary to a neurological disorder that is often associated with physical disability has not been determined. The purpose of this study was to examine whether two domains of chronic pain acceptance—activity engagement and pain willingness—predict adjustment to pain, controlling for pain intensity and key demographic and clinical variables in individuals with muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), or spinal cord injury (SCI). Method: Participants were 508 community-dwelling adults with a diagnosis of MD, MS, PPS, or SCI who also endorsed a chronic pain problem. Participants completed self-report measures of pain acceptance, quality of life, pain interference, pain intensity, depression, and social role satisfaction. Results: Hierarchical linear regressions indicated that activity engagement predicted lower pain interference and depression, and greater quality of life and social role satisfaction. Pain willingness predicted less pain interference and depression. Together, the two pain acceptance subscales accounted for more variance in outcomes than did self-reported pain intensity. Conclusions: Findings correspond with the broader pain acceptance literature, although activity engagement appears to be a more robust predictor of adjustment than does pain willingness. This research supports the need for future studies to determine the extent to which treatments that increase acceptance result in positive outcomes in persons with chronic pain secondary to neurological disorders. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Major depressive disorder and factorial dimensions among individuals with recent-onset spinal cord injury.
Objective: We examine the rates of major depressive disorder, single episode determined by the Inventory to Diagnose Depression (IDD) in a clinical sample of persons with recent-onset spinal cord injury (SCI; ≤52 weeks) participating in an inpatient SCI rehabilitation program. We also analyzed the factor structure of the IDD measure in an attempt to replicate the factor structure reported by Frank et al. (1992), and we examined item endorsement patterns. Design: A retrospective chart review was conducted. Participants were 354 individuals (93 women, 261 men) in an inpatient SCI rehabilitation program. Results: Fifteen percent of the sample met criteria for a major depressive disorder (MDD). A higher rate of depression was observed among women. A “dysphoria” factor accounted for 24% of the variance in the final four-factor model. The four-factor solution explained a total of 35.5% of the variance, with an “anhedonia” factor contributing 4.6%, a “sleep” factor contributing 3.5%, and an “appetite” factor contributing 3.5%, respectively. Items assessing symptoms of insomnia, weight loss, worrying about health, and decreased energy had the highest percentage of endorsement to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM–IV–TR) criteria for clinical significance. Conclusions: The rate of single episodes of MDD determined by the IDD parallels the rate observed with the Patient Health Questionnaire–9 (PHQ-9). The factor structure of the IDD was similar to that reported by Frank et al. (1992). Information provided by the IDD about the presence and severity of MDD symptoms can inform interventions for persons with SCI. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
An examination of factors influencing responses to requests for disability accommodations.
Purpose/Objective: The purpose of this study was to examine the influences of responses to reasonable accommodation requests for an individual with a disability. Research Method/Design: Two-hundred-forty individuals participated in a vignette-based experiment in which aspects of the requestor's disability and the accommodation request were manipulated. Results: The results showed that intentions to grant an accommodation were predicted by a number of factors, including emotional responses toward the requestor, characteristics of the impairment causing the disability, characteristics of the accommodation, and perceptions of fairness. Conclusions/Implications: The Americans with Disabilities Amendments Act (ADAAA) mandates organizations to provide reasonable accommodations to qualified employees with impairments that are disabling, yet discrimination in the form of the unfair rejections of these requests still persists. Altogether, this study provides evidence that decisions regarding reasonable accommodations requests are likely influenced by a number of factors, none of which constitute legal reasons for denying a request. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Correlates of health-related quality of life in African American and Caucasian stroke caregivers.
Objective: Stroke is a leading cause of long-term disability in the United States. Family caregivers are susceptible to negative outcomes as a result of their caregiving role. A stress process model was utilized to identify characteristics of stroke caregivers who are at risk for poor physical and mental health-related quality of life (QOL). Research Method: Individuals who experienced an incident stroke event within the previous year were identified from a larger epidemiologic study of stroke incidence. These stroke survivors were enrolled in the Caring for Adults Recovering from the Effects of Stroke (CARES) study along with their primary family caregivers (N = 146 dyads). Caregivers completed a baseline telephone interview that assessed physical and mental health-related QOL, problems their family members were experiencing, appraisals of those problems, and caregiver resources. Results: Objective stressors, appraisals, and caregiver resources were related to caregiver physical and mental health-related QOL, ps
Treatment adherence in cognitive processing therapy for combat-related PTSD with history of mild TBI.
