Diane Dixon

The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) can measure the impairment, activity limitations and participation restriction constructs from the International Classification of Functioning, Disability and Health (ICF)

BackgroundThe International Classification of Functioning, Disability and Health (ICF) model of the consequences of disease identifies three health outcomes, impairment, activity limitations and participation restrictions. However, few orthopaedic health outcome measures were developed with reference to the ICF. This study examined the ability of a valid and frequently used measure of upper limb function, namely the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), to operationalise the ICF.MethodsTwenty-four judges used the method of Discriminant Content Validation to allocate the 38 items of the DASH to the theoretical definition of one or more ICF outcome. One-sample t-tests classified each item as measuring, impairment, activity limitations, participation restrictions, or a combination thereof.ResultsThe DASH contains items able to measure each of the three ICF outcomes with discriminant validity. The DASH contains five pure impairment items, 19 pure activity limitations items and three participation restriction items. In addition, seven items measured both activity limitations and participation restrictions.ConclusionThe DASH can measure the three health outcomes identified by the ICF. Consequently the DASH could be used to examine the impact of trauma and subsequent interventions on each health outcome in the absence of measurement confound.

Goal setting and action planning in the rehabilitation setting: development of a theoretically informed practice framework

Background: Setting and achieving goals is fundamental to rehabilitation practice but has been criticized for being a-theoretical and the key components of replicable goal-setting interventions are not well established. Purpose: To describe the development of a theory-based goal setting practice framework for use in rehabilitation settings and to detail its component parts. Methods: Causal modelling was used to map theories of behaviour change onto the process of setting and achieving rehabilitation goals, and to suggest the mechanisms through which patient outcomes are likely to be affected. A multidisciplinary task group developed the causal model into a practice framework for use in rehabilitation settings through iterative discussion and implementation with six patients. Results: Four components of a goal-setting and action-planning practice framework were identified: (i) goal negotiation, (ii) goal identification, (iii) planning, and (iv) appraisal and feedback. The variables hypothesized to effect change in patient outcomes were self-efficacy and action plan attainment. Conclusions: A theory-based goal setting practice framework for use in rehabilitation settings is described. The framework requires further development and systematic evaluation in a range of rehabilitation settings.

Social support and regular physical activity: does planning mediate this link?

OBJECTIVES Social support for physical activity is reliably associated with regular physical activity, however the social cognitive processes, particularly post-intentional processes, that can explain this link have not been well characterized. In this study, we examined the extent to which the relationship between social support for physical activity and subsequent physical activity can be accounted for by planning processes. DESIGN AND METHOD The design was prospective observational and the sample consisted of 903 university students. Participants completed standard theory of planned behaviour, planning, and physical activity measures at 2 time points, approximately 7 weeks apart. A gender stratified multiple mediation model was conducted to test the study hypotheses. RESULTS A significant interaction between social support and gender was observed. This indicated that lower levels of social support for physical activity were associated with lower levels of physical activity at Time 2, for women only. In multiple mediation analysis, this was partly explained by the indirect effects of social support through perceived behavioural control and coping planning. CONCLUSION These findings highlight the importance of interpersonal processes in understanding the post-intentional social cognitive determinants of regular physical activity. It is likely that planning processes relating to physical activity are often influenced by those in the ongoing immediate social environment who support this behaviour. Future development of theory and interventions should take account of the socially interactive nature of planning processes.

The Structure and Temporal Stability of the Child and Adolescent Perfectionism Scale

In this study, the authors examined the factor structure and temporal stability of the Child and Adolescent Perfectionism Scale (CAPS; G. L. Flett, P. L. Hewitt, D. J. Boucher, L. A. Davidson, & Y. Munro, 1997) in 2 samples of adolescents (15-16 years old). In Sample 1 (n = 624), confirmatory factor analysis did not support a 2-factor structure (self-oriented and socially prescribed perfectionism). As in B. T. McCreary, T. E. Joiner, N. B. Schmidt, & N. S. Ialongo (2004), reanalysis suggested a 3-factor solution (i.e., socially prescribed perfectionism, self-oriented-Striving perfectionism, self-oriented-Critical perfectionism). The authors validated their 3-factor model in an independent replication sample (Sample 2; n = 514) and confirmed that the 3-factor structure was invariant across gender and time (test-retest over 6 months). Taking these analyses together, the authors concluded that their discriminant 3-factor structure is robust. Theoretical and clinical implications are discussed. More research on the predictive validity of the CAPS is suggested.

