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Neller SA, Hebdon MT, Wickens E, Scammon DL, Utz RL, Dassel KB, Terrill AL, Ellington L, Kirby AV. Family caregiver experiences and needs across health conditions, relationships, and the lifespan: a Qualitative analysis. Int J Qual Stud Health Well-being 2024; 19:2296694. [PMID: 38213230 PMCID: PMC10791097 DOI: 10.1080/17482631.2023.2296694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The purpose of this study was to understand the lived experiences of family caregivers who provide care to individuals across a broad range of ages, caregiving relationships, and health conditions and/or disabilities. Family caregiver research is typically siloed by health condition or by caregiving relationship, leaving gaps in understanding similarities and differences among caregivers. METHODS We hosted three virtual focus groups with diverse family caregivers (n = 26) caring for an individual with a long-term disability and/or health condition(s). We conducted a qualitative thematic analysis using an iterative, inductive process. RESULTS Participants primarily expressed shared experiences, despite having unique caregiving situations. We identified themes among a) caregiver experiences: Trying to Do It All, Balancing Complex Emotions, Managing Expectations, and Adjusting to Changes Over Time and b) caregiver needs: Longing for Breaks and Self-Care; Lacking Help, Support and Resources; and Desiring Understanding and Recognition. CONCLUSIONS These findings emphasize that many elements of the caregiving experience transcend care recipient age, condition, and relationship and are applicable to clinicians, researchers, and policy makers. The evidence of shared caregiver experiences can guide efficiencies in policy and practice (e.g., pooling of existing resources, expansion of interventions) to meet the needs of a broader population of caregivers.
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Affiliation(s)
- Sarah A. Neller
- College of Nursing, University of Tennessee, Knoxville, TN, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Emily Wickens
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Debra L. Scammon
- David Eccles School of Business, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L. Utz
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kara B. Dassel
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Anne V. Kirby
- College of Health, University of Utah, Salt Lake City, UT, USA
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Sparks C, Hsu A, Neller SA, Eaton J, Thompson A, Wong B, Iacob E, Terrill AL, Caserta M, Stark L, Utz RL. Comparison of recruitment methodologies for clinical trials: Results from the time for living and caring (TLC) intervention study. Contemp Clin Trials 2024; 140:107518. [PMID: 38554816 PMCID: PMC11072241 DOI: 10.1016/j.cct.2024.107518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Recruiting participants for research studies is a critical yet challenging task. Community-engaged recruitment strategies have gained prominence as effective means to engage diverse populations and ensure the representativeness of study samples. This case study aims to investigate the cost and effectiveness of various recruitment methods in enhancing research participation. METHODS A comparative approach was employed to assess the outcomes of five different recruitment strategies used in the Time for Living & Caring (TLC) research study. Data on recruitment success, participant demographics, and retention rates were collected and analyzed using descriptive statistics, including ANOVA and Chi-squares, to statistically compare the outcomes associated with 5 different recruitment methodologies. The recruitment methodologies included two community-engaged strategies (community partner referral and community-based recruiters), a clinical database, social media, and word-of-mouth referral. CONCLUSION The meta-data used to build this methodological case study describe different recruitment methodologies that may be used for clinical trials. This data-driven evaluation provides examples and considerations for researchers when developing budgets and proposals for future clinical trials. The primary finding is that there are tradeoffs in terms of cost, time, labor, and ultimately the representativeness of the sample, based on the type of recruitment methodology chosen.
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Affiliation(s)
- Catharine Sparks
- Department of Occupational & Recreational Therapies, 520 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Anna Hsu
- College of Social & Behavioral Science, University of Utah, 260 S Central Campus Dr., Salt Lake City, UT 84112, USA
| | - Sarah A Neller
- College of Nursing, The University of Tennessee, Knoxville, 1412 Circle Dr., Knoxville, TN 37996, USA
| | - Jacqueline Eaton
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Amber Thompson
- College of Social & Behavioral Science, University of Utah, 260 S Central Campus Dr., Salt Lake City, UT 84112, USA
| | - Bob Wong
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Alexandra L Terrill
- Department of Occupational & Recreational Therapies, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Michael Caserta
- College of Nursing, University of Utah, 10 S. 2000 E, Salt Lake City, UT 84112, USA
| | - Louisa Stark
- School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Rebecca L Utz
- College of Social & Behavioral Science, University of Utah, 260 S Central Campus Dr., Salt Lake City, UT 84112, USA
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Thompson AD, Sparks C, Wong B, Iacob E, Terrill AL, Caserta M, Utz RL. Using Digital Inequality Framework to Evaluate a Technology-Delivered Intervention for Caregivers: Age, Education, and Computer Proficiency. J Aging Health 2024:8982643241232173. [PMID: 38327121 DOI: 10.1177/08982643241232173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Objectives: Using "digital inequality" as a conceptual framework, this study evaluates the feasibility and usability of a technology-delivered intervention (an "app") for Alzheimer's and related dementia family caregivers. Time for Living and Caring (TLC) is an on-line intervention that provides virtual coaching and self-administered education and resources. Methods: A sample of family caregivers (n = 163) used the tool for 16 weeks, which included completing the Computer Proficiency Questionnaire (CPQ-12) at baseline. Analyses investigate the relationship between age, CPQ scores, intervention use, appraisal, and caregiver outcomes. Results: Age was inversely associated with CPQ; however, CPQ scores did not have a significant relationship with participant's self-perceived benefits or intervention appraisal. Computer Proficiency Questionnaire scores provided insight regarding research feasibility, with lower scores associated with greater odds of discontinuing engagement. Discussion: CPQ-12 scores can be used as a screening tool to identify those who may need additional support to engage with and benefit from technology-delivered interventions.
