Susan E. Doble

Construction and validation of a fatigue impact scale for daily administration (D-FIS)

The fatigue impact scale (FIS) was developed previously as a symptom-specific profile measure of health-related quality of the (HRQoL) for use in medical conditions in which fatigue is a prominent chronic symptom. Thus, it was not developed to be a responsive measure of daily changes in fatigue. This study describes the development and initial validation of an adaptation of the FIS for daily use. Items for the daily fatigue impact scale (D-FIS) were selected from the pool of original FIS items through Rasch analyses of existing data. The reduced-item FIS was administered to a sample of 93 subjects with flu-like illness, 25 of whom were followed for a 21-day period. Rasch analyses were used to further reduce the scale to a minimum number of items that represented a unidimensional measure of self-reported fatigue impact. This 8-item D-FIS demonstrated good relations to flu symptom ratings and to other general health ratings. It also proved to be a responsive measure of change in reported fatigue impact for subjects who were followed longitudinally. This initial validation study indicates that the D-FIS has considerable promise as a valid measure of the subjective daily experience of fatigue.

Functional competence of community-dwelling persons with multiple sclerosis using the assessment of motor and process skills

The Assessment of Motor and Process Skills (AMPS) is an observational measure of functional competence in instrumental activities of daily living (IADL) that was designed to overcome the limitations of self reports and proxy reports. The AMPS allows simultaneous evaluation of the underlying motor and process (organizational/adaptive) skills necessary for competent task performance. We examined the IADL performance of 22 community-dwelling patients with mild to moderate MS in comparison to nondisabled subjects matched for age and gender. Functional competence of the MS subjects, as measured by the AMPS, was poorer than that of the control group. Many MS subjects who would not have been expected to have IADL difficulties on the basis of ratings of neurologic impairment were impaired in their IADL performance. For some patients, IADL impairment reflected deficits in their motor and process skills, whereas for others, process skill impairments alone were responsible for deficient task performance.

Discharge planning with older adults: toward a negotiated model of decision making.

Background. Occupational therapists are frequently involved in discharge accommodation decision making with older adults. Purpose. The literature regarding this process is reviewed. The ways in which risk avoidance and autonomy promotion philosophies influence decisions are examined and a new approach is proposed. Summary. One approach is based on risk avoidance, where decisional control rests with professionals, but the client is left out of the process. Another is that of autonomy promotion, in which decisional control rests with the client. When risks are high, this can result in ethical dilemmas. The importance of the environment, its relationship to occupational performance, and differing interpretations of client-centred processes are important considerations. Practice Implications. In response to the inadequacy of models grounded in risk avoidance or autonomy promotion, occupational therapists are challenged to move toward a balanced approach to decision making with older people, grounded in partnership, shared power, and negotiation.

Relation between post-stroke satisfaction with time use, perceived social support and depressive symptoms

Purpose. To determine if perceived level of social support and number of depressive symptoms differentiates those who are satisfied with their time use post-stroke from those who are dissatisfied. Method. Secondary analysis of data of 54 subjects grouped by yes/no responses to ‘Are you satisfied with how you spend your time?’ Perceived social support and number of depressive symptoms were evaluated using the MOS Social Support Scale and Geriatric Depression Scale respectively. Results. Time use satisfaction was high (64.8%). Dissatisfied subjects reported lower affectionate support and fewer positive social interactions (t < −2.70, p < 0.009) as well as higher levels of depression (t = 2.06, p = 0.05). Dissatisfied subjects were more likely to endorse only three Geriatric Depression Scale items (i.e., ‘dropped activities’, ‘often bored’, and ‘often felt helpless’) (χ2(1) > 7.27, p < 0.007). Conclusions. Persons post-stroke who are dissatisfied with their time use may not be depressed but may benefit from participation in meaningful social occupations.

Intrinsic Motivation and Clinical Practice: The Key to Understanding the Unmotivated Client:

Although the goal of engaging clients in intrinsically motivating activities has been identified as an essential aspect of clinical practice, occupational therapists continue to find the treatment of unmotivated individuals perplexing. The clinical problem of motivating clients must begin with the therapist having a good understanding of the theory of intrinsic motivation and an ability to utilize research findings from other fields such as psychology, education and management, so that relevant treatment strategies can be developed. However, without access to a conceptual model which can be used to organize experimental findings, the task of making sense of this diverse body of knowledge becomes burdensome. This article presents a conceptual model in which four determinants of intrinsic motivation are delineated. The concepts are identified as the orientation of the task environment, the meaningfulness of the activity, the provision of opportunities for personal control, and for the generation of feelings of competence. Each concept is defined and discussed in relation to the clinical problem of motivating clients.

Measurement Issues in Ageing, Education and Disability

[Extract] This issue of the International Journal of Disability, Development and Education comprises two main sections. The first section relates to the topic “Measurement Issues in Ageing, Education and Disability”. The Editorial relates to this topic with a description of the contents of the articles focusing on this topic. The second section comprises articles that have been submitted by individual authors on the topics of social interaction and behaviour.