Veronica Muller

Motivational and Volitional Variables Associated With Stages of Change for Exercise in Multiple Sclerosis A Multiple Discriminant Analysis

The main objective of this study was to determine whether motivational and volitional variables identified in the health action process approach (HAPA) model can be used to successfully differentiate people with multiple sclerosis (MS) in different stages of change for exercise and physical activity. Ex-post-facto design using multiple discriminant analysis was used. Participants were 215 individuals with MS. The outcome variable was measured by the Physical Activity Stages of Change Instrument, along with motivational and volitional measures (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). Participants in the precontemplation, contemplation, and action groups can be maximally separated by two significant canonical discriminant functions, volition and motivation. The action group can be differentiated from other groups based on high group mean (centroid) score on the volition function, and the precontemplation group can be differentiated based on low group means on both the motivation and volition functions. The contemplation group can be differentiated based on high centroid score on the motivation function. Research findings of this study support the concept of stage-matching exercise and physical activity intervention. The HAPA framework can be used to design health promotion behavioral interventions for people with MS in vocational rehabilitation.

Exercise, Diet, and Stress Management as Mediators between Functional Disability and Health-Related Quality of Life in Multiple Sclerosis.

The main objective of this study was to examine the mediational and moderational effect of exercise, diet, and stress management on the relationship between functional disability and health-related quality of life. Quantitative descriptive research design using multiple regression and correlation techniques was used. Participants were 215 individuals with multiple sclerosis (MS). Outcome measure used was health-related quality of life as measured by the Medical Outcomes Study (MOS) Short-Form Health Survey (SF-12v2). Functional disability and health-promoting behaviors including exercise, diet, and stress management were found to be associated with health-related quality of life. Exercise and stress management (but not diet) were partial mediators between functional disability and health-related quality of life. Exercise was found to be a moderator between functional disability and health-related quality of life. Exercise had a stronger effect on health-related quality of life for individuals with lower functional disability than people with higher functional disability. Health-promoting behaviors are important for health-related quality of life, and health-related quality of life in turn is related to better employment outcomes. Health-promoting behaviors can also mediate the relationship between functional disability and health-related quality of life. Rehabilitation counselors should consider including health promotion interventions in vocational rehabilitation services for individuals with MS.

Positive Coping, Self-Efficacy, and Self-Esteem as Mediators between Seizure Severity and Life Satisfaction in Epilepsy.

This study examined the impact of positive psychological traits (positive coping, self-efficacy, and self-esteem) on the relationship between seizure severity and life satisfaction among individuals with epilepsy. Hierarchical regression analysis and correlation techniques were used to test a hypothesized tri-mediation model of life satisfaction for individuals with epilepsy. Results indicated that seizure severity and positive human traits, including positive coping, self-efficacy, and self-esteem, were indeed associated with overall life satisfaction. Self-efficacy and self-esteem (but not positive coping) fully mediated the relationship between seizure severity and life satisfaction, lending support for a dual-mediation model. These findings suggest there may be considerable value for rehabilitation psychologists and counselors to develop specialized intervention programs that focus on capitalizing these positive human traits to promote life satisfaction and well-being for clients with epilepsy.

Vocational rehabilitation service patterns and employment outcomes of people with epilepsy.

This study aimed to examine the association between vocational rehabilitation (VR) services and employment outcomes of people with epilepsy (PWE), after controlling for demographic covariates. Data was retrieved from the Rehabilitation Services Administration Case Service Report (RSA-911) database for fiscal year (FY) 2011. Multivariate logistic regression was used to predict employment outcomes of PWE. Of the 2030 previously unemployed PWE who received services, 884 (43.5%) achieved successful competitive employment. Results indicate that higher education level and cost of VR services consumed were positively related to successful employment. In contrast, having co-occurring anxiety/depression, receiving cash benefits, or increasing time spent in the VR system was negatively associated with employment. Eight specific VR services (e.g., education, vocational training, and job search and placement assistance) were also found to be significant predictors of employment. Services provided by state VR agencies were proven to be beneficial in improving employment outcomes. PWE should be encouraged to pursue VR services to increase the chances of attaining employment. Health care providers should also become familiar with the array of VR services.

Effect of college or university training on earnings of people with disabilities: A case control study

OBJECTIVE: To examine the effect of college or university training on earnings of individuals with disabilities receiving services through the public vocational rehabilitation system. METHODS: A non-experimental case-control study design. Data for 178,290 individuals closed as successfully rehabilitation in fiscal year 2011 were extracted from the Rehabilitation Services Administration Case Service Report (RSA-911) database. RESULTS: Propensity scores were estimated based on demographic variables using the classification and regression tree (CART) method, which yielded six homogeneous subgroups, ranging from high propensity to received college or university training as a vocational rehabilitation intervention to low propensity to receive such service. Individuals who received college/university training had higher weekly earnings than those who did not, and had the greatest benefit for young adults; White, Asian, or Native American women with physical impairments; and people with mental impairments. CONCLUSION: College or university training should be considered as a viable and beneficial option to improve employment outcomes and job quality for individuals with disabilities.