Objective: This retrospective study examined treatment adherence in Cognitive Processing Therapy (CPT) for combat-related posttraumatic stress disorder (PTSD) in Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with and without history of mild traumatic brain injury (mTBI). Method: Medical record review of consecutive referrals to an outpatient PTSD clinic identified veterans diagnosed with combat-related PTSD who began treatment with CPT. The sample (N = 136) was grouped according to positive (n = 44) and negative (n = 92) mTBI history. Groups were compared in terms of presenting symptoms and treatment adherence. Results: The groups were not different on a pretreatment measure of depression, but self-reported and clinician-rated PTSD symptoms were higher in veterans with history of mTBI. The treatment completion rate was greater than 61% in both groups. The number of sessions attended averaged 9.6 for the PTSD group and 7.9 for the mTBI/PTSD group (p = .05). Implications: Given the lack of marked group differences in treatment adherence, these initial findings suggest that standard CPT for PTSD may be a tolerable treatment for OEF/OIF veterans with a history of PTSD and mTBI as well as veterans with PTSD alone. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Meeting physical activity recommendations: Self-regulatory efficacy characterizes differential adherence during arthritis flares.
Purpose: Using social–cognitive theory, we examined whether adults who experienced an arthritis flare and met/did not meet the disease-specific public health recommended dose for physical activity differed in their self-regulatory efficacy beliefs, overall pain, and flare-related factors. Research Method/Design: Adults with arthritis (N = 56; Mage = 49.41 ± 11.56 years) participated in this prospective study. Results: Multivariate analysis of variance comparing groups who met or did not meet the recommended dose (nmet = 24, ≥ 150 minutes/week vs. nnot met = 32, partial² = .28). People meeting the dose had significantly greater self-regulatory efficacy to overcome arthritis barriers (Mmet dose = 7.33 ± 1.95 vs. Mdid not meet dose = 5.74 ± 2.08, ηpartial² = .14) and to schedule/plan (Mmet dose = 7.27 ± 1.80 vs. Mdid not meet dose = 5.72 ± 1.90, ηpartial² = .15). Overall pain and flare-related factors did not differ (ps > .05). Conclusion/Implication: During flares, individuals with greater self-regulatory efficacy to manage disease barriers and plan their physical activity were more adherent to disease-specific public health activity recommendations. This study was the first to demonstrate differences in social cognitions that characterize adherence to recommended activity among people challenged by arthritis flares. Findings support the theoretical position that self-regulatory efficacy is related to better adherence in the face of challenging disease-related circumstances. The importance of studying individual characteristics of people who succeed in being active despite such obstacles is stressed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Factor structure, reliability, and validity of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury population.
Objective: This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury (TBI) population across indices of factor structure, reliability, and validity. Method: Data were collected from 101 individuals undergoing acute rehabilitation for moderate and severe TBI both upon emergence from posttraumatic amnesia and at hospital discharge, as well as from their family members or caregivers. Results: Four separate confirmatory factor analyses (CFAs) suggested that the FrSBe's three-factor/three-subscale solution did not fit the data well, and follow-up CFAs employing a one-factor structure similarly yielded poor fit indices. Four exploratory factor analyses (EFAs) failed to produce factor solutions consistent with each other or that resembled the factor solution retained in the EFA during the FrSBe's initial construction. The FrSBe had sufficiently high internal consistency at the total-score and subscale-score levels, good convergent validity with other indices of TBI functioning, and good test–retest reliability in the family administration of the measure, but not in the patient administration. Conclusions: The FrSBe is an appropriate measure for use in an inpatient TBI population when using the total score and the family administration, though its subscales and patient administration warrant more rigorous examination. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Predictors of adherence to home rehabilitation exercises following anterior cruciate ligament reconstruction.