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Affiliation(s)
- Amber D Thompson
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Catharine Sparks
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Alexandra L Terrill
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Michael Caserta
- Department of Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L Utz
- College of Social and Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
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Terrill AL, Reblin M, MacKenzie JJ, Baucom BRW, Einerson J, Cardell B, Richards L, Majersik JJ. Promoting Resilience After Stroke in Dyads (ReStoreD): A Supplemental Analysis. Arch Phys Med Rehabil 2023; 104:1580-1587. [PMID: 37075965 PMCID: PMC10543397 DOI: 10.1016/j.apmr.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To examine preliminary effects of ReStoreD (Resilience after Stroke in Dyads) on resilience in couples coping with stroke-related challenges. DESIGN Supplemental analysis of prospective pilot trial with pre-/post-assessments and 3-month follow-up. SETTING Community. PARTICIPANTS Thirty-four cohabitating stroke-care partner dyads (N=34); at least 3 months post-stroke. INTERVENTIONS 8-week self-administered dyadic intervention (ReStoreD) consisting of activities completed individually and as a couple. MAIN OUTCOME MEASURES 10-item Connor-Davidson Resilience Scale. RESULTS Care partner baseline resilience scores were significantly higher than persons with stroke scores. Repeated-measures analysis of variance suggest significant pre-post improvement in resilience for persons with stroke (mean difference [I - J]=-2.42, SE=.91, P=.04, 95% CI [-4.75, -0.08]) with a large effect size (η2=.34), which was maintained at 3-month follow-up. Care partners showed no significant change over time. CONCLUSIONS This study provides preliminary evidence that ReStoreD improves resilience in persons with stroke. More research is needed to address resilience in care partners. These findings represent a promising first step to address the mental health needs in this population.
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Affiliation(s)
- Alexandra L Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT.
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, VT
| | - Justin J MacKenzie
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Jackie Einerson
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT
| | - Beth Cardell
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT
| | - Lorie Richards
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT
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Einerson J, Lundstrom LK, Allen BK, Sefandonakis A, Terrill AL. Learning to flourish in a new reality: a thematic analysis of couples' experience of participation in a positive psychology intervention post-stroke. Disabil Rehabil 2023; 45:2612-2619. [PMID: 35914538 PMCID: PMC10508046 DOI: 10.1080/09638288.2022.2102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Explore the experiences of couples engaging in a positive psychology intervention post-stroke (ReStoreD: Promoting Resilience after Stroke in Dyads). MATERIALS AND METHODS This is a secondary analysis of qualitative data collected following an 8-week self-administered dyadic positive psychology intervention (Clinical Trial number: NCT03335358). Participants included dyads consisting of one partner who had a stroke at least three months prior and their cohabiting partner. Couples had to be community-dwelling and one or both had to report depressive symptoms. A thematic analysis was conducted on semi-structured feedback interviews from 26 dyads (n = 77 interviews). RESULTS Two primary themes with multiple secondary themes were identified, depicting the experiences of couples post-stroke while engaging in the ReStoreD intervention. Primary and secondary themes included: changes in self (learning about the self, building new coping strategies, and acting with intention) and changes in the relationship (awareness of spouse, spending more positive time together, being more intentional in the relationship, and increased/improved communication). CONCLUSIONS Individuals and couples post-stroke often experience negative mood changes, poor health outcomes, and decreased participation. Implementation of ReStoreD activities in the clinical setting can be a valuable and impactful way to encourage and foster positive experiences and re-engagement post-stroke.Implications for RehabilitationThrough dyadic positive psychology intervention activities, rehabilitation professionals can build upon existing strengths and resources to encourage couples to increase their awareness and development of positive coping strategies as individuals and couples.Positive psychology intervention activities can be implemented by rehabilitation professionals at inpatient and outpatient settings through self-directed, low-cost, and time-efficient strategies to increase engagement in positive activities at home.
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Affiliation(s)
- Jackie Einerson
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Lauren K. Lundstrom
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Brieanna K. Allen
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Artemis Sefandonakis
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexandra L. Terrill
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
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Terrill AL. Mental Health Issues Poststroke: Underrecognized and Undertreated. Stroke 2023; 54:1528-1530. [PMID: 37216452 DOI: 10.1161/strokeaha.123.042585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Alexandra L Terrill
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City
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Einerson J, Cardell B, Majersik JJ, Reblin M, Richards LG, Terrill AL. Piloting GETCare: A Goal-Based Education and Skills Training Program for Caregivers. Rehabil Nurs 2022; 47:220-227. [PMID: 35883239 PMCID: PMC10544745 DOI: 10.1097/rnj.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Many individuals with stroke require informal caregiver support. These caregivers are often unprepared and overwhelmed. This study assesses the feasibility and acceptability of GETCare, a remote Goal-based Education and skills Training program for Caregivers caring for an individual poststroke. DESIGN Single-arm mixed-methods pilot trial was performed. METHODS The GETCare program is a 5-week remote, individually administered program for informal stroke caregivers that includes education, skills training, guided goal setting, and resource recommendations. Quantitative data were analyzed using descriptive statistics and qualitative data via a deductive approach. RESULTS Twenty-eight caregivers were recruited with 18 caregivers completing the program. These 18 caregivers reported high satisfaction, and over 75% reported program content was at least quite helpful. Caregivers suggested that the length of the program was appropriate, indicated that weekly check-ins were helpful, and supported this program for informal caregivers across the time trajectory poststroke. Eight of 10 caregivers who dropped out of the program were caring for someone 0-4 months poststroke. CONCLUSIONS Caregivers positively received the GETCare program, which was uniquely structured to provide resources and skills for this high-need population. This pilot study provides valuable insight for future remote interventions poststroke. CLINICAL RELEVANCE TO PRACTICE OF NURSING Results provide foundational knowledge in how to better support caregivers through guided goal setting and individualized education.
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Affiliation(s)
- Jackie Einerson
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Beth Cardell
- Associate Professor, Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Jennifer J. Majersik
- Associate Professor, Department of Neurology, University of Utah, Salt Lake City, USA
| | - Maija Reblin
- Associate Professor, Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Lorie Gage Richards
- Chair and Associate Professor, Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Alexandra L. Terrill
- Associate Professor, Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
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Otto AK, Ketcher D, Reblin M, Terrill AL. Positive Psychology Approaches to Interventions for Cancer Dyads: A Scoping Review. Int J Environ Res Public Health 2022; 19:13561. [PMID: 36294142 PMCID: PMC9602591 DOI: 10.3390/ijerph192013561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Positive psychology approaches (PPAs) to interventions focus on developing positive cognitions, emotions, and behavior. Benefits of these interventions may be compounded when delivered to interdependent dyads. However, dyadic interventions involving PPAs are relatively new in the cancer context. This scoping review aimed to provide an overview of the available research evidence for use of dyadic PPA-based interventions in cancer and identify gaps in this literature. METHODS Following PRISMA guidelines, we conducted a scoping review of intervention studies that included PPAs delivered to both members of an adult dyad including a cancer patient and support person (e.g., family caregiver, intimate partner). RESULTS Forty-eight studies, including 39 primary analyses and 28 unique interventions, were included. Most often (53.8%), the support person in the dyad was broadly defined as a "caregiver"; the most frequent specifically-defined role was spouse (41.0%). PPAs (e.g., meaning making) were often paired with other intervention components (e.g., education). Outcomes were mostly individual well-being or dyadic coping/adjustment. CONCLUSIONS Wide variability exists in PPA type/function and their targeted outcomes. More work is needed to refine the definition/terminology and understand specific mechanisms of positive psychology approaches.
