Search tips
Search criteria

Results 1-25 (47)

Clipboard (0)

Select a Filter Below

Year of Publication
Document Types
1.  [No title available] 
PMCID: PMC4032025  PMID: 24446671
2.  [No title available] 
PMCID: PMC4046637  PMID: 24320943
3.  Self-Efficacy as a Predictor of Self-Reported Physical, Cognitive and Social Functioning in Multiple Sclerosis 
Rehabilitation psychology  2013;59(1):27-34.
Investigate whether self-efficacy is associated with physical, cognitive and social functioning in individuals with Multiple Sclerosis (MS) when controlling for disease-related characteristics and depressive symptomatology.
81 individuals between the ages of 29 and 67 with a diagnosis of clinically definite MS.
Hierarchical regression analysis was employed to examine the relationships between self-efficacy and self-reported physical, cognitive, and social functioning.
Self-efficacy is a significant predictor of self-reported physical, cognitive and social functioning in MS after controlling for variance due to disease related factors and depressive symptomatology.
Self-efficacy plays a significant role in individual adjustment to MS across multiple areas of functional outcome, beyond that which is accounted for by disease related variables and symptoms of depression.
PMCID: PMC4138971  PMID: 24320946
self-efficacy; Multiple Sclerosis; functional outcomes
4.  Maternal Warm Responsiveness and Negativity Following Traumatic Brain Injury in Young Children 
Rehabilitation psychology  2013;58(3):223-232.
To understand how traumatic brain injury (TBI) affects maternal warm responsiveness and negativity over the first 12 months following injury.
We used a concurrent cohort research design to examine dyadic interactions in young children with a TBI (n = 78) and a comparison group of young children with orthopedic injuries (OI; n = 112) and their families during the initial weeks following injury (i.e., baseline) and at two follow-up periods (approximately 6 and 12 months later). Trained raters coded videotaped interactions during a free play and structured teaching task for maternal warm responsiveness and negativity.
Mothers in the complicated mild/moderate TBI group, but not those in the severe TBI group, exhibited significantly lower levels of maternal warm responsiveness than mothers in the OI group. However, these differences were observed only at baseline during free play and only at baseline and 6 months postinjury during the structured teaching task, suggesting diminishing adverse effects of complicated mild/moderate TBI on parenting over time postinjury. Analysis failed to reveal group differences in maternal negativity at any of the assessments. Across groups, lower socioeconomic status (SES) was associated with lower levels of warm responsiveness and higher levels of negativity.
These findings, though preliminary, indicate possible alterations in mother–child interactions in the months following a TBI.
PMCID: PMC4278364  PMID: 23978080
mother–child interactions; traumatic brain injury; early childhood; direct observation; longitudinal study
5.  The Kennedy Krieger Independence Scales–Spina Bifida Version: A Measure of Executive Components of Self-Management 
Rehabilitation psychology  2013;58(1):98-105.
Successful implementation of functional self-care skills depends upon adequate executive functioning; however, many scales assessing adaptive skills do not address the inherent executive burden of these tasks. This omission is especially relevant for individuals with spina bifida, for whom medical self-care tasks impose a significant burden requiring initiation and prospective memory. The Kennedy Krieger Independence Scales–Spina Bifida Version (KKIS–SB) is a caregiver-reported measure designed to address this gap; it assesses skills for managing both typical and spina bifida-related daily self-care demands, with a focus on the timely and independent initiation of adaptive skills.
Research Method/Design
Parents of 100 youth and young adults with spina bifida completed the KKIS–SB. Exploratory factor analysis and Pearson's correlations were used to assess the factor structure, reliability, and construct validity of the KKIS–SB.
The scale demonstrates excellent internal consistency (Cronbach's alpha = .891). Exploratory factor analysis yielded four factors, explaining 65.1% of the total variance. Two primary subscales were created, initiation of routines and prospective memory, which provide meaningful clinical information regarding management of a variety of typical (e.g., get up on time, complete daily hygiene routines on time) and spina bifida-specific self-care tasks (e.g., begin self-catheterization on time, perform self-examination for pressure sores).
Based upon internal consistency estimates and correlations with measures of similar constructs, initial data suggest good preliminary reliability and validity of the KKIS–SB.