What does the chronic pain grade questionnaire measure

Abstract This study explored the ability of the Chronic Pain Grade Questionnaire (CPG) to operationalise the WHO’s model of health outcomes, namely the International Classification of Functioning, Disability and Health (ICF). Twelve expert judges used the method of discriminant content validation to allocate the seven items of the CPG to one or more ICF outcome, namely, impairment, activity limitations and participation restrictions. One‐sample t‐tests classified each item as measuring impairment, activity limitations or participation restrictions, or a combination thereof. The results indicated that the CPG contains items able to measure each of the three ICF outcomes. However, the pain grade classification system used in the CPG conflates the ICF outcomes. The implication of this conflation of outcome for the assessment of interventions is discussed.

Using the ICF and psychological models of behavior to predict mobility limitations

Aims to test the ability of a model that integrates the theory of planned behavior (TPB) into the International Classification of Functioning Disability and Health (ICF) to predict walking limitations in adults awaiting hip or knee replacement surgery. Study Design and Participants: Cross-sectional structural equation modeling study of activity limitations in 190 adults. Method: A postal questionnaire measuring the TPB, ICF and walking limitations. Results: The integrated model accounted for more variance in activity limitations (57%) than either the TPB or ICF alone. Control beliefs (TPB) significantly mediated the relationship between impairment (ICF) and activity limitations. Conclusions: The integrated model provides an interdisciplinary theoretical framework that identifies intervention targets to effect reductions in disability without the need for concomitant reductions in impairment.

Theoretical framework and methodological development of common subjective health outcome measures in osteoarthritis: a critical review.

Subjective measures involving clinician ratings or patient self-assessments have become recognised as an important tool for the assessment of health outcome. The value of a health outcome measure is usually assessed by a psychometric evaluation of its reliability, validity and responsiveness. However, psychometric testing involves an accumulation of evidence and has recognised limitations. It has been suggested that an evaluation of how well a measure has been developed would be a useful additional criteria in assessing the value of a measure. This paper explored the theoretical background and methodological development of subjective health status measures commonly used in osteoarthritis research. Fourteen subjective health outcome measures commonly used in osteoarthritis research were examined. Each measure was explored on the basis of their i) theoretical framework (was there a definition of what was being assessed and was it part of a theoretical model?) and ii) methodological development (what was the scaling strategy, how were the items generated and reduced, what was the response format and what was the scoring method?). Only the AIMS, SF-36 and WHOQOL defined what they were assessing (i.e. the construct of interest) and no measure assessed was part of a theoretical model. None of the clinician report measures appeared to have implemented a scaling procedure or described the rationale for the items selected or scoring system. Of the patient self-report measures, the AIMS, MPQ, OXFORD, SF-36, WHOQOL and WOMAC appeared to follow a standard psychometric scaling method. The DRP and EuroQol used alternative scaling methods. The review highlighted the general lack of theoretical framework for both clinician report and patient self-report measures. This review also drew attention to the wide variation in the methodological development of commonly used measures in OA. While, in general the patient self-report measures had good methodological development, the clinician report measures appeared less well developed. It would be of value if new measures defined the construct of interest and, that the construct, be part of theoretical model. By ensuring measures are both theoretically and empirically valid then improvements in subjective health outcome measures should be possible.

Patient preoperative expectations of total hip replacement in European orthopedic centers.

Patient expectations have been identified as a factor that may account for individual differences in recovery after total hip replacement (THR) surgery. However, patient expectations have not been studied within a valid theoretical framework. This study employed the World Health Organizations model of health, the International Classification of Functioning, Disability and Health (ICF), to classify the content of preoperative patient expectations of THR.

Current Issues and New Directions in Psychology and Health: What happened to behaviour in the decade of behaviour?

This editorial addresses two key aspects of the investigation of behaviour: the science and the application. On the one hand, researchers and policy makers recognise a need for good scientific evidence about behaviour and behaviour change, but are slow to turn to psychology for such evidence. On the other hand, there is a gap in scientific thinking about behaviour and behaviour change.

Can the theory of planned behaviour predict the physical activity behaviour of individuals

The Theory of Planned Behaviour (TPB) can identify cognitions that predict differences in behaviour between individuals. However, it is not clear whether the TPB can predict the behaviour of an individual person. This study employs a series of n-of-1 studies and time series analyses to examine the ability of the TPB to predict physical activity (PA) behaviours of six individuals. Six n-of-1 studies were conducted, in which TPB cognitions and up to three PA behaviours (walking, gym workout and a personally defined PA) were measured twice daily for six weeks. Walking was measured by pedometer step count, gym attendance by self-report with objective validation of gym entry and the personally defined PA behaviour by self-report. Intra-individual variability in TPB cognitions and PA behaviour was observed in all participants. The TPB showed variable predictive utility within individuals and across behaviours. The TPB predicted at least one PA behaviour for five participants but had no predictive utility for one participant. Thus, n-of-1 designs and time series analyses can be used to test theory in an individual.