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Affiliation(s)
- Amy K. Otto
- University of Minnesota Medical School, Duluth Campus, Duluth, MN 55812, USA
| | - Dana Ketcher
- University of Minnesota Medical School, Duluth Campus, Duluth, MN 55812, USA
| | - Maija Reblin
- College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Alexandra L. Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT 84112, USA
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Gordon EL, Terrill AL, Smith TW, Ibele AR, Martinez P, McGarrity LA. Overvaluation of Shape and Weight (Not BMI) Associated with Depressive Symptoms and Binge Eating Symptoms Pre- and Post-bariatric Surgery. Obes Surg 2022; 32:2272-2279. [DOI: 10.1007/s11695-022-06062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
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Niermeyer M, Einerson J, Terrill AL. Perceptions of function and recovery among persons with stroke and care partners. Rehabil Psychol 2022; 67:215-225. [PMID: 35377699 PMCID: PMC10131190 DOI: 10.1037/rep0000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Perceptions of function can differ between persons with stroke and care partners. The current study described the frequency of discrepancy in ratings of poststroke functioning across romantic partners and examined associations between perceptions of function, depressive symptoms, and caregiver strain. RESEARCH METHOD/DESIGN A secondary analysis was conducted using data from the baseline visit of an intervention pilot study. Twenty-nine dyads completed measures of perceived current functioning of the person with stroke (Stroke Impact Scale 3.0: overall percent recovery, ADL, and cognition), self-reported ratings of depressive symptoms for both partners (PROMIS Depression Short Form v8b), and self-reported caregiver strain for the care partners only (Caregiver Strain Index). RESULTS A discrepancy of over 10 points on the SIS 3.0 variables was seen in over 50% of dyads for all subscales, with care partners rating worse recovery on average. Actor partner interdependence models showed that more depressive symptoms were associated with perceptions of worse overall recovery and ADL function in persons with stroke, whereas more depressive symptoms were associated with perceptions of worse cognitive and ADL function in care partners. Discrepancy in perception of ADL function was associated with more caregiver strain though this was inextricable from the overall level of impairment in ADL function perceived by the care partner. CONCLUSIONS/IMPLICATIONS These findings suggest that discrepancy in perceptions of stroke recovery among romantic partners is common. This underscores the importance of perception when considering risk for depression and caregiver strain as well as how to best promote psychological resilience following stroke. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Dionisio MC, Terrill AL. Constraint-Induced Movement Therapy for Infants With or at Risk for Cerebral Palsy: A Scoping Review. Am J Occup Ther 2022; 76:23209. [PMID: 35179556 DOI: 10.5014/ajot.2022.047894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Although research shows that older children with hemiplegic cerebral palsy (CP) benefit from constraint-induced movement therapy (CIMT), the efficacy of CIMT among the infant population is unknown. OBJECTIVE To explore the existing evidence on CIMT for infants age 24 mo and younger with CP or at risk for CP. DATA SOURCES PubMed, CINAHL, Cochrane, and ProQuest were searched. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and American Occupational Therapy Association guidelines were used for abstracting data and assessing data quality. Two frameworks guided this scoping review. Studies met the following criteria: infants with hemiplegic CP, published in English between 2000 and 2020, peer reviewed, and addressed changes in upper limb function of the hemiplegic upper limb. FINDINGS Eight articles met the inclusion criteria: 2 randomized controlled trials, 1 retrospective cohort design, 1 pretest-posttest study, 2 single-subject studies, and 2 case studies. In this scoping review, we examined CIMT protocols for an overview of dosage, constraint, administration, parent training and education, and objective outcome measures. CONCLUSIONS AND RELEVANCE Existing literature supports CIMT protocols for infants with CP. However, much variability exists in protocol design and appropriate outcome measures among studies. Higher level research is needed to support the efficacy of CIMT among infants with CP. What This Article Adds: This scoping review summarizes the existing literature on CIMT for infants with hemiplegic CP. This information can help guide therapists to implement CIMT protocols in the clinical setting and to identify additional research to establish practice standards.
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Affiliation(s)
- Monik Castillo Dionisio
- Monik Castillo Dionisio, MS, OTR/L, BCP, CPAM, is Occupational Therapist, California Children's Services, Anaheim, and Post-Professional Doctoral Student, Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City;
| | - Alexandra L Terrill
- Alexandra L. Terrill, PhD, is Clinical Psychologist and Associate Professor, Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City
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McGarrity LA, Terrill AL, Martinez PL, Ibele AR, Morrow EH, Volckmann ET, Smith TW. The Role of Resilience in Psychological Health Among Bariatric Surgery Patients. Obes Surg 2022; 32:792-800. [PMID: 35091900 DOI: 10.1007/s11695-021-05855-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Many individuals who undergo bariatric surgery have experienced repeated unsuccessful diet attempts and negative messages from healthcare providers, family, and others about their weight. Research pre- and post-operatively has taken a pathological or risk-based approach, investigating psychiatric problems and disordered eating. In contrast, the current study explores resilience in this population. METHODS Participants were 148 bariatric surgery patients. Participants completed measures pre-operatively and 1.5-3 years post-operatively, including the Binge Eating Scale, Eating Disorder Examination Questionnaire, Patient Health Questionnaire, Generalized Anxiety Questionnaire, Impact of Weight on Quality of Life, Coping Responses Inventory, and Duke Social Support and Stress Scales. The Connor-Davidson Resilience Scale was measured post-operatively. RESULTS Correlations demonstrated a significant association between post-operative resilience and lower symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life. Resilience was also associated with greater social support and less social stress, and greater use of approach coping strategies. Resilience was significantly associated with improvements in symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life from pre- to post-operative assessments. In regression models, associations remained significant after controlling for psychosocial variables at baseline (e.g., binge eating symptoms pre-operatively) and demographic covariates. CONCLUSIONS Psychological resilience has been under-studied in the literature on obesity and bariatric surgery, with a primary focus on risk factors for poor outcomes. This study was among the first to investigate associations between resilience and post-operative psychological outcomes. Results suggest the field would benefit from consideration of patient resilience in psychological assessments and interventions.