Objective: Although home exercises are commonly prescribed following anterior cruciate ligament (ACL) reconstruction and are considered important in obtaining successful rehabilitation outcomes, little is known about factors associated with the completion of such exercises. Consequently, this study was designed to identify predictors of adherence to home rehabilitation exercises after ACL surgery. Method: Participants (33 women, 58 men) completed indices of athletic identity, neuroticism, optimism, and pessimism before ACL surgery and measures of daily pain, negative mood, stress, and home exercise completion for 42 days postoperatively. Results: Participants reported a high level of adherence to the prescribed regimen. Home exercise completion increased significantly over time as the number of sets of prescribed home exercises declined. Personal factors were not predictive of home exercise completion. Participants completed fewer home exercises on days when they experienced more stress or negative mood. Conclusions: Day-to-day variations in negative mood and stress may contribute to adherence to prescribed home exercises. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Experiences of stigma by association among family members of people with mental illness.
Objective: To investigate the relationships between public stigma, stigma by association (SBA), psychological distress, perceived closeness, perceived heredity, and the type of family relationship among family members of people with a mental illness. Method: In this cross-sectional survey, data from 527 family members of people with a mental illness were analyzed. Results: Perceptions of public stigma were found to be positively related to SBA and SBA correlated with greater psychological distress and less perceived closeness. SBA also mediated relationships between perceived public stigma and psychological distress, and between perceived public stigma and perceived closeness. Further, among participants who reported SBA, immediate family members showed lower levels of perceived closeness than extended family members. Also, the perceived heredity of mental illness was associated with perceptions of public stigma and psychological distress. Conclusion: The findings suggest that family members of people with a mental illness could benefit from education on mental illnesses, their treatment, and the extent to which they are hereditary. Additionally, particular attention should be paid to the psychological needs that arise from being a caregiver of someone with a mental illness. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Boosting workplace stair utilization: A study of incremental reinforcement.
Purpose: This study was designed to determine whether engagement in stair taking can be increased in a worksite setting through the provision of an employer-sponsored, behavior-based incentive system in which employees (members) accumulate points that can be redeemed for merchandise. Methods/Design: ChipRewards implemented stair utilization in one employer as a part of a larger health incentive engagement program. Using an AB (baseline-intervention) design, members (N = 216) were observed for 6 months (6.17.10 to 12.14.10 or 129 weekdays after excluding 52 weekend days) before the intervention (baseline) and after 6 months (1.1.11 to 6.30.11 with the same number of weekdays) of implementation. Results: Members were 84% female, 51% Caucasian, 48% African American, 3% Hispanic, and 45 years average age. The number of total stair transactions for all members for all days monitored increased from 5,070 to 38,900, and the average number of stair transactions per day rose from 39 to 301, representing over a 600% increase. The overall cost of incentives for stair utilization was $3,739.30 or $17.55 per member on average. Conclusion/Implications: This study supports that stair usage in the workplace is a viable way to increase physical activity. This study adds to existing research that attempted to increase stair utilization through promotion only by adding a behavioral reinforcement strategy. Finally, this study demonstrates that a physical activity among employees at the worksite can be increased with minimal relative cost. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Promoting physical activity: Fertile ground for rehabilitation psychology.
Comments on the article by Schmacher et al. (see record 2013-06066-009). Readers of Rehabilitation Psychology might be surprised, or maybe even alarmed, to find an article on promoting physical activity in able-bodied people between the covers of their latest issue. This commentary contends that this area of research and practice might be one into which rehabilitation psychologists want to venture. Schumacher and coworkers describe a field test ( N = 216) of a token system for reinforcing stair taking. The setting was an eight-story office building housing a single company in a midsized city in the southeastern United States. Schumacher et al. report an increase from 39 stair transactions per day by all study participants in the 6 months before implementation of the intervention to 301 transactions in the 6 months after the implementation of the intervention, which represents a 600% increase. The cost of the intervention was only $17 per person. Although replication of these results in a study with additional sources of control would increase confidence in the validity of the findings, the size of the gains in stair taking, the number of participants in the study, the length of the baseline and implementation periods, and the objective measurement of outcome warrant attention. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Coping humor and family functioning in parents of children with disabilities.
