Role of self-efficacy (SE) and anxiety among pre-clinically disabled older adults when using compensatory strategies to complete daily tasks

Pre-Clinical Mobility Limitation (PCML) Outcomes in Rehabilitation Interventions for Middle-Aged and Older Adults: A Scoping Review

Individuals with pre-clinical mobility limitation (PCML) are at a high risk of future functional loss and progression to disability. The purpose of this scoping review was to provide a comprehensive understanding of PCML intervention studies in middle-aged and older adults. We present the interventions that have been tested or planned, describe how they have been conducted and reported, identify the knowledge gaps in current literature, and make recommendations about future research directions. An initial search of 2,291 articles resulted in 14 articles that met criteria for inclusion. Findings reveal that: (1) there is limited published work on PCML interventions, especially in middle-aged populations; and (2) the complexity and variety of PCML measures make it difficult to compare findings across PCML studies. Despite the diversity of measures, this review provides preliminary evidence that rehabilitation interventions on PCML help to delay or prevent disability progression.

Defining and Measuring Preclinical Mobility Limitation: An Expert Consensus Exercise Informed by a Scoping Review

BACKGROUND

Early change in function in older adults has been termed preclinical disability (PCD). PCD has been understudied compared to other stages of disability because it is unlikely to receive comparative priority in clinical settings. It has major implications for prevention and population health as it may be the optimal time to intervene to prevent further decline. A standardized approach to research in PCD, including a common definition and measurement approaches, is needed to advance this work.

METHODS

The process to establish how PCD should be defined and measured was undertaken in 2 stages: (1) a scoping review of the literature, which was used to inform (2) a web-enabled consensus meeting with content experts.

RESULTS

The scoping review and the consensus meeting support the use of the term preclinical mobility limitation (PCML) and that it should be measured using both patient-reported and performance-based measures. It was agreed that the definition of PCML should include modification of frequency and/or method of task completion, without overt disability, and that requisite mobility tasks include walking (distance and speed), stairs, and transfers.

CONCLUSIONS

Currently, there are few standardized assessments that can identify PCML. PCML is the term that most clearly describes the stage where people experience a change in routine mobility tasks, without a perception of disability. Further evaluation into the reliability, validity, and responsiveness of outcome measures is needed to advance research on PCML.

Motor Performance, Mental Workload and Self-Efficacy Dynamics during Learning of Reaching Movements throughout Multiple Practice Sessions

The human capability to learn new motor skills depends on the efficient engagement of cognitive-motor resources, as reflected by mental workload, and psychological mechanisms (e.g., self-efficacy). While numerous investigations have examined the relationship between motor behavior and mental workload or self-efficacy in a performance context, a fairly limited effort focused on the combined examination of these notions during learning. Thus, this study aimed to examine their concomitant dynamics during the learning of a novel reaching skill practiced throughout multiple sessions. Individuals had to learn to control a virtual robotic arm via a human-machine interface by using limited head motion throughout eight practice sessions while motor performance, mental workload, and self-efficacy were assessed. The results revealed that as individuals learned to control the robotic arm, performance improved at the fastest rate, followed by a more gradual reduction of mental workload and finally an increase in self-efficacy. These results suggest that once the performance improved, less cognitive-motor resources were recruited, leading to an attenuated mental workload. Considering that attention is a primary cognitive resource driving mental workload, it is suggested that during early learning, attentional resources are primarily allocated to address task demands and not enough are available to assess self-efficacy. However, as the performance becomes more automatic, a lower level of mental workload is attained driven by decreased recruitment of attentional resources. These available resources allow for a reliable assessment of self-efficacy resulting in a subsequent observable change. These results are also discussed in terms of the application to the training and design of assistive technologies.

Community and social participation among adults with mobility impairments: A mixed methods study

BACKGROUND

Community and social participation is a complex phenomenon that is influenced by personal and environmental factors and is linked to a good quality of life and well-being. Individuals with mobility impairments are at risk of experiencing limitations in participating in community activities due to a wide range of factors.

OBJECTIVE

To understand community participation as defined by adults with mobility impairments and to examine relationships among factors that influence community participation.

METHODS

A mixed-methods study design was used. In-depth interviews of 13 adults with mobility impairments were conducted and themes related to community participation were identified. Data from the Americans' Changing Lives Survey were used to construct variables that mimic the themes from the qualitative phase and structural equation modeling was used to examine the relationships among those variables including community participation.

RESULTS

Individuals with mobility impairments identified health and function, neighborhood factors and self-efficacy as possible factors influencing participation in community activities. Findings from the SEM suggest a strong causal pathway between health and function and community and social participation. Neighborhood factors and health and function had a significant impact on self-efficacy, and a possible indirect effect through self-efficacy on community and social participation.

CONCLUSIONS

Our study provides new empirical evidence that health and function have a significant impact on community and social participation. Our quantitative findings did not support the direct influence of neighborhood factors in community and social participation, yet these factors may have an indirect role by influencing the self-efficacy of individuals with mobility impairments.