Rehabilitation Psychology最新文献

Purpose/objective: To examine, among survivors of stroke: (a) the prevalence of and most frequently reported unmet needs; and (b) the sociodemographic and clinical factors associated with higher counts of unmet needs.

Research method/design: A cross-sectional study was undertaken with survivors of stroke recently discharged from eight hospitals in Australia, with institutional board approval. Survivors were mailed one survey for completion after their discharge from hospital. Unmet needs were measured by the Longer-Term Unmet Needs After Stroke (LUNS) tool. The number and percentage of participants who reported unmet needs were calculated. The association of sociodemographic factors, type of stroke, and thrombolysis treatment to total LUNS scores was examined using mixed ordinal logistic regression.

Results: A total of 402 survivors (35% of those approached) between April 2018 to December 2019 returned a completed survey. 83% reported at least one unmet need. The most frequently reported unmet need was needing more information about their stroke (n = 239, 61%). Those who identified as Aboriginal and/or Torres Strait Islander had approximately 5.6-fold higher odds (OR = 5.59, p = .025) of having more longer-term unmet needs compared to those who did not identify as Aboriginal and/or Torres Strait Islander.

Conclusions/implications: Unmet needs are common in recently discharged survivors of stroke. These findings may be used to inform strategies that support recovery. Providing more information may help reduce unmet needs among survivors of stroke. Enhanced hospital discharge planning and enhanced community services for survivors may help better prepare them and their caregivers for the return home. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Purpose/objective: Many qualitative studies have focused on sex and spinal cord injury (SCI), often taking a deficit lens to interpretation and reporting. However, it is important to understand what can facilitate positive sexuality for people with SCI; therefore this study examines facilitators of sexuality for people with SCI.

Research method/design: A systematic review and metasynthesis of 38 qualitative papers (published before February 2024) on sexuality for people with SCI was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thematic synthesis was conducted in three stages: line-by-line coding; the identification of common descriptive themes across papers; and the generation of novel analytical themes.

Results: Thirty-eight eligible papers were analyzed. Thematic synthesis resulted in four common descriptive themes that were linked to positive sexuality: (a) being sexually active; (b) trying new and other ways of sexual expression; (c) having a positive relationship with a partner; and (d) peer support. These descriptive themes were interrelated and incorporated in two in-depth analytical themes: (a) redefining sexuality and (b) establishing a sexual identity.

Conclusions/implications: This study highlights facilitators to sexuality post-SCI. In order to maintain a sex-positive approach to sexuality rehabilitation for people with SCI, sexuality facilitators should remain at the forefront of sexual rehabilitation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: This study examined (a) characteristics of maintenance of business activity among self-employed individuals with chronic health conditions (CHCs) and (b) the relationships of coping strategies with maintenance of business activity.

Method: This cross-sectional study involved 294 self-employed participants aged 26-77 who were at most 2 years since their diagnosis and had one of the following CHCs: cancer (23.4%), cardiac disease (21.7%), respiratory disease (36.2%), or inflammatory bowel disease (18.6%). Participants answered questionnaires on workability limitations, business maintenance, sense of mastery, and coping strategies.

Results: Participants reported a substantial decrease in business profitability since their CHC diagnosis but high job satisfaction. The structural equation model had good fit indicators and revealed that the association between workability limitations and lower maintenance of business profitability was partially mediated by lower use of disengaged coping strategies. The association between sense of mastery and job satisfaction was partially mediated by engaged and disengaged coping strategies.

Conclusions: Self-employed individuals with CHCs are at risk of declining of business profitability; however, degree of workability limitations alone did not explain business profitability maintenance or job satisfaction, but it was related to coping resources and strategies. Interventions that strengthen personal resources and promote engaged coping strategies should be provided with direct support to business maintenance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: To develop longitudinal structural models of social isolation and probable major depression (PMD) over a 5-year interval among participants with spinal cord injury (SCI).

Design: Longitudinal structural equation modeling of self-report assessments collected during two follow-ups (2013 as Time 1, 2018 as Time 2) of a 45-year multicohort longitudinal study. Participants (n = 557) were identified from a specialty hospital in the Southeastern United States and two Midwestern hospitals and were initially enrolled in 1973-1974, 1984-1985, 1993-1994, or 2003-2004. PMD symptomology was measured by the Patient Health Questionnaire-9 (PHQ-9) and was defined by PHQ-9 scores ≥ 10. Social isolation was represented by two latent dimensions: social disconnectedness, objective component measured by activities, and perceived isolation, based on subjective appraisals. Structural equation modeling assessed the relationship among social disconnectedness and perceived isolation measured at Time 1 and PMD measured at Times 1 and 2.