Objective: The purpose of this study was to investigate whether coping humor predicted certain measures of family functioning in parents of children with disabilities. Method: Seventy-two parents of children diagnosed primarily with autism spectrum disorders and multiple disabilities completed the Coping Humor Scale (CHS) and Family Adaptability and Cohesion Evaluation Scales (FACES IV). The FACES IV measures two major dimensions of family functioning: cohesion and flexibility. The CHS measures the degree to which participants use humor to cope with stressful experiences in their lives. Optimal functioning of the family is theorized to be based on a balanced level of both cohesion and flexibility. In the present study, coping humor was hypothesized to predict balanced cohesion as well as balanced flexibility. The data were analyzed using single and hierarchical linear regression. Results: The results of the regressions indicated that coping humor significantly, albeit weakly, predicted cohesion and flexibility. However, the effects of education level and the number of children in the family also had a significant predictive effect on cohesion and flexibility. Conclusions: Contributions of the study, limitations, and implications for future research and clinical practice are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
The Kennedy Krieger Independence Scales–Spina Bifida Version: A measure of executive components of self-management.
Purpose/Objective: Successful implementation of functional self-care skills depends upon adequate executive functioning; however, many scales assessing adaptive skills do not address the inherent executive burden of these tasks. This omission is especially relevant for individuals with spina bifida, for whom medical self-care tasks impose a significant burden requiring initiation and prospective memory. The Kennedy Krieger Independence Scales–Spina Bifida Version (KKIS–SB) is a caregiver-reported measure designed to address this gap; it assesses skills for managing both typical and spina bifida-related daily self-care demands, with a focus on the timely and independent initiation of adaptive skills. Research Method/Design: Parents of 100 youth and young adults with spina bifida completed the KKIS–SB. Exploratory factor analysis and Pearson's correlations were used to assess the factor structure, reliability, and construct validity of the KKIS–SB. Results: The scale demonstrates excellent internal consistency (Cronbach's alpha = .891). Exploratory factor analysis yielded four factors, explaining 65.1% of the total variance. Two primary subscales were created, initiation of routines and prospective memory, which provide meaningful clinical information regarding management of a variety of typical (e.g., get up on time, complete daily hygiene routines on time) and spina bifida-specific self-care tasks (e.g., begin self-catheterization on time, perform self-examination for pressure sores). Conclusions/Implications: Based upon internal consistency estimates and correlations with measures of similar constructs, initial data suggest good preliminary reliability and validity of the KKIS–SB. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Evaluating the needs of military and veterans' families in a polytrauma setting.
Objective: To examine the perceived importance of needs and the extent to which they are met among a sample of family members in an inpatient polytrauma setting. Method: The Family Needs Questionnaire was administered to 44 family members of patients at the Polytrauma Rehabilitation Center at McGuire Veterans Affairs Medical Center over a 30-month period. Results: Families rated health information needs as most important and most frequently met. conversely, family members rated emotional support and instrumental support needs as least important and most frequently unmet. Conclusion: Preliminary data suggest that the similarity between family needs in military and civilian settings is noteworthy, and provide direction for development of empirically based family intervention models for polytrauma settings. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Chronic pain and the interpersonal theory of suicide.
Objective: Chronic pain is a known risk factor for suicide. To date, however, few studies of people with chronic pain have tested specific predictions about suicidal ideation that are derived from theory. The interpersonal theory of suicide proposes that the psychological constructs of thwarted belongingness and perceived burdensomeness are unique and independent precursors to suicidal ideation. We tested this hypothesis in a clinical sample of patients with chronic pain. Method: A total of 303 patients of a chronic pain rehabilitation program completed measures of pain severity, duration, and disability; cognitive–affective measures of depression and catastrophizing; and interpersonal measures of relationship distress and self-perceived burden to others. The latter measures were included as indices of the belongingness and burdensomeness constructs. Participants also rated two items pertaining to suicidal ideation. Results: In a multiple regression analysis, both distress in interpersonal relations (β = 0.12, p = .037) and self-perceived burden to others (β = 0.25, p <.001) were significant predictors of suicidal ideation, even after adjusting statistically for demographic characteristics, pain severity and duration, functional limitations, catastrophizing, and depression. Conclusions: These findings suggest that the interpersonal theory is relevant to understanding elevated rates of suicidal ideation among people with chronic pain, and may have broader applicability to other populations with chronic illness or disability. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Rehabilitation Psychology - Vol 58, Iss 1