Rehabilitation Psychology

Parallel processing modeling in longitudinal designs: An example predicting trajectories of distress and life satisfaction.
Purpose: Parallel process modeling (PPM) can be used to analyze co-occurring relationships between health and psychological variables over time. A demonstration is provided using data obtained from the British Household Panel Survey (years 2005, 2006, 2007, and 2008), examining predictors of ongoing changes in their distress and life satisfaction of a subsample from the survey. Research Method: In the 2005 survey, data were available from 7,970 participants based on the following demographic variables: gender, age, ever registered as disabled, and ever experienced any strokes (before or at 2005). Time-varying variables included distress and life satisfaction collected yearly from 2005 to 2008. Time-invariant variables included age (65 or older), gender, disability condition, and stroke survivor status. Results: Steps of fitting the PPM are presented. Four distinct distress trajectory groups—chronic, recovery, delayed, and resilient—were identified from the PPM estimates. Resilient and recovery groups showed a positive trend in life satisfaction. The delayed distress and chronic groups had a slight decrease in satisfaction. The time-invariant covariates only significantly predicted baseline levels of distress and satisfaction (i.e., their intercepts). Conclusions: PPM is a relatively simple and powerful tool for simultaneously studying relations between multiple processes. A step-by-step approach on decomposing the significant predictive relation from the change of distress to the change of satisfaction is presented. Properly decomposing any significant growth factor regressed on another growth factor is necessary to fully comprehend the intricate relationships within the results. Practical implications and additional methodological information about fitting PPM are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Methodological considerations for collecting and analyzing data on multiply marginalized psychology trainees with disabilities.
Objective/Purpose: Historically, psychology trainees from marginalized communities have been underrepresented both as researchers and as participants in research on trainee experiences and outcomes. The current research can be used to develop evidence-based strategies to understand and improve the recruitment, retention, advancement, and overall training experiences of trainees with marginalized identities. Method: We review the existing literature on the experiences of psychology trainees, particularly that focused on trainees from marginalized backgrounds. Results: Quantitative, qualitative, and archival data collection and analysis methods each carry their own benefits and limitations, which must be considered and addressed intentionally to optimize the impact of research findings for multiply marginalized individuals. Mixed methods approaches are also discussed. Matching each limitation with a research design strategy is recommended, including the use of sample weights from population archival data to contextualize sample results, incorporating flexibility for reasonable accommodations for intensive qualitative studies, and other strategies. Conclusions/Implications: We provide guidance on selecting a methodology based on specific research and dissemination goals within this area and discuss implications and recommendations for both rehabilitation psychology specifically and the field more broadly. Training programs, governing bodies, faculty, researchers, and other invested parties have shared accountability to deliver diverse, equitable, and inclusive education and training experiences, and conducting high-quality research on the experiences of multiply marginalized trainees, including those with disabilities, is a key component of that process. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Initial development and psychometric properties of the Therapist Quality Scale.
Purpose/Objective: This study sought to develop and evaluate the psychometric properties of a brief measure of the quality of therapist treatment delivery that would be applicable for use across different types of psychosocial chronic pain treatments: the Therapist Quality Scale (TQS). Research Method/Design: An initial pool of 14 items was adapted from existing measures, with items selected that are relevant across interventions tested in a parent trial comparing an 8-week, group, Zoom-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic back pain from which data for this study were obtained. A random selection of 25% of video-recorded sessions from each cohort was coded for therapist quality (two randomly selected sessions per group), with 66 sessions included in the final analyses (n = 33 completed pairs). Items were coded on a 7-point Likert-type scale. Exploratory factor analysis (EFA) and reliability estimates were generated. Results: EFA showed a single-factor solution that provided a parsimonious explanation of the correlational structure for both sessions. Eight items with factor loadings of ≥ .60 in both sessions were selected to form the TQS. Reliability analyses demonstrated all items contributed to scale reliability, and internal consistency reliabilities were good (αs ≥ .86). Scores for the eight-item TQS from the two sessions were significantly correlated (r = .59, p <.001). Conclusions/Implications: The TQS provides a brief measure with preliminary psychometric support that is applicable for use across different types of treatments to rate the quality of the therapist’s delivery. The items assess quality in delivering specific techniques, maintaining session structure, and in developing and maintaining therapeutic rapport. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Dealing with small samples in disability research: Do not fret, Bayesian analysis is here.
Purpose/Objective: Small sample sizes are a common problem in disability research. Here, we show how Bayesian methods can be applied in small sample settings and the advantages that they provide. Method/Design: To illustrate, we provide a Bayesian analysis of employment status (employed vs. unemployed) for those with disability. Specifically, we apply empirically informed priors, based on large-sample (N = 95,593) July 2019 Current Population Survey (CPS) microdata to small subsamples (average n = 26) from July 2021 CPS microdata, defined by six specific difficulties (i.e., hearing, vision, cognitive, ambulatory, independent living, and self-care). We also conduct a sensitivity analysis, to illustrate how various priors (i.e., theory-driven, neutral, noninformative, and skeptical) impact Bayesian results (posterior distributions). Results: Bayesian findings indicate that people with at least one difficulty (especially ambulatory, independent living, and cognitive difficulties) are less likely to be employed than people with no difficulties. Conclusions/Implications: Overall, results suggest that Bayesian analyses allow us to incorporate known information (e.g., previous research and theory) as priors, allowing researchers to learn more from small sample data than when conducting a traditional frequentist analysis. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Psychometric network analysis in rehabilitation research: A methodological demonstration in depression symptoms of veterans and service members at 1 and 2 years after traumatic brain injury.