Results: Both social disconnectedness and perceived isolation, measured at Time 1, were significantly related with PMD measured at Time 1 (r_{SD_Time 1 and PMD_Time 1} = .49, p < .001; r_{PI_Time 1 and PMD_Time 1} = .66, p < .001) and Time 2 (r_{SD_Time 1 and PMD_Time 2} = .37, p < .001; r_{PI_Time 1 and PMD_Time 2} = .54, p < .001), indicating participants with greater perceived isolation and social disconnectedness were more likely to have greater likelihood of PMD, both cross-sectionally and longitudinally. Perceived isolation was more strongly related to PMD compared with social disconnectedness.

Conclusion: Social isolation was associated with both current and future depression symptoms. People with more years post-SCI were less likely to have PMD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Purpose/objective: To examine longitudinal change in health-related quality of life (HRQOL) in caregivers of service members/veterans with traumatic brain injury and factors associated with clinically elevated symptoms.

Research method/design: Caregivers (N = 220) completed nine HRQOL outcome measures and 10 risk factor measures at a baseline evaluation and follow-up evaluation 3 years later. Caregiver's responses on the nine HRQOL outcome measures were classified into four clinical change categories based on the presence/absence of clinically elevated T-scores (≥ 60 T) at baseline and follow-up: (a) Persistent (baseline ≥ 60T + follow-up ≥ 60 T), (b) Developed (baseline < 60 T + follow-up ≥ 60 T), (c) Improved (baseline ≥ 60 T + follow-up < 60 T), and (d) Asymptomatic (baseline < 60 T + follow-up < 60 T). A clinical change composite score was calculated by summing the number of Persistent or Developed HRQOL outcome measures and used to create three clinical change groups: (a) No Symptoms (n = 69, zero measures), (b) Some Symptoms (n = 88, one to three measures), and (c) Numerous Symptoms (n = 63, four to nine measures).

Results: Of the nine HRQOL outcome measures, Bodily Pain, Perceived Stress, Sleep-Related Impairment, and Fatigue were most frequently classified as Persistent or Developed from baseline to follow-up in the entire sample. A linear relationship was found between the vast majority of risk factors across the three clinical change groups at baseline and follow-up (Numerous > Some > None). The risk factors were correlated with the number of elevated HRQOL symptoms at baseline and follow-up. Most Asymptomatic or Persistent caregivers did not have meaningful change (≥ 1 SD) in HRQOL scores. A sizable proportion of Developed or Improved caregivers had either meaningful or no change in HRQOL scores.

Conclusions/implications: There is a need for ongoing clinical services for military caregivers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Purpose/objective: Higher levels of resilience is associated with improved pain outcomes in chronic pain and other neurological populations, but the role of resilience in pain following spinal cord injury (SCI) remains unclear. This study examined resilience as a moderator in the relationship between perceived stress and both pain intensity and interference during acute rehabilitation for SCI.

Research method/design: Individuals admitted to inpatient rehabilitation acutely following SCI (N = 57) completed measures of perceived stress, resilience, pain intensity, and interference. The Johnson-Neyman procedure was used to examine significance of conditional relationships that emerged.

Results: Resilience was found to moderate the relationship between perceived stress and pain interference, but not pain intensity, during inpatient rehabilitation.

Conclusions/implications: When resilience is low, perceived stress has a more profound and adverse impact on pain interference during inpatient rehabilitation, suggesting therapeutic strategies that build components of resilience are needed during acute rehabilitation following SCI. The relationship between stress, resilience, and pain may differ postinpatient rehabilitation for SCI and warrants further investigation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: Neurocognitive deficits in schizophrenia have a major impact on functioning; however, they remain poorly targeted by available treatment offerings. Cognitive remediation (CR) is effective in improving neurocognition and functioning. Despite clinical guidelines for schizophrenia recommending CR, it is still not readily available in clinical services and sizeable attrition rates are reported in clinical trials.

Method: To elucidate the barriers and facilitators of CR access and engagement, we conducted a mixed methods qualitative-dominant study with 12 clinicians in Australia, in 2021, with 1 hr interviews and additional rating scales completed.

Results: Thematic analysis highlighted four themes (cognitive symptoms, CR intervention, motivation and engagement in CR, and CR implementation), and 14 subthemes. Clinicians emphasized the broad impact of cognitive deficits and outlined pros and cons of different CR approaches. Several factors were suggested as impacting engagement, including motivation assessments/techniques, neurocognitive insight, illness, and demographic factors. Lack of routine implementation in Australia was unanimously espoused and partly explained by a need for cost-effectiveness analyses, remote and flexible delivery, and increasing service resource provision and staff training in CR.