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Affiliation(s)
- Larissa A McGarrity
- University of Utah, Salt Lake City, UT, 84103, USA. .,Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, 84103, USA.
| | - Alexandra L Terrill
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, 84103, USA
| | - Paige L Martinez
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Anna R Ibele
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Ellen H Morrow
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Eric T Volckmann
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Timothy W Smith
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Psychology, University of Utah, Salt Lake City, UT, 84103, USA
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Anderson MA, Buffo C, Ketcher D, Nguyen H, MacKenzie JJ, Reblin M, Terrill AL. Applying the RISE Model of Resilience in Partners Post-Stroke: A Qualitative Analysis. Ann Behav Med 2021; 56:270-281. [PMID: 34228090 DOI: 10.1093/abm/kaab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Resilience is dynamic and influenced by internal and external factors. In persons with chronic illness and/or disability, resilience is viewed as the ability to adapt to new life circumstances. Existing models of resilience typically focus on the absence of deficit and pathology in the individual, overlooking resources, well-being, and broader social impacts. Our proposed novel Relational, Intrapersonal, Social and Environmental (RISE) Model of resilience incorporates and describes the interconnection and influence of constructs that impact resilience and affect the quality of life. PURPOSE The purpose of this study is to examine the fit of the RISE Model against original interview data obtained from persons with stroke and their partners. METHODS This study is a secondary analysis of qualitative data collected from post-intervention interviews that were part of an intervention pilot study designed to promote resilience in couples coping with stroke. Interviews were coded to examine relationships between RISE Model constructs. RESULTS The study included 36 interviews from 18 cohabitating couples; mean participant age was 53.33 years (SD ±14.70). Examples of each construct within the RISE Model appeared in transcribed interviews and common patterns of co-occurring constructs were identified. CONCLUSION The constructs within the RISE Model were supported by the interviews. The impact of disability does not remain confined to a single individual and instead branches out into the broader social context, including close interpersonal relationships. A deeper understanding of resilience and its relationship with intrapersonal, interpersonal and socio-ecological constructs would add value to our understanding and fostering of resilience in persons with disabilities and/or chronic illness. CLINICAL TRIAL INFORMATION NCT03335358.
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Affiliation(s)
- Miranda A Anderson
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Corinne Buffo
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Dana Ketcher
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Hop Nguyen
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Justin J MacKenzie
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Alexandra L Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
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Utz RL, Terrill AL, Thompson A. Online interventions to support family caregivers: The value of community-engaged research practices. J Prev Interv Community 2021:1-16. [PMID: 34053412 PMCID: PMC8691858 DOI: 10.1080/10852352.2021.1930817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Family members provide significant amounts of unpaid care to aging, chronically ill, and disabled persons in their homes. They often do this with little education or support and commonly report feeling overwhelmed and stressed. Providing education and support to family caregivers has demonstrated benefit on the health and well-being of the caregiver and care-receiver. However, because "caregiver" is not a reimbursable category in health care, caregiver interventions need to be delivered in a cost-efficient way. Technology-delivered and self-administered intervention models are increasingly being recommended as a pragmatic way to support aging families in our communities. This paper outlines the redevelopment of two behavioral interventions to an exclusively online delivery. This case-study analysis presents a model for community-engaged intervention research practices, which have the potential to create interventions that are more sustainable and more likely to be implemented than those designed and tested with more traditional research methodology.
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Affiliation(s)
- Rebecca L Utz
- Department ofSociology, University of Utah, Salt Lake City, Utah, USA
| | - Alexandra L Terrill
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, Utah, USA
| | - Amber Thompson
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
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15
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Akinwuntan A, Hu X, Terrill AL, Burns SP, Hay CC, Belagaje SR. Young Stroke: Resources for Patients, Their Families, and Caregivers for Long-Term Community Living. Arch Phys Med Rehabil 2021; 102:1035-1039. [PMID: 33243426 DOI: 10.1016/j.apmr.2020.10.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022]
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16
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Bristol AA, Mata AC, Mickens M, Dassel KB, Ellington L, Scammon D, Thompson A, Towsley GL, Utz RL, Terrill AL. "You Feel Very Isolated": Effects of COVID-19 Pandemic on Caregiver Social Connections. Gerontol Geriatr Med 2021; 7:23337214211060166. [PMID: 34993276 PMCID: PMC8724994 DOI: 10.1177/23337214211060166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
One in five individuals in the United States provides care and support to ill, disabled, and aging family members in the home, leading to feelings of burden, stress, and poor health and well-being. Social support represents an important buffer for family caregivers that allows them to feel less isolated and more positive about their caregiving role. This sequential mixed-methods study aimed to examine the effect of the COVID-19 pandemic on family caregivers' social connections. Eighty-two caregivers completed a web-based survey which comprised of fixed-choice and open-ended questions. Survey data showed that the majority of caregivers (83%) reported an increase in stress and feeling lonely (77%) during the pandemic. Qualitative interviews with a subsample of caregivers (n=27) further explored social connections during the pandemic. Three themes echoed the quantitative findings and centered around defining boundaries, intentionality in social interactions, and loss of social resources. Although caregivers were often strained by new or increased caregiving demands, many experienced positive changes such as feeling a deeper connection with the care-recipient. Findings from this study highlight the need for further consideration of the impact of social isolation on the well-being of caregivers.