Purpose/Objective: Psychometric network analysis (PNA) is an application of dynamic systems theory that can inform measurement of complex rehabilitation phenomena such as depressive symptom patterns in veterans and service members (V/SMs) after traumatic brain injury (TBI). This study applied PNA to the Patient Health Questionnaire-9 (PHQ-9), a common measure of depressive symptoms, in a sample of V/SMs with TBI at Years 1 and 2 (Y1–2) postinjury. Research Method/Design: A sample of 808 V/SMs with TBI participated, 594 contributing PHQ-9 data at Y1 and 585 at Y2. Participants were recruited while or after receiving inpatient postacute rehabilitation from one of five Veterans Affairs Polytrauma Rehabilitation Centers. Results: The networks were stable and invariant over time. At both times, network structure revealed the cardinal depressive symptom “feeling down, depressed, or hopeless,” as evidenced by its strength centrality. In the Y1 network, the suicidal ideation node was connected exclusively to the network through the guilt node, and in the Y2 network, the suicidal ideation node formed a second connection through the low mood node. The guilt node was the second most influential node at Y1 but was replaced by anhedonia node at Y2. Conclusions/Implications: This study demonstrated the potential of PNA in rehabilitation research and identified the primacy of feeling down, depressed, and hopeless after TBI at both Y1 and Y2, with guilt being the second most influential symptom at Y1, but replaced by anhedonia at Y2, providing supportive evidence that the relationships among depressive symptoms after TBI are dynamic over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Dos and don’ts for conducting mediation analysis: A commentary with practical tips to avoid common problems.
Purpose: Mediation analyses allow for exploration of causal mechanisms that explain how a predictor is related to an outcome. Tests of mediation are fundamental to addressing some of the most consequential questions in rehabilitation science. In recent decades, the development of easy-to-use analytical tools has made conducting statistical tests of mediation more accessible to researchers. Unfortunately, there are persistent problems in the conceptual underpinning of many tests of mediation. Even in cases where the statistical analyses are correctly run, problems with the underlying rationale for the mediational analysis will render the results inconsequential, in the best case, or misleading, in the worst case. Method: In this commentary, I summarize the uses of mediation analysis and through a series of six main types of errors provide practical, plain language guidance (“Dos and Don’ts”) for conducting a conceptually robust mediation analysis. Results: The “Dos and Don’ts” laid out in this commentary highlight that there are persistent issues with lack of understanding of mediation, confusion about the differences between moderation, mediation, and covariates, lack of strong theoretical justification for mediation, and lack of attention to methodological issues (e.g., measurement) in many mediation analyses. Conclusions: Promoting the use of mediation analysis in rehabilitation research will advance theory and effective practice in our field. Researchers undertaking mediation analysis are encouraged to prioritize developing a strong theoretical framework that justifies use of mediation analysis, ensuring study methodology supports and enables tests of mediation, as well emphasizing a strong statistical approach to conducting the test of mediation. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Prediction of caregiver psychological distress in amyotrophic lateral sclerosis: A cross-sectional study.
Purpose/Objective: To propose a predictive model for caregivers’ psychological distress (including anxiety, depression, and cognitive overload) based on different data gathered from amyotrophic lateral sclerosis (ALS) patients (cognitive level, psychological distress, type of ALS, and sex). Research Method/Design: A cross-sectional study with a sample of 51 ALS patients and their respective main carers. Various instruments were used such as the Beck Anxiety Inventory, ALS Depression Inventory-12, and the Edinburgh Cognitive and Behavioral ALS Screen, Zarit Burden Interview, Self-Rating Depression Scale, and Self-Rating Anxiety Scale for caregivers. Results: ALS type, sex, and cognition were predictive variables for caregiver distress, with the main explanatory variable being the distress of the patients themselves. Spinal ALS led to higher psychological distress in caregivers (β = .38), as did male patients with ALS and preserved cognition. Conclusions/Implications: The proposed confirmatory model demonstrates that patients’ psychological distress is the best predictor of psychological distress in their caregivers. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
The experience of gender in spousal caregiving: A phenomenological psychological study (Greece).
