Publications by authors named "Diane Dixon"

51 Publications

The Association Between Psychological Factors and Outcomes After Distal Radius Fracture.

J Hand Surg Am 2021 Jun 7. Epub 2021 Jun 7.

Department of Orthopaedics, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.

Purpose: The aim of this study was to identify psychological factors associated with pain intensity and disability following distal radius fracture.

Methods: We prospectively followed 216 adult patients with distal radius fracture for 9 months. Demographics, injury and treatment details, and psychological measures (Hospital Anxiety and Depression Score [HADS], Pain Catastrophizing Scale, Posttraumatic Stress Disorder Checklist-Civilian, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire Brief [IPQB], General Self-Efficacy Scale, and Recovery Locus of Control [RLOC]) were collected at enrollment. Multivariable linear regression was used to identify factors associated with Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Likert pain scores.

Results: Higher 10-week DASH scores were associated with increased age, the presence of a nerve pathology, increased HADS Depression subscale scores, increased IPQB scores, and lower RLOC scores. Higher 9-month DASH scores were associated with increased age, increased deprivation scores, increased numbers of medical comorbidities, a greater degree of radial shortening, increased HADS Depression subscale scores, and lower RLOC scores. A higher 10-week pain score was associated with increased deprivation and IPQB scores. A higher pain score at 9 months was associated with an increased number of medical comorbidities.

Conclusions: Psychosocial factors measured early after fracture are associated with pain and disability up to 9 months after distal radius fracture. Illness perception is a potentially modifiable psychological construct not previously studied in hand conditions. It may provide a suitable target for psychological interventions that could enhance recovery.

Type Of Study/level Of Evidence: Prognostic II.
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http://dx.doi.org/10.1016/j.jhsa.2021.04.012DOI Listing
June 2021

The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A qualitative systematic review and thematic synthesis.

Breast 2021 May 17;58:147-159. Epub 2021 May 17.

University of Strathclyde, UK. Electronic address:

Background: Hormone Therapy (HT) reduces the risk of breast cancer recurrence and mortality in women with breast cancer. Despite these clinical benefits, rates of HT non-adherence and non-persistence are high. Research suggests this may be due to the impact of HT side effects. However, little research has explored the individual contribution of side effects to non-adherence and non-persistence behaviours, thereby hindering the implementation of targeted intervention strategies. Our aim is to review the published literature on breast cancer survivors' lived experiences of HT side effects and explore how these may be related to non-adherence and non-persistence behaviour.

Methods: Electronic searches were conducted from inception to May 2020, utilising Cochrane CENTRAL, Medline, Embase, Web of Science and PsycINFO databases. Searches included a combination of terms related to breast cancer, adherence, hormone therapy and side effects.

Results: Sixteen eligible papers were identified, and study quality was high. Data were thematically synthesised into four analytical themes, which encompassed 13 descriptive sub-themes: 'Daily impact of side-effects', 'Role of Health Care Professionals', 'Managing HT side-effects', and 'Weighing up the pros and cons'.

Conclusions: HT side effects significantly impact breast cancer survivor's quality of life. A lack of support from healthcare providers leads to self-management strategies, which negatively affects adherence and persistence behaviour.
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http://dx.doi.org/10.1016/j.breast.2021.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165559PMC
May 2021

Using behavioural theory to understand adherence to behaviours that reduce transmission of COVID-19; evidence from the CHARIS representative national study.

Br J Health Psychol 2021 May 17. Epub 2021 May 17.

Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, UK.

Objectives: To examine the ability of four models of behaviour, namely, Protection Motivation Theory (PMT), the Common Sense Self-Regulation Model (CS-SRM), and Social Cognitive Theory and the Reasoned Action Approach (SCT and RAA) to understand adherence to transmission-reducing behaviours (TRBs) advised by national governments for suppression of SARS-CoV2.

Design: A series of six cross-sectional telephone surveys of a random representative sample of adults living in Scotland.

Methods: Self-reported adherence to three TRBs (physical distancing, wearing a face covering and handwashing), PMT, CS-SRM, and SCT/RAA constructs, and sociodemographic variables were measured each week for 6 weeks (n = ~500 p/w; third June-15th July) via a 15 min telephone survey.