PMCID: PMC4154366  PMID: 23438006
transition; adaptive functioning; validity; factor structure; executive function
6.  Clinically Significant Behavior Problems During the Initial 18 Months Following Early Childhood Traumatic Brain Injury 
Rehabilitation psychology  2010;55(1):48-57.
The present study looked at the emergence of clinically significant problems in behavior, executive function skills (EF), and social competence during the initial 18 months following TBI in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Children, ages 3-7 years, hospitalized for severe TBI moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point post injury. Results suggest that, compared to the OI group, the severe TBI developed significantly more externalizing behavior problems and EF problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low SES. The findings are similar to those found in school-aged children.
PMCID: PMC4137557  PMID: 20175634
Traumatic Brain Injury; Early Childhood; Behavior Problems
7.  Older Adult Stroke Survivors Discussing Post-stroke Depressive Symptoms with a Healthcare Provider: A Preliminary Analysis 
Rehabilitation psychology  2013;58(3):263-271.
The purposes of this study were to examine the relationship between the post-stroke depressive symptoms, older adult stroke survivors’ perceptions of the depressive symptoms, and the congruence with an informal caregiver about the presence of depressive symptoms, and comfort talking to the healthcare provider with whether or not older stroke survivors discussed their depressive symptoms with a healthcare provider.
A cross-sectional study where 44 caregiver/older adult stroke survivor dyads completed questionnaires including the Center for Epidemiologic Studies Depression Scale, Symptom Perception Questionnaire, and reporting of depressive symptoms to the healthcare provider via one time interview.
Thirty-seven percent (n=16) of all older stroke survivors reported depressive symptoms to their healthcare provider. Of the stroke survivors who had high levels of depressive symptoms (CESD≥16; n=11), seven reported the depressive symptoms to their healthcare provider. Identifying the symptoms as possible depression and attributing the cause of the depressive symptoms to the stroke were related to stroke survivors reporting the depressive symptoms to a health care provider.
High functioning, older stroke survivors may benefit from strategies to help them identify when they experience depressive symptoms, in order to be able to play an active role in their recovery by appropriately discussing their symptoms with a healthcare provider.
PMCID: PMC4115660  PMID: 23855380
Stroke; caregiver; depressive symptoms; congruence; symptom reporting
8.  Meaning in Life: An Important Factor for the Psychological Well-Being of Chronically Ill Patients? 
Rehabilitation psychology  2013;58(4):334-341.
This study aimed to investigate 2 dimensions of meaning in life—Presence of Meaning (i.e., the perception of your life as significant, purposeful, and valuable) and Search for Meaning (i.e., the strength, intensity, and activity of people's efforts to establish or increase their understanding of the meaning in their lives)—and their role for the well-being of chronically ill patients.
Research design
A sample of 481 chronically ill patients (M = 50 years, SD = 7.26) completed measures on meaning in life, life satisfaction, optimism, and acceptance. We hypothesized that Presence of Meaning and Search for Meaning will have specific relations with all 3 aspects of well-being.
Cluster analysis was used to examine meaning in life profiles. Results supported 4 distinguishable profiles (High Presence High Search, Low Presence High Search, High Presence Low Search, and Low Presence Low Search) with specific patterns in relation to well-being and acceptance. Specifically, the 2 profiles in which meaning is present showed higher levels of well-being and acceptance, whereas the profiles in which meaning is absent are characterized by lower levels. Furthermore, the results provided some clarification on the nature of the Search for Meaning process by distinguishing between adaptive (the High Presence High Search cluster) and maladaptive (the Low Presence High Search cluster) searching for meaning in life.
The present study provides an initial glimpse in how meaning in life may be related to the well-being of chronically ill patients and the acceptance of their condition. Clinical implications are discussed.
PMCID: PMC4113206  PMID: 24295525
acceptance; chronic illness; cluster analysis; meaning in life; well-being
9.  Predictors of Adherence to Home Rehabilitation Exercises Following Anterior Cruciate Ligament Reconstruction 
Rehabilitation psychology  2013;58(1):64-72.
Although home exercises are commonly prescribed following anterior cruciate ligament (ACL) reconstruction and are considered important in obtaining successful rehabilitation outcomes, little is known about factors associated with the completion of such exercises. Consequently, this study was designed to identify predictors of adherence to home rehabilitation exercises after ACL surgery.
