Matthew Kehn

The SCI Exercise Self-Efficacy Scale (ESES): development and psychometric properties

BackgroundRising prevalence of secondary conditions among persons with spinal cord injury (SCI) has focused recent attention to potential health promotion programs designed to reduce such adverse health conditions. A healthy lifestyle for people with SCI, including and specifically, the adoption of a vigorous exercise routine, has been shown to produce an array of health benefits, prompting many providers to recommend the implementation of such activity to those with SCI. Successfully adopting such an exercise regimen however, requires confidence in ones ability to engage in exercise or exercise self-efficacy. Exercise self-efficacy has not been assessed adequately for people with SCI due to a lack of validated and reliable scales, despite self efficacys status as one of the most widely researched concepts and despite its broad application in health promotion studies. Exercise self efficacy supporting interventions for people with SCI are only meaningful if appropriate measurement tools exist. The objective of our study was to develop a psychometrically sound exercise self-efficacy self-report measure for people with SCI.MethodsBased on literature reviews, expert comments and cognitive testing, 10 items were included and made up the 4-point Likert SCI Exercise Self-Efficacy Scale (ESES) in its current form. The ESES was administered as part of the first wave of a nationwide survey (n = 368) on exercise behavior and was also tested separately for validity in four groups of individuals with SCI. Reliability and validity testing was performed using SPSS 12.0.ResultsCronbachs alpha was .9269 for the ESES. High internal consistency was confirmed in split-half (EQ Length Spearman Brown = .8836). Construct validity was determined using principal component factor analysis by correlating the aggregated ESES items with the Generalised Self Efficacy Scale (GSE). We found that all items loaded on one factor only and that there was a statistically significant correlation between Exercise Self-Efficacy Scale (ESES) and Generalised Self Efficacy Scale (GSE) (Spearman RHO = .316; p < .05; n = 53, 2-sided).ConclusionPreliminary findings indicate that the ESES is a reliable instrument with high internal consistency and scale integrity. Content validity both in terms of face and construct validity is satisfactory.

Perceived exercise self-efficacy as a predictor of exercise behavior in individuals aging with spinal cord injury.

ObjectiveThe purpose of this study was to test the hypothesized association between exercise self-efficacy and exercise behavior, controlling for demographic variables and clinical characteristics, in a sample of individuals with spinal cord injuries. DesignA cross-sectional national survey of 612 community-dwelling adults with spinal cord injury in the United States ranging from 18 to 89 yrs of age was conducted. Sample consisted of 63.1% men with a mean (SD) duration of 15.8 (12.79) yrs postinjury; 86.3% reported using a wheelchair. ResultsSelf-efficacy was the only independent variable that consistently predicted all four exercise outcomes. Self-efficacy beliefs were significantly related to frequency and intensity of resistance training (R2 change = 0.08 and 0.03, respectively; P < 0.01 for all) and aerobic training (R2 change = 0.07 and 0.05, respectively; P < 0.01 for all), thus explaining between 3% and 8% of the variance. Hierarchical linear regression analysis revealed that controlling for other demographic and physical capability variables, the age-related variables made statistically significant contributions and explained between 1% and 3% of the variance in aerobic exercise frequency and intensity (R2 change = 0.01 and 0.03, respectively; P < 0.01 for all). Clinical functional characteristics but not demographic variables explained participation in resistance exercise. ConclusionsSelf-efficacy beliefs play an important role as predictors of exercise. Variations in exercise intensity along the age continuum have implications for exercise prescription and composition. Future research should replicate findings with objective activity measures.