Results: Adherence was high ('Always' or 'Most times') throughout for physical distancing and handwashing, and, when mandated, for wearing a face covering. Older people were more adherent to all TRBs. Constructs from all three models predicted all three TRBs. Intention and self-efficacy (SCT/RAA) were the only beliefs to predict to all three TRBs each week and for all groups equally; intention was the strongest predictor. The predictive utility of PMT and CS-SRM varied by TRB and by group. Of note was the observation that several illness beliefs were associated with adherence only for those who believed they had not had COVID-19.

Conclusions: The CHARIS project has identified beliefs about specific behaviours, the illness and the risks associated with lower adherence rates that might be addressed in national interventions. It confirms previous findings that some groups show lower levels of adherence and might be specially targeted.
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http://dx.doi.org/10.1111/bjhp.12533DOI Listing
May 2021

Are Rurality, Area Deprivation, Access to Outside Space, and Green Space Associated with Mental Health during the COVID-19 Pandemic? A Cross Sectional Study (CHARIS-E).

Int J Environ Res Public Health 2021 04 7;18(8). Epub 2021 Apr 7.

Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen 999020, UK.

The study investigated if rurality, area deprivation, access to outside space (Study 1), and frequency of visiting and duration in green space (Study 2) are associated with mental health during the COVID-19 pandemic and examined if individual demographics (age, gender, COVID-19 shielding status) and illness beliefs have a direct association with mental health during the COVID-19 pandemic. A serial, weekly, nationally representative, cross-sectional, observational study of randomly selected adults was conducted in Scotland during June and July 2020. If available, validated instruments were used to measure psychological distress, individual demographics, illness beliefs, and the following characteristics: Rurality, area deprivation, access to residential outside space, frequency of visiting, and duration in green space. Simple linear regressions followed by examination of moderation effect were conducted. There were 2969 participants in Study 1, of which 1765 (59.6%) were female, 349 (11.9%) were in the shielding category, and the median age was 54 years. There were 502 participants in Study 2, of which 295 (58.60%) were female, 58 (11.6%) were in shielding category, and the median age was 53 years. Direct effects showed that psychological distress was worse if participants reported the following: Urban, in a deprived area, no access to or sharing residential outside space, fewer visits to green space (environment), younger, female, in the shielding category (demographics), worse illness (COVID-19) representations, and greater threat perception (illness beliefs). Moderation analyses showed that environmental factors amplified the direct effects of the individual factors on psychological distress. This study offers pointers for public health and for environmental planning, design, and management, including housing design and public open space provision and regulation.
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http://dx.doi.org/10.3390/ijerph18083869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067699PMC
April 2021

Sociodemographic and Psychological Risk Factors for Anxiety and Depression: Findings from the Covid-19 Health and Adherence Research in Scotland on Mental Health (CHARIS-MH) Cross-sectional Survey.

Int J Behav Med 2021 Mar 3. Epub 2021 Mar 3.

Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, Scotland.

Background: Investigations about mental health report prevalence rates with fewer studies investigating psychological and social factors influencing mental health during the Covid-19 pandemic.

Study Aims: (1) identify sociodemographic groups of the adult population at risk of anxiety and depression and (2) determine if the following social and psychological risk factors for poor mental health moderated these direct sociodemographic effects: loneliness, social support, threat perception, illness representations.

Methods: Cross-sectional nationally representative telephone survey in Scotland in June 2020. If available, validated instruments were used, for example, Patient Health Questionnaire (PHQ-4) to measure anxiety and depression. Simple linear regressions followed by examination of moderation effect.

Results: A total of 1006 participants; median age 53 years, 61.4% female, from all levels of area deprivation (i.e., 3.8% in the most deprived decile and 15.6% in the most affluent decile). Analyses show associations of anxiety and depression with sociodemographic (age, gender, deprivation), social (social support, loneliness) and psychological factors (perceived threat and illness representations). Mental health was poorer in younger adults, women and people living in the most deprived areas. Age effects were exacerbated by loneliness and illness representations, gender effects by loneliness and illness representations and deprivation effects by loneliness, social support, illness representations and perceived threat. In each case, the moderating variables amplified the detrimental effects of the sociodemographic factors.