Research Method/Design
Participants (33 women, 58 men) completed indices of athletic identity, neuroticism, optimism, and pessimism before ACL surgery and measures of daily pain, negative mood, stress, and home exercise completion for 42 days postoperatively.
Participants reported a high level of adherence to the prescribed regimen. Home exercise completion increased significantly over time as the number of sets of prescribed home exercises declined. Personal factors were not predictive of home exercise completion. Participants completed fewer home exercises on days when they experienced more stress or negative mood.
Day-to-day variations in negative mood and stress may contribute to adherence to prescribed home exercises.
PMCID: PMC4045843  PMID: 23438001
compliance; knee; surgery; psychology
10.  Methods Used to Quit Smoking by People with Physical Disabilities 
Rehabilitation psychology  2013;58(2):117-123.
People with mobility impairments (MIs) have higher smoking rates than the general population. We evaluated the use of psychosocial and pharmacological methods to quit smoking and readiness to quit smoking in this population in a cross-sectional study.
Research Method/Design
Current and former smokers with MIs who needed equipment to ambulate (e.g. cane, wheelchair; N=152, 53.3% female, 86.2% current smokers) were recruited from the community and interviewed by telephone regarding their lifetime use of various quit methods and readiness to quit smoking.
Results indicated that 57.3% reported a quit attempt in the past year, and 62% and 88.4% were planning on quitting in the next 30 days and six months, respectively. A minority of smokers with MIs reported using any type of counseling (5.3%; 3.3% in person counseling and 2.6% phone counseling) or tablet medication (8.6%); 75% had made a “cold turkey” quit attempt (e.g., without any assistance). 36.8% and 19.7% reported using the nicotine patch and gum respectively. Regression analyses indicated that greater nicotine dependence was associated with lower use of psychosocial treatments (p<.05), greater education was associated with greater tablet medication use (p=.051), and higher income was associated with both greater nicotine replacement therapy (NRT) and tablet medication use (p<.05). Minorities with MIs were significantly less likely to use NRT than non-Hispanic whites (p<.05).
Individuals with MIs are motivated to quit smoking but under-utilize some empirically validated cessation treatment options.
PMCID: PMC3667967  PMID: 23437992
Smoking; physical disabilities; nicotine replacement; stop smoking medication; smoking cessation; motivation; quitline
11.  Brief Report: Chronic Pain and the Interpersonal Theory of Suicide 
Rehabilitation psychology  2013;58(1):111-115.
Although chronic pain is a known risk factor for suicide, few studies to date have tested specific predictions about suicidal ideation that are derived from theory. The interpersonal theory of suicide proposes that the psychological constructs of thwarted belongingness and perceived burdensomeness are unique and independent precursors to suicidal ideation. We tested this hypothesis in a clinical sample of patients with chronic pain.
A total of 303 patients of a chronic pain rehabilitation program completed measures of pain severity, duration, and disability, cognitive-affective measures of depression and catastrophizing, and interpersonal measures of relationship distress and self-perceived burden to others. The latter measures were included as indices of the belongingness and burdensomeness constructs. Participants also rated two items pertaining to suicidal ideation.
In a multiple regression analysis, both distress in interpersonal relations (β = 0.12, p = .037) and self-perceived burden to others (β = 0.25, p < .001) were significant predictors of suicidal ideation, even after adjusting statistically for demographic characteristics, pain severity and duration, functional limitations, catastrophizing, and depression.
These findings suggest that the interpersonal theory is relevant to understanding elevated rates of suicidal ideation among people with chronic pain and may have broader applicability to other populations with chronic illness or disability.
PMCID: PMC3998981  PMID: 23438008 CAMSID: cams4369
chronic pain; suicide; suicidal ideation; interpersonal theory; interdisciplinary treatment
12.  Acceptance of Pain in Neurological Disorders: Associations With Functioning and Psychosocial Well-Being 
Rehabilitation psychology  2013;58(1):1-9.
Chronic pain acceptance has been shown to be related to positive adjustment to chronic pain in patients presenting with pain as a primary problem. However, the role of pain acceptance in adjustment to chronic pain secondary to a neurological disorder that is often associated with physical disability has not been determined. The purpose of this study was to examine whether two domains of chronic pain acceptance—activity engagement and pain willingness—predict adjustment to pain, controlling for pain intensity and key demographic and clinical variables in individuals with muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), or spinal cord injury (SCI).