Purpose/Objective: To explore how spousal caregivers of older people undergoing rehabilitation experience gender within the Greek community. Research Method/Design: A psychological phenomenological design and analysis were used to illuminate the unique meanings 11 spousal caregivers attribute to their experience of gender by gathering qualitative data via interviews. Results: The data provided an insight into the structure of the experience of gender for the spousal caregivers as a normative diachronic identity in a succession of phases: normative constitution, alienation, and reparation. Conclusions/Implications: The findings highlight the influence of gender stereotypes on spousal caregivers’ self-concept, agency, caregiving evaluations, and practices, emphasizing the importance of adopting an intersectional perspective in future research and interventions, considering various factors such as ethnicity, gender, sexuality, age, power dynamics, and cultural norms. Spousal caregivers experience alienation on entering the caregiving journey, with gender-related vulnerabilities affecting their psychological well-being. Addressing these vulnerabilities can improve caregivers’ mental health and foster effective coping strategies. The study emphasizes the moral aspect of caregiving, highlighting the relationship between a sense of obligation, feelings of guilt, gender norms, and motivations calling for challenging self-sacrificial morals and societal norms associated with them to empower caregivers to prioritize their well-being while maintaining their caregiving motivations. This shift in perspective can lead to a more positive and fulfilling caregiving experience. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Dyadic coping and illness adjustment after stroke: A longitudinal prospective study.
Purpose/Objective: To investigate associations between illness appraisals, dyadic coping, and illness adjustment in individuals with stroke and their healthy partners. Method/Design: This longitudinal observational study examined dyadic data in 17 couples (patient and partner) after stroke. Patients and partners completed self-report measures on event centrality of the stroke (appraisal) at 2 months (t₁), common dyadic coping (CDC) at 5 months (t₂), and quality of life (adjustment) at 8 months (t₃) after the stroke. Dyadic data were analyzed using actor–partner interdependence models. Results: Higher event centrality at t₁ predicted more CDC at t₂ in patients (b = 0.38, p <.05). For partners, the effect of event centrality on dyadic coping differed significantly from the patients’ effect but was not significant itself (b = −0.17, p = .601). More CDC at t2 predicted higher physical (b = 3.21, p <.05) and psychological quality of life at t₃ (b = 3.66, p <.05) for partners but not for patients. Conclusions/Implications: Preliminary evidence suggests that patients and their healthy partners may endorse event centrality of the stroke differentially. Perceiving dyadic coping processes seems to be especially important to the healthy partners’ illness adjustment. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Behavior problems 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de L’Enfant study.
Purpose/Objective: To investigate the occurrence of behavioral problems 7 years after severe pediatric traumatic brain injury (TBI), and their evolution from 3 months to 7 years postinjury. Method/Design: Thirty-four participants, 38% girls, M (SD) age at injury 7.6 (4.7) years, age at assessment 15 (4.6) years, underwent comprehensive assessments 7 years after severe TBI from March 2014 to March 2016 and were matched to a control group by age, gender, and parental education. A subgroup of 20 participants had available behavioral assessments at 3, 12, and 24 months postinjury. Internalizing, externalizing, and total behavioral problems were assessed with self- and parent reports of the Achenbach’s Behavioral Checklist. Additional data included sociodemographic background, initial injury severity, and specific outcomes assessed concurrently 7 years postinjury. Results: Compared to controls: (a) a significant proportion of participants with severe TBI fell above the clinical cutoff for self- (42%) and parent-reported (36%) externalizing problems, but not for self- (33%) or parent-reported (45%) internalizing problems; (b) withdrawn/depressed, intrusive behavior, and somatic complaints were significantly higher in self-reports; and (c) rule-breaking behavior, attention, and social problems were significantly higher in parent reports. Parent-reported internalizing problems were associated with older age at injury, whereas externalizing problems correlated with greater injury severity and concurrent levels of greater overall disability, lower intellectual ability, and poorer family functioning. In multiple hierarchical regression analyses, overall disability and worse family functioning significantly predicted externalizing problems. Parent-reported internalizing and externalizing problems persisted over time. Conclusions/Implications: These results highlight the importance of long-term follow-up and individualized behavioral interventions for children who sustained severe TBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Patients’ beliefs as predictors of patient satisfaction and health-related quality of life in pediatric rehabilitation.
Objective: This study investigated the predictive value of illness and treatment beliefs for patient satisfaction and health-related quality of life (HRQOL) in adolescents receiving inpatient rehabilitation treatment. In addition, we examined the relationship between fulfilled rehabilitation-related treatment expectations and patient satisfaction. Method: In this longitudinal study (recruitment between April 2019 and March 2020), 170 participants (M = 14.3 years [SD = 1.6]) answered self-report questionnaires before and at the end of rehabilitation (6 weeks later). We applied multiple hierarchical regression analyses, controlling for sociodemographic and diagnoses variables. Results: The results showed fulfilled expectations of treatment success and sustainability to be a significant predictor of patient satisfaction (p <.01). The illness belief dimension of emotional representation predicted HRQOL (p <.01). Rehabilitation-related treatment beliefs were not predictive of any outcome. Conclusion: This study provides a first insight into the relationships between these constructs in the context of inpatient pediatric rehabilitation. However, future research is needed to further examine illness and treatment beliefs in this specific treatment setting. Practical implications concern the incorporation of children’s and adolescents’ beliefs into treatment management to optimize rehabilitation outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Rehabilitation Psychology - Vol 69, Iss 4