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Affiliation(s)
- Alycia A. Bristol
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Aaron C. Mata
- College of Social & Behavioral Sciences, University of Utah, Salt Lake City, UT, USA
| | - Melody Mickens
- Division of Rehabilitative Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kara B. Dassel
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Debra Scammon
- Department of Marketing, School of Business, University of Utah, Salt Lake City, UT, USA
| | - Amber Thompson
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Gail L. Towsley
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Gerontology Interdisciplinary Program, University of Utah, Salt Lake City, UT, USA
| | - Rebecca L. Utz
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Alexandra L. Terrill
- Department of Occupational & Recreational Therapy, College of Health, University of Utah, Salt Lake City, UT, USA
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17
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Kirby AV, Terrill AL, Schwartz A, Henderson J, Whitaker BN, Kramer J. Occupational Therapy Practitioners' Knowledge, Comfort, and Competence Regarding Youth Suicide. OTJR (Thorofare N J) 2020; 40:270-276. [PMID: 32100598 DOI: 10.1177/1539449220908577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide rates for young people are climbing in the United States and worldwide. Increasing rates of youth suicide are of concern to occupational therapy (OT) practitioners in pediatric settings, yet the profession's role in this area is poorly defined. To understand OT practitioners' awareness and needs related to youth suicide, we administered a survey including objective (e.g., knowledge of suicide-related facts) and subjective items (open- and close-ended questions) related to youth suicide to 134 OT practitioners working in pediatric settings. Only 5.2% of respondents correctly answered four items about youth suicide facts and only 32% reported they had received suicide-focused education. Just under half (45%) of respondents were able to identify all best practice responses to clinical scenarios related to youth suicide; older practitioner age was the only significant predictor of best practices. OT practitioners in pediatric settings would benefit from youth-focused suicide education and training.
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18
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Amtmann D, Bamer AM, Alschuler KN, Bocell FD, Ehde DM, Jensen MP, Johnson K, Nery-Hurwit MB, Salem R, Silverman A, Smith AE, Terrill AL, Molton I. Development of a resilience item bank and short forms. Rehabil Psychol 2020; 65:145-157. [PMID: 32039618 DOI: 10.1037/rep0000312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The purpose of this study was to develop a publicly available, psychometrically sound item bank and short forms for measuring resilience in any population, but especially resilience in individuals with chronic medical conditions or long-term disability. RESEARCH METHODS A panel of 9 experts including disability researchers, clinical psychologists, and health outcomes researchers developed a definition of resilience that guided item development. The rigorous methodology used focus groups, cognitive interviews, and modern psychometric theory quantitative methods, including item response theory (IRT). Items were administered to a sample of people with chronic medical conditions commonly associated with disability (N = 1,457) and to a general population sample (N = 300) representative of the Unites States general population with respect to age, gender, race, and ethnicity. RESULTS The final item bank includes 28 items calibrated to IRT with the scores on a T-metric. A mean of 50 represents the mean resilience in the general population sample. Four and eight item short forms are available, and their scores are highly correlated with the item bank score (r ≥ .94). Reliability is excellent across most of the resilience continuum. Initial analyses provide strong support for validity of the score. CONCLUSIONS The findings support reliability and validity of the University of Washington Resilience Scale (UWRS) for assessing resilience in any population, including individuals with chronic health conditions or disabilities. It can be administered using computerized adaptive testing or by short forms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington
| | | | - Fraser D Bocell
- Department of Rehabilitation Medicine, University of Washington
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | - Kurt Johnson
- Department of Rehabilitation Medicine, University of Washington
| | | | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington
| | | | - Amanda E Smith
- Department of Rehabilitation Medicine, University of Washington
| | | | - Ivan Molton
- Department of Rehabilitation Medicine, University of Washington
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Pincock JS, Terrill AL. Association of mindfulness to resilience, anxiety, and depressive symptoms after spinal cord injury-a correlational study. Spinal Cord Ser Cases 2020; 6:7. [PMID: 32019913 DOI: 10.1038/s41394-020-0256-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/26/2019] [Accepted: 01/10/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Online survey of individuals with spinal cord injuries (SCI). OBJECTIVE This pilot study examined associations between mindfulness factors, resilience, and levels of depression and anxiety after SCI. SETTING Community-based; United States. METHODS A survey was posted online and shared with individuals with recent SCI (≤5 years). RESULTS Thirty-four individuals responded to the survey. The Five Facet Mindfulness Questionnaire (FFMQ) measures mindfulness with the following subscales: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity of inner experience. Nonjudgment of inner experience was significantly associated with depression (β = -0.74, p = 0.007) and anxiety (β = -0.60, p = 0.01). Nonreactivity to inner experience was significantly associated with anxiety (β = -0.57, p = 0.007) and resilience (β = 0.55, p = 0.004); and there was a trend with depression (β = -0.45, p = 0.07). Higher resilience was significantly associated with less anxiety (r = -0.62, p = 0.04) and less depression (r = -0.75, p < 0.001). Depression and anxiety were significantly correlated (r = 0.84, p < 0.001). When comparing those who are employed to those who are not, they differed significantly in terms of anxiety (t(32) = 2.53, p = 0.02). CONCLUSIONS These findings suggest that factors of mindfulness, specifically the practice of acting nonjudgmentally and nonreactively to one's inner experience, may act as protective factors against depression and anxiety following SCI. These preliminary data support the literature that individuals with lower resilience are more susceptible to depression following SCI. Interventions aimed at maximizing mental well-being following SCI may benefit from incorporating these factors of mindfulness practice.
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Affiliation(s)
- Jace S Pincock
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Alexandra L Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT, USA.