Conclusions: This study offers key insights into CR access, while recommending methods for optimizing CR implementation and dissemination to improve recovery outcomes of people diagnosed with schizophrenia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This proof-of-concept study was conducted to establish the feasibility of compiling Federal Interagency Traumatic Brain Injury Research (FITBIR) data pertaining to depression and suicide risk, with the secondary goal of improving understanding regarding these outcomes. FITBIR is a national repository of participant-level traumatic brain injury (TBI) data designed to address methodological limitations (e.g., small sample size, heterogeneity of injuries).

Method: FITBIR studies with TBI severity and measures related to depression and suicidal ideation were identified. Data were harmonized across relevant studies and grouped to identify "probable depression" and suicidal ideation, resulting in a large, combined sample. Rates of probable depression and suicidal ideation were described across the available studies, considering the influence of demographic and/or injury-related factors on outcomes.

Results: Cross-sectional studies meeting criteria included four studies with depression outcomes and two with suicidal ideation outcomes. Two studies reported data appropriate for comparative analyses on depression. Combined results suggested that approximately 71% of participants were categorized as having probable depression. Participants with a history of mild TBI had 2.54 greater odds of probable depression (95% confidence interval [1.93, 3.34]) than those without a history of TBI.

Conclusions: Methods, harmonization code, and meta-databases related to TBI, probable depression, and suicidal ideation are now publicly available on the FITBIR website. Even with limited data, harmonization of FITBIR studies can serve as the basis for ongoing TBI and mental health research. Analyses will be more robust in the future as more studies with relevant outcome data are added to the FITBIR database. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Purpose/objective: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life. Yet, insight and quality of life are broad constructs that encompass several dimensions. Here, we investigated differential associations between insight and quality-of-life dimensions using a psychological network approach.

Research method/design: We extracted data from the French network of rehabilitation centers REHABase (January 2016 to December 2022, N = 1,056). Our psychological network analysis modeled insight and quality of life as a network of interacting dimensions: three insight dimensions (awareness of illness, reattribution of symptoms to the disease, and recognition of treatment need) and eight quality-of-life dimensions (autonomy, physical and psychosocial well-being, relationships with family, friends and romantic partners, resilience, and self-esteem).

Results: Insight was negatively associated with quality of life. Our psychological network analysis revealed a strong negative association between awareness of disease and self-esteem. Both dimensions were the strongest nodes in the overall network. Our network analysis also revealed a significant but positive connection between recognition of treatment needs and resilience.

Conclusion/implications: While insight and quality of life are overall negatively associated, we found both negative and positive connections between insight and quality-of-life dimensions. The negative relationship between insight and quality of life may reflect the deleterious effects of diagnostic labeling on a patient's self-esteem. Yet, acknowledgment of treatment needs may have positive effects on quality of life and may promote recovery, perhaps because it emphasizes the need for support rather than labels and abnormalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Purpose/objective: Walking dysfunction, depression, and anxiety are prevalent, burdensome, and interrelated outcomes in persons with multiple sclerosis (MS). The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is a common patient-reported outcome (PRO) of walking dysfunction in research and practice involving MS, but the construct validity of its scores might be influenced by symptoms of depression and anxiety. This study examined if symptoms of depression and anxiety influenced the construct validity of MSWS-12 scores.

Research method/design: The sample included 189 participants with MS who completed the MSWS-12, Hospital Anxiety and Depression Scale (HADS-Depression subscale [HADS-D] and HADS-Anxiety subscale [HADS-A]), 6-minute walk (6MW), and timed 25-foot walk (T25FW). We conducted bivariate correlation analysis to examine the associations between MSWS-12 scores and both the 6MW and T25FW, while controlling for HADS-D and HADS-A scores.

Results: MSWS-12 scores were significantly correlated with the 6MW (r = -.752), T25FW (r = .694), HADS-D (r = .405), and HADS-A (r = .235). The correlations between MSWS-12 and 6MW (pr = -.725) and T25FW (pr = .685) did not change when controlling for HADS-D and HADS-A scores. The correlations between MSWS-12 and 6MW (r = -.708 and r = -.726) and T25FW (r = .687 and r = .748) were strong in subsamples with elevated HADS-D and HADS-A scores.

Conclusions/implications: Our results strengthen the validity evidence for MSWS-12 scores as a PRO of walking dysfunction in MS, including among those with symptoms of depression and anxiety. (PsycInfo Database Record (c) 2024 APA, all rights reserved).