Richard Trigg

The Subjective Index of Physical and Social Outcome (SIPSO): a new measure for use with stroke patients

Objective: To develop a measure of social integration following stroke. Design: Question and response scale generation from qualitative interview-based work followed by item and factor analytic methods of test construction. Analysis of the psychometric properties of final index. Measures: Frenchay Activities Index, Nottingham Health Profile, Wakefield Depression Inventory, Barthel Index. Setting: Community setting, Bath, UK. Subjects: Two hundred and sixty survivors of stroke, discharged at least six months previously from a general hospital. Results: A 10-item Subjective Index of Physical and Social Outcome (SIPSO) was developed. Each question is scored on a scale of 0–4 with a low score indicating a poor level of integration. From the 157 completed questionnaires, total scores ranged from 0 to 40 with a median of 24 (interquartile range 15–32). Initial testing of the psychometric properties of the SIPSO suggest that it is able to provide assessment of two distinct areas of patient integration. From analysis of completed questionnaires it is suggested that questions 1–5 on the SIPSO measure a factor related to physical functioning/mobility whilst questions 6–10 measure a factor related to social/emotional functioning. Internal consistency, test–retest reliability and construct validity were established. Conclusions: The SIPSO provides a brief, valid and reliable assessment of an individuals ability to reintegrate to a ‘normal’ lifestyle. The SIPSO differs from other measures in that it provides assessment of both quantity and quality of activities and interaction, reflecting an individual’s ability to reintegrate to his/her own satisfaction. As a 10-item self-report questionnaire the SIPSO can be administered quickly and cheaply to large numbers of patients.

Predictors of quality of life ratings from persons with dementia: the role of insight

Evidence suggests that people with dementia are able to respond accurately and consistently to questions about quality of life (QoL), although large discrepancies exist between patient and proxy ratings. This may be due, in part, to the reduced insight of the person with dementia. The aim of this study was to explore the predictors of QoL ratings in a sample of people with mild dementia, with a particular focus on the role of insight.

An Empirical Investigation of Music and Gambling Behaviour

There has been an increasing amount of research that has examined the structural and situational characteristics of gambling behaviour. However, there is a lack of research examining the role of music and gambling. This study investigated the effects of background music on virtual roulette gaming behaviour under laboratory conditions. There was one independent variable of music with three conditions. The three conditions were (i) no music, (ii) slow tempo music, and (iii) fast music. A total of 60 participants were allocated to one of the three conditions. Ten games of roulette were played with speed of betting, amount spent across high, medium and low-level risk bets and total amount spent recorded. The winner with the most money at the end of the session was rewarded with a non-monetary prize. Results indicated that speed of betting was influenced by musical tempo with faster betting occurring while listening to higher tempo music. There was no relationship between musical tempo and either the size of the bet or the overall amount spent. The results provide valuable insight into how background music can be manipulated to increase betting speed. The implications of these findings for problem gambling management and commercial benefits are discussed.

Dependence in Alzheimer's disease and service use costs, quality of life, and caregiver burden: The DADE study

Most models determining how patient and caregiver characteristics and costs change with Alzheimers disease (AD) progression focus on one aspect, for example, cognition. AD is inadequately defined by a single domain; tracking progression by focusing on a single aspect may mean other important aspects are insufficiently addressed. Dependence has been proposed as a better marker for following disease progression.

The validation of the Subjective Index of Physical and Social Outcome (SIPSO)

Objective: To validate the Subjective Index of Physical and Social Outcome (SIPSO) in its final 10-item version as a measure of reintegration to pre-stroke lifestyle. Design: Postal and interview administration of questionnaires. Measures: SIPSO, Functional Limitations Profile (FLP), Reintegration to Normal Living Index (RNLI). Setting: Community setting, Bath, UK. Subjects: Two hundred and sixty-one survivors of stroke discharged from a district general hospital. Results: Internal consistency (item-total correlations >0.6) and test–retest reliability (intraclass correlation coefficient (ICC) = 0.96) of the measure were confirmed. Construct validity was confirmed through significant correlations with the six subsections of the FLP and the RNLI. Confirmatory factor analysis of the measure found that the first five items form a robust subscale that clearly relates to physical function. The items within the second subscale (questions 6–10) measure several domains (social, leisure, self-image) and do not form a homogeneous group. The SIPSO was able to detect an improvement in integration within a sample of patients over a three-month period soon after discharge (effect size = 0.26). The hypothesis that the degree of improvement experienced by patients following discharge from hospital would be small, but should be detectable was confirmed. The agreement between proxy and patient on the SIPSO was acceptable for individual items (kappa value range = 3.1–5.8) and total score (ICC = 0.96). Conclusions: The SIPSO is a brief self-complete measure, with proven validity and reliability, which addresses both quantitative and qualitative aspects of activities and interaction. It provides a useful measure for evaluating rehabilitation programmes that aim to reintegrate patients to their pre-stroke lifestyle. The authors suggest that the SIPSO should be used as a 10-item measure.