Participants were 508 community-dwelling adults with a diagnosis of MD, MS, PPS, or SCI who also endorsed a chronic pain problem. Participants completed self-report measures of pain acceptance, quality of life, pain interference, pain intensity, depression, and social role satisfaction.
Hierarchical linear regressions indicated that activity engagement predicted lower pain interference and depression, and greater quality of life and social role satisfaction. Pain willingness predicted less pain interference and depression. Together, the two pain acceptance subscales accounted for more variance in outcomes than did self-reported pain intensity.
Findings correspond with the broader pain acceptance literature, although activity engagement appears to be a more robust predictor of adjustment than does pain willingness. This research supports the need for future studies to determine the extent to which treatments that increase acceptance result in positive outcomes in persons with chronic pain secondary to neurological disorders.
PMCID: PMC3670089  PMID: 23437995
chronic pain acceptance; multiple sclerosis; muscular dystrophy; post-polio syndrome; spinal cord injury
Rehabilitation psychology  2013;58(1):10.1037/a0031726.
Stroke is a leading cause of long-term disability in the United States. Family caregivers are susceptible to negative outcomes as a result of their caregiving role. A stress process model was utilized to identify characteristics of stroke caregivers who are at risk for poor physical and mental health-related quality of life (QOL).
Research Method
Individuals who experienced an incident stroke event within the previous year were identified from a larger epidemiologic study of stroke incidence. These stroke survivors were enrolled in the Caring for Adults Recovering from the Effects of Stroke (CARES) study along with their primary family caregivers (N=146 dyads). Caregivers completed a baseline telephone interview that assessed physical and mental health-related QOL, problems their family members were experiencing, appraisals of those problems, and caregiver resources.
Objective stressors, appraisals, and caregiver resources were related to caregiver physical and mental health-related QOL, p’s <.05. Objective stressors were found to have a stronger association with caregiver mental health than physical health. Hierarchical regression models showed the relative importance of each category of predictors. In the final models, older age and receiving more support were associated with worse physical health-related QOL while African American race and fewer stroke survivor problems were associated with better mental health.
The correlates of health-related QOL identified in this national sample of caregivers can help identify stroke caregivers who are at-risk for poor adjustment to the caregiving role and aid in identifying areas that can potentially be intervened upon for these caregivers.
PMCID: PMC3851300  PMID: 23437997
stroke caregiving; health disparities; health-related quality of life; stress process; social support
14.  Helping People with HIV/AIDS Return to Work: A Randomized Clinical Trial 
Rehabilitation psychology  2012;57(4):10.1037/a0030207.
New treatments introduced in the mid 1990s led many people with HIV/AIDS who previously had been disabled by their disease to contemplate workforce reentry; many remain unemployed, and little is known concerning interventions that might help them return to work. We report the results of a randomized clinical trial (RCT) of an intervention designed to help people with HIV/AIDS reenter the workforce.
We tested a mixed (group – individual) modality intervention that incorporated elements of Motivational Interviewing (Miller & Rollnick, 2002), skills building from Dialectical Behavior Therapy (Linehan, 1993), and job-related skills (Price & Vinokur, 1995). A total of 174 individuals participated in either the intervention or in standard of care and were followed for 24 months.
Compared to individuals referred for standard of care, participants in the intervention engaged in more workforce-reentry activities over time and, once employed, were more likely to remain employed. Dose-response analyses revealed that among intervention participants, participants who attended more than one individual session engaged in more workforce-reentry activities than did individual who attended one or fewer individual sessions, whereas frequency of group session participation did not effect a difference between participants who attended more than six group sessions and participants who attended six or fewer group sessions.
Theoretically-based workforce-reentry assistance programs can assist disabled people with HIV/AIDS in their return-to-work efforts.
PMCID: PMC3839569  PMID: 23148715
Human Immunodeficiency Virus; Habilitation; Controlled Clinical Trials; Randomized
15.  Mothers Report More Child-Rearing Disagreements Following Early Brain Injury Than Do Fathers 
Rehabilitation psychology  2011;56(4):374-382.
To investigate differences between mother’s and father’s perceptions of marital relationship quality, child rearing disagreements, and family functioning over the initial 18 months following traumatic brain injury (TBI) in early childhood relative to an orthopedic-injury comparison group.