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20
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Terrill AL, MacKenzie JJ, Reblin M, Einerson J, Ferraro J, Altizer R. A Collaboration Between Game Developers and Rehabilitation Researchers to Develop a Web-Based App for Persons With Physical Disabilities: Case Study. JMIR Rehabil Assist Technol 2019; 6:e13511. [PMID: 31573927 PMCID: PMC6789424 DOI: 10.2196/13511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/21/2019] [Accepted: 06/29/2019] [Indexed: 01/12/2023] Open
Abstract
Background Individuals with a disability and their partners, who often provide care, are both at risk for depression and lower quality of life. Mobile health (mHealth) interventions are promising to address barriers to mental health care. Rehabilitation researchers and software development researchers must collaborate effectively with each other and with clinical and patient stakeholders to ensure successful mHealth development. Objective This study aimed to aid researchers interested in mHealth software development by describing the collaborative process between a team of rehabilitation researchers, software development researchers, and stakeholders. Thus, we provide a framework (conceptual model) for other teams to replicate to build a Web-based mHealth app for individuals with physical disability. Methods Rehabilitation researchers, software development researchers, and stakeholders (people with physical disabilities and clinicians) are involved in an iterative software development process. The overall process of developing an mHealth intervention includes initial development meetings and a co-design method called design box, in which the needs and key elements of the app are discussed. On the basis of the objectives outlined, a prototype is developed and goes through scoping iterations with feedback from stakeholders and end users. The prototype is then tested by users to identify technical errors and gather feedback on usability and accessibility. Results Illustrating the overall development process, we present a case study based on our experience developing an app (SupportGroove) for couples coping with spinal cord injury. Examples of how we addressed specific challenges are also included. For example, feedback from stakeholders resulted in development of app features for individuals with limited functional ability. Initial designs lacked accessibility design principles made visible by end users. Solutions included large text, single click, and minimal scrolling to facilitate menu navigation for individuals using eye gaze technology. Prototype testing allowed further refinement and demonstrated high usability and engagement with activities in the app. Qualitative feedback indicated high levels of satisfaction, accessibility, and confidence in potential utility. We also present key lessons learned about working in a collaborative interdisciplinary team. Conclusions mHealth promises to help overcome barriers to mental health intervention access. However, the development of these interventions can be challenging because of the disparate and often siloed expertise required. By describing the mHealth software development process and illustrating it with a successful case study of rehabilitation researchers, software development researchers, and stakeholders collaborating effectively, our goal is to help other teams avoid challenges we faced and benefit from our lessons learned. Ultimately, good interdisciplinary collaboration will benefit individuals with disabilities and their families.
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Affiliation(s)
- Alexandra L Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT, United States
| | - Justin J MacKenzie
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Jackie Einerson
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT, United States
| | - Jesse Ferraro
- Entertainment Arts and Engineering, University of Utah, Salt Lake City, UT, United States
| | - Roger Altizer
- Entertainment Arts and Engineering, University of Utah, Salt Lake City, UT, United States
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Beier M, Hartoonian N, D'Orio VL, Terrill AL, Bhattarai J'J, Paisner ND, Alschuler KN. Relationship of perceived stress and employment status in individuals with multiple sclerosis. Work 2019; 62:243-249. [PMID: 30829635 DOI: 10.3233/wor-192859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many individuals with multiple sclerosis (MS) are unemployed relatively soon after diagnosis. There is a paucity of research on the relationship between psychological distress and employment status in persons with MS. OBJECTIVE To explore the relative distress of employed versus unemployed individuals with MS. METHODS Secondary cross-sectional analysis of a mailed survey. Variables were categorized by demographics (age, gender, education, marital status), disease (EDSS, MS symptom duration, fatigue, MS-type), and psychosocial factors (depression, anxiety, perceived stress, self-reported general cognitive concerns, self-reported executive dysfunction). Univariate logistic regression analysis was used to identify variables significantly associated with employment status. All significant variables were then included in a multivariate model to identify the most salient correlates. RESULTS Univariate analyses identified 10 variables that were significantly associated with employment status: age, education, EDSS, MS symptom duration, MS-type, depression symptoms, perceived stress, fatigue, and self-reported cognitive symptoms. The multivariate model yielded four demographic and disease-related variables and one emotional distress variable (older age, moderate disability [EDSS], longer symptom duration, MS-type, higher perceived stress) as significant. CONCLUSIONS After adjusting for disease variables, demographics, and significant psychosocial factors, perceived stress remained associated with employment status, such that greater perceived stress was associated with being unemployed.
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Affiliation(s)
- Meghan Beier
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Division of Rehabilitation Psychology and Neuropsychology, Baltimore, MD, USA
| | - Narineh Hartoonian
- Multiple Sclerosis Center of Excellence, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Vanessa L D'Orio
- Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY, USA
| | - Alexandra L Terrill
- University of Utah, Division of Occupational Therapy, Salt Lake City, UT, USA
| | - Jagriti 'Jackie' Bhattarai
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Division of Rehabilitation Psychology and Neuropsychology, Baltimore, MD, USA
| | - Noah D Paisner
- Department of Rehabilitation Medicine, University of Washington (UW), UW Medicine Multiple Sclerosis Center, Seattle, WA, USA
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington (UW), UW Medicine Multiple Sclerosis Center, Seattle, WA, USA
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22
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Terrill AL, Schwartz JK, Belagaje S. Understanding Mental Health Needs After Mild Stroke. Arch Phys Med Rehabil 2019; 100:1003-1008. [PMID: 30755316 DOI: 10.1016/j.apmr.2018.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 01/04/2023]
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Terrill AL, Reblin M, MacKenzie JJ, Cardell B, Einerson J, Berg CA, Majersik JJ, Richards L. Development of a novel positive psychology-based intervention for couples post-stroke. Rehabil Psychol 2019; 63:43-54. [PMID: 29553781 DOI: 10.1037/rep0000181] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Stroke provides challenges for survivors and partner caregivers. Stroke survivors and caregivers are interconnected in their emotional health, including depression, a common stroke sequelae. The purpose of this study was to develop and test the feasibility of a dyadic positive psychology-based intervention (PPI) for couples coping poststroke. DESIGN Community-dwelling couples consisted of 1 partner who had a stroke ≥6 months ago and a cohabiting partner caregiver. One or both partner(s) had to report depressive symptoms. The PPI consisted of 1 brief face-to-face training session and an 8-week self-administered intervention in which participants were instructed to engage in at least 2 activities alone and 2 together each week. Two dyads were randomly assigned to a waitlist control to test feasibility of this process. Baseline, postintervention, and 3-month follow-up assessments and post-program feedback were obtained. Descriptive statistics were used to analyze sample characteristics, recruitment and retention rates, adherence, key pre- and postintervention outcomes, and satisfaction with the intervention. RESULTS Eleven of 20 couples responding to recruitment letters were enrolled in the study. Ten of 11 dyads completed the program. All participants engaged in activities for at least 6 of 8 weeks. Feedback data indicated participant satisfaction with the intervention, and key outcome measures demonstrated adequate variability. CONCLUSIONS The self-administered dyadic PPI is feasible for implementation with couples poststroke. The PPI represents a first step in a novel dyadic approach in this population. Recruitment, enrollment and attrition rates, and feedback will be used to inform a larger randomized trial. (PsycINFO Database Record