The relationship between changes in quality of life outcomes and progression of Alzheimer's disease: results from the dependence in AD in England 2 longitudinal study.

The relationship between conventional indicators of Alzheimers disease (AD) progression and quality of life (QoL) outcomes is unclear. Dependence on others has been recommended as a unifying construct in defining AD severity. This study examined the relationship between indicators of disease severity (including dependence) and changes in QoL and utility over 18 months.

Self-reported quality of life ratings of people with dementia: the role of attitudes to aging

BACKGROUND Attitudes to aging have not previously been assessed in people with dementia. The possession of positive life attitudes into older age has the potential to induce resilience to health changes and may explain the discrepancy between self-reported and proxy ratings of quality of life (QoL). The aim of this study was to explore the attitudes of people with dementia to determine the main factors that predict these attitudes and any relationship that exists with self-reported QoL. METHODS Fifty-six participants with dementia were recruited from a memory clinic setting. The Bath Assessment of Subjective Quality of Life in Dementia, Attitudes to Aging Questionnaire (AAQ), Memory Functioning Scale, Alzheimers Disease Cooperative Study Activities of Daily Living Inventory, and Mini-Mental State Examination were administered. The AAQ was also completed by 86 community-dwelling older adults without dementia. RESULTS Participants with dementia displayed a significantly stronger endorsement of the negative attitude that aging is a time of psychosocial loss than those without dementia. Regression analyses suggest this negative attitude acts as a partial mediator in the relationship between the persons level of insight and self-reported QoL. CONCLUSIONS Negative attitudes to aging had a direct impact on the self-reported QoL ratings of people with dementia. The view of aging as a time of psychosocial loss was most significant for people with dementia and suggests that negative stereotypes of dementia need to be challenged. In order to promote QoL, care should focus on abilities that the person retains rather than what has been lost.

Living with Type 1 diabetes: a by-person qualitative exploration

Type 1 diabetes is a chronic condition which places enormous demands on the individual diabetic. A strict care routine is necessitated, yet even the most controlled and disciplined diabetic is likely to experience associated health problems and automatically faces a reduced life expectancy. The current study explores the psychological repercussions of this situation via a small scale qualitative study which focuses on the very different viewpoints and experiences of four adults living with Type 1 diabetes. A new and original form of by-person (or by-case) qualitative analysis is employed in order to capture, in a rich and holistic fashion, each participants current relationship with their condition, their experience of living and dealing with diabetes and the ways in which diabetes is integrated within their lives and identities. The findings have implications for, and are discussed in relation to, issues of control, regimen adherence, and what it means to be a ‘good’ or ‘successful’ diabetic. The conclusion is drawn that the satisfaction of personal goals and a focus on psychological as well as physical health may be very important if positive quality of life outcomes are to be attained in the context of Type 1 diabetes.

Improving the psychological evaluation of exercise referral: Psychometric properties of the Exercise Referral Quality of Life Scale

There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral.

Centres for People with Intellectual Disabilities: Attendees’ Perceptions of Benefit

BACKGROUND Day and community learning centres aim to provide intellectually disabled (ID) people with social support, life skills and greater control over their lives. However, there is little research exploring the benefits of attendance from the perspective of attendees and whether these goals are met. MATERIALS AND METHODS Unstructured interviews were held with four female and three male participants with a mild level of disability, from an East Midlands Mencap facility. Interviews were transcribed and analysed through the Grounded Theory approach. RESULTS Themes of social support, life skills, control and self-image emerged from the transcripts. This brief report focuses on issues of self-image and internal control of behaviour and emotion, as these constructs have received less attention within existing literature. CONCLUSIONS Learning centres provide important psychological benefits for people with learning difficulties. These are often less accessible to evaluation, but are nonetheless key outcomes from the perspective of attendees.