Participants included 147 parent-dyads of children with TBI (n = 53) and orthopedic injuries (OI; n = 94) who were between the ages of 3 and 7 years at injury. Family functioning, marital quality, and child-rearing disagreements were assessed shortly after injury and at 6, 12, and 18-month follow-ups, with ratings at the initial assessment completed to reflect preinjury functioning. Mixed model analyses were used to examine mother and father’s reports of family functioning, marital quality, and child-rearing disagreements over time as a function of injury severity and parent gender.
We found a significant Group x Gender interaction for ratings of love and parenting disagreements. As hypothesized, mothers of children with severe TBI rated the relationship as significantly less loving than did their partners, and mothers of children with both moderate and severe TBI endorsed more parenting disagreements than did their partners. However, fathers reported higher levels of family dysfunction than their partners, regardless of injury type or severity.
Implications for treatment based on differences in mothers’ and fathers’ perceptions of family and marital functioning, and future directions for research, are discussed.
PMCID: PMC3755597  PMID: 22121941
brain injury; family functioning; marital relationship; parental perceptions
16.  Age at Injury and Long-Term Behavior Problems After Traumatic Brain Injury in Young Children 
Rehabilitation psychology  2012;57(3):256-265.
This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI).
A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems.
At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury.
Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age.
PMCID: PMC3750969  PMID: 22946613
traumatic brain injury; long-term behavior problems; young children
17.  Parenting Style Is Related to Executive Dysfunction After Brain Injury in Children 
Rehabilitation psychology  2011;56(4):351-358.
The goal of this study was to examine how parenting style (authoritarian, authoritative, permissive) and family functioning are related to behavioral aspects of executive function following traumatic brain injury (TBI) in young children.
Participants included 75 children with TBI and 97 children with orthopedic injuries (OI), ages 3–7 years at injury. Pre-injury parenting behavior and family functioning were assessed shortly after injury, and postinjury executive functions were assessed using the Behavior Rating Inventory of Executive Functioning (BRIEF; Gioia & Isquith, 2004) at 6, 12, and 18 months postinjury. Mixed model analyses, using pre-injury executive functioning (assessed by the BRIEF at baseline) as a covariate, examined the relationship of parenting style and family characteristics to executive functioning in children with moderate and severe TBI compared to OI.
Among children with moderate TBI, higher levels of authoritarian parenting were associated with greater executive difficulties at 12 and 18 months following injury. Permissive and authoritative parenting styles were not significantly associated with postinjury executive skills. Finally, fewer family resources predicted more executive deficits across all of the groups, regardless of injury type.
These findings provide additional evidence regarding the role of the social and familial environment in emerging behavior problems following childhood TBI.
PMCID: PMC3739476  PMID: 21928918
traumatic; parenting; permissive; authoritarian; preschool
18.  [No title available] 
PMCID: PMC3645911  PMID: 21574730
19.  The Pediatric Motor Activity Log-Revised: Assessing Real-world Arm Use in Children with Cerebral Palsy 
Rehabilitation Psychology  2012;57(2):149-158.
Widely accepted models of disability suggest that actual use of an impaired upper-extremity in everyday life frequently deviates from its motor capacity, as measured by laboratory tests. Yet, direct measures of real-world use of an impaired upper-extremity are rare in pediatric neurorehabilitation. This paper examines how well the Pediatric Motor Activity Log-Revised (PMAL-R) measures this parameter, when the PMAL-R is administered as a structured interview as originally designed.
Parents of sixty children between 2–8 years with upper-extremity hemiparesis due to cerebral palsy (CP) completed the PMAL-R twice. Additionally, the children were videotaped during play structured to elicit spontaneous arm use. More-affected arm use was scored by masked raters; it was thought to reflect everyday activity since no cues were given about which arm to employ. Testing sessions were separated by 3 weeks, during which 29 children received upper-extremity rehabilitation and 31 did not.
The PMAL-R had high internal consistency (Cronbach's α = .93) and test-retest reliability (r = .89). Convergent validity was supported by a strong correlation between changes in PMAL-R scores and more-affected arm use during play, r(53) = .5, p < .001.
The PMAL-R interview is a reliable and valid measure of upper-extremity pediatric neurorehabilitation outcome.