An examination of the psychometric properties of the community integration questionnaire (CIQ) in spinal cord injury

Abstract Objective To examine the psychometric properties of the Community Integration Questionnaire (CIQ) in large samples of individuals with spinal cord injury (SCI). Design Longitudinal 12-month survey study. Setting Nation-wide, community dwelling. Participants Adults with SCI: 627 at Time 1, 494 at Time 2. Interventions Not applicable. Outcome measures The CIQ is a 15-item measure developed to measure three domains of community integration in individuals with traumatic brain injury: home integration, social integration, and productive activity. SCI consumer input suggested the need for two additional items assessing socializing at home and internet/email activity. Results Exploratory factor analyses at Time 1 indicated three factors. Time 2 confirmatory factor analysis did not show a good fit of the 3-factor model. CIQ scores were normally distributed and only the Productive subscale demonstrated problems with high (25%) ceiling effects. Internal reliability was acceptable for the Total and Home scales, but low for the Social and Productive activity scales. Validity of the CIQ is suggested by significant differences by sex, age, and wheelchair use. Conclusions The factor structure of the CIQ was not stable over time. The CIQ may be most useful for assessing home integration, as this is the subscale with the most scale stability and internal reliability. The CIQ may be improved for use in SCI by including items that reflect higher levels of productive functioning, integration across the life span, and home- and internet-based social functioning.

The Missing Link: Examining the Impact of Housing Vouchers and Community-Based Services and Supports on Transitions From Nursing Facilities to the Community

Several government initiatives aim to increase the availability of home and community-based services. These efforts have helped facilitate the transition of individuals with disabilities living in institutions such as nursing facilities to community living, resulting in improved quality of life and potential health care savings. However, evidence suggests that a lack of affordable housing remains a key barrier that keeps some individuals living in institutions from transitioning to community living. This study evaluated the effect on transition rates among nursing home residents eligible for the Non-Elderly Disabled Housing Choice Voucher Program. The program provided housing vouchers that subsidized rental costs along with access to home and community-based services to nonelderly institutionalized residents with a disability. We assessed this program’s impact on the likelihood of community transitions among the target population in five areas for which these vouchers were made available. In a pooled sample of three of the five areas, the program increased community transition rates by 8.7 percentage points. This finding suggests that targeting housing vouchers to people with disabilities living in institutions could help facilitate or expedite transitions to community living.

Matching Study Designs to Disability-Related Comparative Effectiveness Research Questions

Comparative effectiveness research can help patients with disabilities; their caregivers and providers determine which healthcare choices are beneficial and will most reduce limitations and barriers, and improve quality of life. Well-designed comparative effectiveness research will be critical as the number of working-age adults affected by disability grows in the future, along with disability-related health expenditures. To better address the need for high-quality and informative research on the effectiveness of interventions for people with disabilities, the authors conducted a comprehensive review of existing standards for assessing evidence quality, collecting input from a wide range of experts and policy makers to determine the type of evidence needed for informing disability-related decision-making and the applicability of existing standards to disability research. This review article presents methodological and design issues for researchers to consider when addressing disability-related comparative effectiveness research questions.

State Strategies for Coordinating Medicaid and Housing Services.

Objective: This article reports findings from case studies of 4 states (Illinois, Louisiana, Massachusetts, and Tennessee) that used different approaches to coordinate Medicaid services with temporary or permanent housing supports for individuals with psychiatric disabilities. Method: Data were collected through document review, telephone interviews with state officials and managed care organizations, and site visits to behavioral health and housing providers, and consumer organizations. Qualitative analyses focused on identifying key features of each state’s approach, including the strengths and limitations from multiple perspectives. Results: All 4 states facilitated partnerships between behavioral health and housing providers. Each state used managed care strategies to some degree and identified opportunities to use Medicaid to finance the coordination of services with housing providers. These financing strategies included using flexible case rates to fund community support workers; using a 1915(i) state plan amendment to fund intensive Medicaid behavioral health services for those in permanent supportive housing; funding new local entities to support local partnerships between health and housing organizations; and creating a Medicaid supportive housing benefit. Conclusions and Implications for Practice: These 4 states took advantage of the flexibility that Medicaid offers to implement different service models in an effort to improve the coordination of behavioral health services and housing. The strategies used in these states may be useful to other states and communities seeking to strengthen coordination of care for individuals who require housing support.