Predictors of perceived social effectiveness of individuals with serious mental illness.

Objective: Social effectiveness continues to play a critical role in recovery of people with serious mental illness (SMI), with greater social effectiveness predicting many positive life outcomes. Despite the abundance of literature supporting the relationship between perceptions and behavior, little is known about predictors of perceived social effectiveness of individuals with SMI. Methods: The purpose of this study is to examine the predictors of perceived social effectiveness of individuals with SMI. Cross-sectional data of 192 participants with SMI recruited from four psychiatric rehabilitation clubhouses in 2 states in the South and Midwest regions of the United States were used for this study. Self-report data on category of psychiatric disabilities, psychiatric symptoms, cognition, insight, educational attainment, empathy, interpersonal interactions and relationships, self-stigma, disability acceptance, and perceived social effectiveness were collected and analyzed using multiple regression analysis (MRA). Results: MRA yielded a regression model that accounted for 56% of the variance in perceived social effectiveness, which is considered a large effect size. Controlling for all other factors, mood disorder, educational attainment, empathy, interpersonal interactions and relationships, and disability acceptance were found to be significant predictors of perceived social effectiveness of persons with SMI. Conclusions and Implications for Practice: Practitioners should consider determining points of intervention and targeting specific elements that enhance perceived social effectiveness.

Psychometric Properties of the Vocational Rehabilitation Engagement Scale When Used with People with Mental Illness in Clubhouse Settings.

Purpose: The purpose of this study was to validate the Vocational Rehabilitation Engagement Scale (VRES) for use in the Clubhouse Model of Psychosocial Rehabilitation. Method: There were 124 individuals with serious mental illness recruited from 8 Clubhouse programs in Hawaii. Measurement structure of the VRES was evaluated using exploratory factor analysis. Results: Exploratory factor analysis of the Clubhouse version of the VRES yielded 2 reliable factors (cognitive-affective engagement and behavioral engagement). Both the cognitive-affective engagement and behavioral engagement factors were found to correlate with other self-determination theory constructs including autonomy support, relatedness, and outcome expectancy. Conclusions: The Clubhouse version of the VRES is a brief, reliable, and valid instrument for assessing vocational rehabilitation (VR) engagement and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

Personal and environmental contextual factors as mediators between functional disability and quality of life in adults with serious mental illness: a cross-sectional analysis

PurposeTo examine personal and environmental contextual factors as mediators of functional disability on quality of life (QOL) in a sample of individuals with serious mental illness (SMI).MethodsA cross-sectional analysis of 194 individuals with SMI (major depressive disorder = 38.1%; bipolar disorder = 35.6%; schizophrenia spectrum disorder = 25.8%) recruited from four psychosocial rehabilitation clubhouses was undertaken to test a multiple regression model assuming that personal (i.e., resilience, social competence, and disability acceptance) contextual factors and environmental (i.e., family support, support from friends, and support from significant others) contextual factors would mediate the relationship of functional disability on QOL. The bootstrap test for multiple mediators was then used to test for the significance of the indirect effects functional disability on QOL through the mediators.ResultsIn the simple regression model, functional disability had a strong relationship with QOL; however, after introducing the potential mediators, its effect was significantly reduced indicating partial mediation effects. The final regression model yielded a large effect, accounting for 44% of the variance in QOL. Controlling for all other potential mediating factors, social competence, disability acceptance, family support, and support from friends were found to partially mediate the relationship between functional disability and QOL. Bias-corrected bootstrap procedure results further supported the mediation model.ConclusionsThe findings from the study provide good support for the inclusion of person–environment contextual factors in conceptualizing the relationship between functional disability and QOL for individuals with SMI.

Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia

Abstract Background: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions. Aims: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM. Methods: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms. Results: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity. Conclusions: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.

Social Cognitive and Planned Behavior Variables Associated with Stages of Change for Physical Activity in Spinal Cord Injury: A Multivariate Analysis.

Purpose: To apply the constructs of social cognitive theory (SCT) and the theory of planned behavior (TPB) to understand the stages of change (SOC) for physical activities among individuals with a spinal cord injury (SCI). Method: Ex post facto design using multivariate analysis of variance (MANOVA). The participants were 144 individuals with SCI who completed an online SCT, TPB, and SOC for physical activities survey. Results: Participants in the preintender, intender, and actor groups differed significantly in functional disability, secondary health conditions, exercise self-efficacy, perceived benefits and barriers, intention, and physical health. Conclusion: Findings support the concept of stage-matching exercise and physical activity cognitive behavioral interventions for people with SCI.