PMCID: PMC3375622  PMID: 22686553
arm; function; daily living activity; hemiparesis; cerebral palsy
20.  Comparison of the psychometric properties of two fatigue scales in multiple sclerosis 
Rehabilitation psychology  2012;57(2):159-166.
To compare psychometric functioning of the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS) in a community sample of persons with multiple sclerosis (MS).
Research Method
A self-report survey including the FSS, MFIS, demographic and other health measures was completed by 1271 individuals with MS. Analyses evaluated the reliability and validity of the scales, assessed their dimensional structures, and estimated levels of floor and ceiling effects. Item response theory (IRT) was used to evaluate the precision of the MFIS and FSS at different levels of fatigue.
Participants had a mean score on the FSS of 5.1 and of 44.2 on the MFIS. Cronbach’s alpha values for FSS and MFIS were all 0.93 or greater. Known-groups and discriminant validity of MFIS and FSS scores were supported by the analyses. The MFIS had low floor and ceiling effects, while the FSS had low floor and moderate ceiling effects. Unidimensionality was supported for both scales. IRT analyses indicate the FSS is less precise in measuring both low and high levels of fatigue compared to the MFIS.
Researchers and clinicians interested in measuring physical aspects of fatigue in samples whose fatigue ranges from mild to moderate can choose either instrument. For those interested in measuring both physical and cognitive aspects of fatigue, and whose sample is expected to have higher levels of fatigue, the MFIS is a better choice even though it is longer. IRT analyses suggest both scales could be shortened without a significant loss of precision.
PMCID: PMC3422656  PMID: 22686554
Fatigue Severity Scale; Modified Fatigue Impact Scale; multiple sclerosis; psychometrics; Item Response Theory
21.  Reducing Depression in Stroke Survivors and their Informal Caregivers: A Randomized Clinical Trial of a Web-Based Intervention 
Rehabilitation psychology  2012;57(3):196-206.
To develop and test the efficacy of a web-based intervention for alleviating depression in male stroke survivors (SSs) and their spousal caregivers (CGs) that blends both peer and professional support.
Design and Methods
The research consisted of an intervention protocol evaluated by a focus group of rehabilitation professionals, a “think aloud” session conducted with female stroke CGs, and a usability test of the intervention’s online features with 7 female stroke CGs. Efficacy of the final protocol was tested in a two-group randomized clinical trial with a sample of 32 CG-SS dyads. The CGs in the intervention condition received an online group intervention. Intervention components were based on the Stress Process Model. Those CGs in a control condition received minimal support with individualized access to relevant online information. Measures of depression, as well as the secondary outcomes of mastery, self-esteem, and social support, were obtained from SSs and CGs at pretest, post-test, and one-month later.
At posttest and one month later, CGs in the intervention condition reported significantly lower depression than CGs in the control condition with baseline depression controlled. There was no significant effect on depression among SSs. Although no significant treatment effects for either SSs or CGs were found on the secondary outcomes, post-treatment changes on some constructs were significantly correlated with change in depression.
CGs benefit from web-based programs that help them better understand both their emotional needs and those of the SS.
PMCID: PMC3434961  PMID: 22946607
22.  The Effect of Homework Compliance on Treatment Outcomes for Participants with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome 
Rehabilitation psychology  2011;56(3):212-218.
This study examined the relationship between level of treatment engagement through completion of homework and treatment outcomes within non-pharmacological interventions for participants with ME/CFS.
A sample of 82 participants with ME/CFS was randomly assigned to one of four non-pharmacological interventions. Each intervention involved 13 sessions over the course of six months. Change scores were computed for self-report measures taken at baseline and 12-month follow-up. Homework compliance was calculated as the percentage of completed assignments across the total number of sessions and grouped into three categories: minimum (0–25%), moderate (25.1–75%), or maximum (75.1–100%).
Findings revealed that after controlling for treatment condition, those who completed a maximum amount of homework had greater improvement on a number of self-report outcome measures involving role, social and mental health functioning. There were no differential improvements in physical and fatigue functioning based on level of homework compliance.
Findings from this study suggest homework compliance can have a positive influence on some aspects of physical, social, and mental health functioning in participants with ME/CFS. It should be emphasized that these interventions do not cure this illness. The lack of significant changes in physical functioning and fatigue levels suggests a need for more multidisciplinary treatment approaches that can elicit improvement in these areas.