Conclusions: These findings confirm the results of pre-Covid-19 pandemic studies about associations between sociodemographics and mental health. Loneliness, lack of social support and thoughts about Covid-19 exacerbated these effects and offer pointers for pre-emptive action.
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http://dx.doi.org/10.1007/s12529-021-09967-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929550PMC
March 2021

Protocol of the COVID-19 Health and Adherence Research in Scotland (CHARIS) study: understanding changes in adherence to transmission-reducing behaviours, mental and general health, in repeated cross-sectional representative survey of the Scottish population.

BMJ Open 2021 02 18;11(2):e044135. Epub 2021 Feb 18.

Institute of Applied Health Sciences, Health Psychology, University of Aberdeen, Aberdeen, UK.

Introduction: COVID-19 has unprecedented consequences on population health, with governments worldwide issuing stringent public health directives. In the absence of a vaccine, a key way to control the pandemic is through behavioural change: people adhering to transmission-reducing behaviours (TRBs), such as physical distancing, hand washing and wearing face covering. Non-adherence may be explained by theories of how people think about the illness (the common-sense model of self-regulation) and/or how they think about the TRBs (social cognition theory and protection motivation theory). In addition, outbreaks of infectious diseases and the measures employed to curb them are likely to have detrimental effects on people's mental and general health. Therefore, in representative repeated surveys, we will apply behavioural theories to model adherence to TRBs and the effects on mental and general health in the Scottish population from June to November 2020, following the initial outbreak of COVID-19.

Methods And Analysis: Repeated 20 min structured telephone surveys will be conducted with nationally representative random samples of 500 adults in Scotland. The first 6 weeks the survey will be conducted weekly, thereafter fortnightly, for a total of 14 waves (total n=7000). Ipsos MORI will recruit participants through random digit dialling. The core survey will measure the primary outcomes of adherence to TRBs, mental and general health, and explanatory variables from the theories. Further questions will be added, enabling more detailed measurement of constructs in the core survey, additional themes and questions that align with the evolving pandemic.

Ethics And Dissemination: Ethical approval for this study was granted by the Life Sciences and Medicine College Ethics Review Board (CERB) at the University of Aberdeen (CERB/2020/5/1942). Results will be made available to policy makers, funders, interested lay people and other researchers through weekly reports and three bimonthly bulletins placed on the CHARIS website and advertised through social media.
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http://dx.doi.org/10.1136/bmjopen-2020-044135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896376PMC
February 2021

Characterization of Preoperative, Postsurgical, Acute and Chronic Pain in High Risk Breast Cancer Patients.

J Clin Med 2020 11 26;9(12). Epub 2020 Nov 26.

Department of Gynecology, Breast Clinic, King Albert II Institute, Cliniques universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium.

Background: Pain after breast cancer surgery remains largely unexplained and inconsistently quantified. This study aims to describe the perioperative pain patterns in patients with breast cancer, up to two years after surgery.

Methods: This is a pre-planned sub-study of the Ketorolac in Breast Cancer (KBC) trial. The KBC trial was a multicentre, prospective, double-blind, placebo-controlled, randomised trial of a single dose of 30 mg of ketorolac just before breast cancer surgery, aiming to test its effect on recurrences. This sub-study focuses only on pain outcomes. From 2013 to 2015, 203 patients were randomised to ketorolac ( = 96) or placebo ( = 107). Structured questionnaires were delivered by telephone after one and two years, exploring the presence, location, permanence, and frequency of pain. Patients' perceptions of pain were captured by an open-ended question, the responses to which were coded and classified using hierarchical clustering.

Results: There was no difference in pain between the ketorolac and the placebo group. The reported incidence of permanent pain was 67% and 45% at one and two years, respectively. The largest category was musculoskeletal pain. Permanent pain was mainly described in patients with musculoskeletal pain. The description of pain changed in most patients during the second postoperative year, i.e., moved from one category to another (no pain, permanent, or non-permanent pain, but also, the localisation). This phenomenon includes patients without pain at one year.