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Affiliation(s)
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center
| | | | - Beth Cardell
- Department of Occupational & Recreational Therapies, University of Utah
| | - Jackie Einerson
- Department of Occupational & Recreational Therapies, University of Utah
| | | | | | - Lorie Richards
- Department of Occupational & Recreational Therapies, University of Utah
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24
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Einerson J, Cardell B, Giles S, Richards L, Terrill AL. Addressing Social Participation and Roles in Care-Partners Post-Stroke: Burden, Fatigue, and Depression. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Terrill AL, MacKenzie J, Reblin M, Einerson J, Ferraro J, Altizer R. Helping Couples With Spinal Cord Injury Get Their Groove Back: Interdisciplinary Online Intervention Development. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Terrill AL, Ellington L, John KK, Latimer S, Xu J, Reblin M, Clayton MF. Positive emotion communication: Fostering well-being at end of life. Patient Educ Couns 2018; 101:631-638. [PMID: 29241975 PMCID: PMC5878994 DOI: 10.1016/j.pec.2017.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Little is known about positive emotion communication (PEC) in end-of-life care. This study aims to identify types and patterns of PEC among hospice nurses, caregivers, and patients. METHODS A coding system based on positive psychology theory was applied as a secondary analysis to audio recordings of hospice nurse home visits with cancer patients and family caregivers, collected as part of a prospective longitudinal study. Eighty recordings (4 visits from 20 triads) were coded for humor, connection, praise, positive focus, gratitude, taking joy/savoring, and perfunctory statements. RESULTS Descriptive statistics revealed the greatest proportion of PEC was made by nurses. Humor was most frequently used across all speakers. Cluster analysis revealed four PEC visit types: Savor/Take Joy; Humor; Perfunctory; and Other-focused Expressions of Positive Emotions. Linear mixed effect regression was used to estimate the trajectory of PEC over time, but no significant change was found. CONCLUSION We found that positive emotions are common in nurse, caregiver and patient communication at end-of-life and do not decline closer to death. PRACTICE IMPLICATION This study is among the first to explore PEC at end-of-life, and offers a way to bring strengths-based approaches into end of life communication research.
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Affiliation(s)
- Alexandra L Terrill
- University of Utah, Department of Occupational & Recreational Therapies, Salt Lake City, USA.
| | - Lee Ellington
- University of Utah, College of Nursing, Salt Lake City, USA
| | - Kevin K John
- Brigham Young University, School of Communication, Provo, USA
| | - Seth Latimer
- University of Utah, College of Nursing, Salt Lake City, USA
| | - Jiayun Xu
- Purdue University School of Nursing, West Lafayette, USA
| | - Maija Reblin
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, Tampa, USA
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27
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Affiliation(s)
- Alexandra L. Terrill
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| | - Ivan R. Molton
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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28
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Furrer A, Michel G, Terrill AL, Jensen MP, Müller R. Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing. Disabil Rehabil 2017; 41:498-507. [DOI: 10.1080/09638288.2017.1390614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Angela Furrer
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | | | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rachel Müller
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Terrill AL, Gjerde JM, Garofalo JP. Background Stress Inventory: Developing a Measure of Understudied Stress. Stress Health 2015; 31:290-8. [PMID: 26468688 DOI: 10.1002/smi.2554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/25/2013] [Accepted: 10/23/2013] [Indexed: 01/10/2023]
Abstract
Background stress is an understudied source of stress that involves both ambient stress and daily hassles upon which new stressors are superimposed. To date, an accurate measure of the background stress construct has not been available. We developed the Background Stress Inventory, a 25-item self-report measure that asks respondents to indicate how distressed they have felt over the past month and the majority of the past year across five domains: financial, occupation, environment, health and social. Seven hundred seventy-two participants completed the paper-and-pencil measure; the sample was randomly split into two separate subsamples for analyses. Exploratory factor analysis suggested five factors corresponding to these domains, and confirmatory factor analysis showed acceptable global fit (X(2)(255) = 456.47, comparative fit index = 0.94, root mean square error of approximation = 0.045). Cronbach's alpha (0.89) indicated good internal reliability. Construct validity analyses showed significant positive relationships with measures of perceived stressfulness (r = 0.62) and daily hassles (0.41), p's < 0.01. Depressive symptoms (0.62) and basal blood pressure (0.21) were both significantly associated with background stress, p's < 0.01. The importance of the proposed measure is reflected in the limited research base on the impact of background stress. Systematic investigation of this measure will provide insight into this understudied form of chronic stress and its potential influence on both psychological and physical endpoints.
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Terrill AL, Hartoonian N, Beier M, Salem R, Alschuler K. The 7-item generalized anxiety disorder scale as a tool for measuring generalized anxiety in multiple sclerosis. Int J MS Care 2015; 17:49-56. [PMID: 25892974 DOI: 10.7224/1537-2073.2014-008] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is common in multiple sclerosis (MS) but understudied. Reliable and valid measures are needed to advance clinical care and expand research in this area. The objectives of this study were to examine the psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in individuals with MS and to analyze correlates of GAD. METHODS Participants (N = 513) completed the anxiety module of the Patient Health Questionnaire (GAD-7). To evaluate psychometric properties of the GAD-7, the sample was randomly split to conduct exploratory and confirmatory factor analyses. RESULTS Based on the exploratory factor analysis, a one-factor structure was specified for the confirmatory factor analysis, which showed excellent global fit to the data (χ(2) 12 = 15.17, P = .23, comparative fit index = 0.99, root mean square error of approximation = 0.03, standardized root mean square residual = 0.03). The Cronbach alpha (0.75) indicated acceptable internal consistency for the scale. Furthermore, the GAD-7 was highly correlated with the Hospital Anxiety and Depression Scale-Anxiety (r = 0.70). Age and duration of MS were both negatively associated with GAD. Higher GAD-7 scores were observed in women and individuals with secondary progressive MS. Individuals with higher GAD-7 scores also endorsed more depressive symptoms. CONCLUSIONS These findings support the reliability and internal validity of the GAD-7 for use in MS. Correlational analyses revealed important relationships with demographics, disease course, and depressive symptoms, which suggest the need for further anxiety research.