PMCID: PMC3166212  PMID: 21767035
Myalgic Encephalomyelitis; chronic fatigue syndrome; Non-pharmacological; Homework; Outcomes
23.  Does Problem-Solving Training for Family Caregivers Benefit Their Care Recipients With Severe Disabilities? A Latent Growth Model of the Project CLUES Randomized Clinical Trial 
Rehabilitation Psychology  2012;57(2):98-112.
To examine whether an individualized problem-solving intervention provided to family caregivers of persons with severe disabilities provides benefits to both caregivers and their care recipients.
Family caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year.
Family caregivers (129 women, 18 men) and their care recipients (81 women, 66 men) consented to participate.
Main Outcome Measures
Caregivers completed the Social Problem-Solving Inventory–Revised, the Center for Epidemiological Studies-Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in 3 additional assessments throughout the year. Care recipient depression was assessed with a short form of the Hamilton Depression Scale.
Latent growth modeling was used to analyze data from the dyads. Caregivers who received PST reported a significant decrease in depression over time, and they also displayed gains in constructive problem-solving abilities and decreases in dysfunctional problem-solving abilities. Care recipients displayed significant decreases in depression over time, and these decreases were significantly associated with decreases in caregiver depression in response to training.
PST significantly improved the problem-solving skills of community-residing caregivers and also lessened their depressive symptoms. Care recipients in the PST group also had reductions in depression over time, and it appears that decreases in caregiver depression may account for this effect.
PMCID: PMC3401541  PMID: 22686549
caregivers; brain injury; disability; randomized clinical trial; problem-solving
24.  Does Individualism Help Explain Differences in Employers' Stigmatizing Attitudes Toward Disability Across Chinese and American Cities? 
Rehabilitation Psychology  2010;55(4):351-359.
Stigmatizing attitudes toward people with disabilities can jeopardize such individuals' well-being and recovery through denial of employment and community isolation. By shaping social norms that define group membership, the construct of individualism may partially explain differences in stigmatizing attitudes across cultures. Further, widespread globalization has brought intensely individualistic social practices to certain segments of non-Western cultures. This paper examines whether the construct of individualism can help to explain cross-cultural differences in stigmatizing attitudes observed between American and Chinese employers.
Employers (N = 879) from Beijing, Hong Kong, and Chicago provided information on their attitudes toward hiring people with disabilities, and Path Analyses were conducted to examine potential mediating relationships.
Path analyses indicated that vertical individualism, along with perceived responsibility for acquiring a condition, partially mediated the relationship between culture and employers' negative attitudes about job candidates with disabilities.
These results suggested that greater espousal of competitive and individualist values may drive stigmatizing attitudes across cultures.
PMCID: PMC3295591  PMID: 21171794
Individualism; China; Employers; Stigma
25.  Positive Affect and Pain Ratings in Persons with Stroke 
Rehabilitation psychology  2011;56(1):52-57.
To examine the association between positive affect at discharge from inpatient medical rehabilitation and pain ratings three months post-discharge in persons with stroke aged 50 or older.
A longitudinal study using information from the Stroke Recovery in Underserved Population (SRUP) data base. A 4-item positive affect scale and an 11-point visual analog pain scale were collected at discharge and at 3 months post-discharge.
The study included 917 adults aged 50 and older with first-time stroke admitted to one of eleven inpatient medical rehabilitation facilities across the United States.
The mean age of the sample was 71 years, 51.0% were women, and 51.6% were married. One third of the sample reported pain and the mean positive affect score was 9.2 (range 0–12). Cumulative logit models showed higher positive affect scores at discharge were significantly associated with lower pain ratings (OR: 0.87, 95% CI 0.81, 0.92) at 3 month follow-up after adjusting for discharge pain ratings, negative affect, and demographic and clinical characteristics.
High positive affect at discharge from inpatient medical rehabilitation was associated with lower pain ratings three months post discharge after controlling for pain and negative affect at discharge and clinical and demographic characteristics. The identification of links between positive affect and pain may contribute to a better understanding of functional recovery processes post stroke and the planning of therapeutic programs directed at the positive psychological strengths in elderly persons with stroke.
PMCID: PMC3063951  PMID: 21401286
Positive affect; pain; cerebrovascular accident; stroke

Results 1-25 (47)