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Affiliation(s)
- Alexandra L Terrill
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (ALT, NH, MB, RS, KA); and Veterans Affairs Puget Sound Health Care System, Multiple Sclerosis Center of Excellence West, Seattle, WA, USA (NH)
| | - Narineh Hartoonian
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (ALT, NH, MB, RS, KA); and Veterans Affairs Puget Sound Health Care System, Multiple Sclerosis Center of Excellence West, Seattle, WA, USA (NH)
| | - Meghan Beier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (ALT, NH, MB, RS, KA); and Veterans Affairs Puget Sound Health Care System, Multiple Sclerosis Center of Excellence West, Seattle, WA, USA (NH)
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (ALT, NH, MB, RS, KA); and Veterans Affairs Puget Sound Health Care System, Multiple Sclerosis Center of Excellence West, Seattle, WA, USA (NH)
| | - Kevin Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA (ALT, NH, MB, RS, KA); and Veterans Affairs Puget Sound Health Care System, Multiple Sclerosis Center of Excellence West, Seattle, WA, USA (NH)
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Terrill AL, Müller R, Jensen MP, Molton IR, Ipsen C, Ravesloot C. Association between age, distress, and orientations to happiness in individuals with disabilities. Rehabil Psychol 2014; 60:27-35. [PMID: 25496435 DOI: 10.1037/rep0000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE To determine how age and distress are associated in individuals with disabilities, and how happiness and its components (meaning, pleasure, and engagement) mediate or moderate this relationship. RESEARCH METHOD/DESIGN These were cross-sectional analyses of survey data from 508 community-dwelling adults with a variety of self-reported health conditions and functional disabilities. Measures included the Orientations to Happiness Questionnaire and items from the Behavior Risk Factor Surveillance System. RESULTS Greater distress was associated with lower global happiness in both mediation and moderation models. The mediation model showed that middle-aged participants (age: 45-64) scored lowest in global happiness, and the effect of age on distress was partially mediated by happiness. None of the happiness components mediated the relationship of age on distress. The moderation model showed a significant interaction effect for age and global happiness on distress, where younger participants low on happiness were significantly more distressed. Of the three happiness components, only meaning was significantly associated with distress. There was a significant interaction between age and meaning, where participants who were younger and scored low on the meaning scale reported significantly higher distress. CONCLUSIONS/IMPLICATIONS Findings from this study lay groundwork for the development of clinical interventions to address distress in individuals with functional disabilities. Middle-aged and younger people with disabilities may be particularly affected by lower levels of happiness and might benefit from psychological interventions that focus on increasing overall well-being and providing meaning and purpose in life.
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Affiliation(s)
| | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | - Ivan R Molton
- Department of Rehabilitation Medicine, University of Washington
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Abstract
PURPOSE/OBJECTIVES The aims of this study were to (1) identify the predictors of symptoms of anxiety, and (2) evaluate the differential association of somatic and nonsomatic symptoms of depression on anxiety over time in persons with multiple sclerosis (MS). METHOD/DESIGN Participants were 513 persons with MS who previously enrolled in a study exploring the experience of living with MS and completed a 4-month follow-up survey. The main outcome measure used was the Hospital Anxiety and Depression Scale-Anxiety. Demographic, disease-associated variables (time since onset of MS, Expanded Disability Status Scale Mobility, pain, and fatigue), and Time 1 psychological variables were entered into a hierarchical regression model to examine predictors at baseline for anxiety symptoms at Time 2. RESULTS A large portion of the sample was White (92%), female (82%), and had relapsing-remitting MS (57%). After adjusting for demographic and disease related variables, anxiety (β <.001), employment (β = .07), and nonsomatic depressive symptoms (β = .10) at baseline significantly predicted anxiety at Time 2, ps < .05. Interactions revealed significant effects for time since onset of MS and somatic symptoms as well as time since onset and nonsomatic symptoms, ps < .05. Nonsomatic symptoms were more linked to anxiety early in the disease and somatic symptoms were more prominently linked to anxiety later in the disease. CONCLUSIONS Findings suggest that nonsomatic symptoms of depression and employment predict anxiety in MS. The relationship between different aspects of depression and anxiety may change over the course of the disease.
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Affiliation(s)
| | | | | | | | - Melissa A Day
- School of Psychology, Australian Catholic University
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine
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Terrill AL, Molton IR, Ehde DM, Amtmann D, Bombardier CH, Smith AE, Jensen MP. Resilience, age, and perceived symptoms in persons with long-term physical disabilities. J Health Psychol 2014; 21:640-9. [PMID: 27165965 DOI: 10.1177/1359105314532973] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Resilience may mitigate impact of secondary symptoms such as pain and fatigue on quality of life in persons aging with disability. This study examined resilience in a large sample of individuals with disabling medical conditions by validating the Connor-Davidson Resilience Scale, obtaining descriptive information about resilience and evaluating resilience as a mediator among key secondary symptoms and quality of life using structural equation modeling. Results indicated that the measure's psychometric properties were adequate in this sample. Resilience was lowest among participants who were middle-aged or younger, and participants with depression. Resilience mediated associations between secondary symptoms and quality of life.
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Affiliation(s)
| | | | - Dawn M Ehde
- University of Washington School of Medicine, USA
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Molton IR, Terrill AL, Smith AE, Yorkston KM, Alschuler KN, Ehde DM, Jensen MP. Modeling Secondary Health Conditions in Adults Aging With Physical Disability. J Aging Health 2014; 26:335-59. [DOI: 10.1177/0898264313516166] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To test a conceptual model of secondary health conditions, age, and function in persons aging with long-term physical disabilities. Methods: Surveys were collected from 1,862 adults with spinal cord injury, neuromuscular disease, multiple sclerosis, or post-polio syndrome. Structural equation modeling was used to build a model describing relationships among physical and psychosocial secondary health conditions, pain, functional impairments, chronic medical conditions, and age. Results: In total, 12 individual symptom or function domains (latent factors) were identified, grouped into 5 broader factors. Increasing age was associated with greater rates of physical and health problems and poorer function, and showed curvilinear relationships with pain and psychosocial difficulties. Discussion: These data support a biopsychosocial model of secondary health conditions in adults aging with physical disability and suggest a five-factor approach for conceptualizing secondary conditions and their impact. Results also emphasize the importance of age in symptom severity and impact.
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Affiliation(s)
| | | | | | | | | | - Dawn M. Ehde
- University of Washington Medical Center, Seattle, USA
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