Conclusions: Pain is a complex phenomenon, but also a fragile and unstable endpoint. Pain after breast cancer surgery does not necessarily mean breast pain but also musculoskeletal and other pains. The permanence of pain and the pain phenotype can change over time.
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http://dx.doi.org/10.3390/jcm9123831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759784PMC
November 2020

Self-Regulatory Processes, Motivation to Conserve Resources and Activity Levels in People With Chronic Pain: A Series of Digital N-of-1 Observational Studies.

Front Psychol 2020 4;11:516485. Epub 2020 Sep 4.

Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.

Objectives: Motivational and self-regulatory processes during goal pursuit may account for activity patterns in people with chronic pain. This article describes a series of N-of-1 observational studies designed to investigate the influence of goal-related factors on fluctuations in motivation to conserve resources and objectively measured activity levels.

Methods: Four participants with chronic pain who attended a formal pain management program (PMP; 41-59 years old; three female) were recruited and completed digital daily diaries for 11-12 weeks. The daily dairies, delivered via text message, measured self-regulatory fatigue, goal self-efficacy, goal striving, perceived demands, pain, and motivation to conserve resources. Continuously worn accelerometers measured physical activity and sedentary time. Analyses were conducted individually for each participant. The effects of self-regulatory fatigue, goal self-efficacy, goal striving, perceived demands, and pain on motivation to conserve resources, physical activity and sedentary time were assessed with dynamic regression modeling.

Results: Different patterns of associations between the predictors and outcomes were observed across participants. Most associations occurred concurrently (e.g., on the same day). Perceived demand was the only variable to predict motivation to conserve resources, physical activity, and sedentary time. Motivation to conserve resources and sedentary time were most frequently predicted by goal striving and perceived demand. Self-regulatory fatigue and pain intensity both predicted motivation to conserve resources in two participants and sedentary time in one participant. Motivation to conserve resources predicted sedentary time in two participants.

Conclusion: This study was the first to examine the impact of fluctuations in self-regulatory processes on motivation to conserve resources and objective activity levels within individuals with chronic pain. The results generally supported recent affective-motivational views of goal pursuit in chronic pain. This study demonstrated that N-of-1 observational studies can be conducted with patients during a PMP using digital technologies. The use of these approaches may facilitate the application of personalized medicine.
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http://dx.doi.org/10.3389/fpsyg.2020.516485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499816PMC
September 2020

MAP: A mnemonic for mapping BCTs to three routes to behaviour change.

Br J Health Psychol 2020 11 27;25(4):1086-1101. Epub 2020 Jul 27.

University of Aberdeen, UK.

Objective: Over 90 behaviour change techniques (BCTs) have been specified but there is limited guidance to assist non-specialist practitioners in the choice of which BCTs to select for use with clients. This paper describes the development of MAP, a theory-based mnemonic designed to aid practitioners in their use of BCTs. Each BCT is MAPed to one or more of three recognized routes to behaviour change, namely Motivation development, Action control, and Prompted or cued route.

Design: A cross-sectional online discriminant content validity (DCV) questionnaire.

Methods: Fourteen judges participated, decided whether each BCT affects behaviour via each of the three routes, and provided a confidence rating for each judgement. Wilcoxon one-sample tests classified each BCT to a route or combination of routes. Intraclass correlation coefficients (ICC) assessed agreement between judges.

Results: Fifty-eight BCTs were judged to affect behaviour via a single route; 28, 21, and nine BCTs were judged to act via the Motivation, Action, or Prompted routes, respectively. Judges did not agree on a route for 35 BCTs. Overall ICC (0.89) value was high and did not differ between routes.

Conclusions: There was good agreement on candidate BCTs for interventions designed to operate through Motivation, Action, or Prompted/Cued psychological processes. MAP is a mnemonic that can be used by non-specialist practitioners who implement behaviour change with their clients. MAP is not a replacement for sophisticated theory-based organization of BCTs required for theory testing. While providing practical guidance, further work is necessary to establish effectiveness of BCTs tailored to each route.
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http://dx.doi.org/10.1111/bjhp.12458DOI Listing
November 2020

What Competences Are Required to Deliver Person-Person Behaviour Change Interventions: Development of a Health Behaviour Change Competency Framework.

Int J Behav Med 2021 Jun;28(3):308-317

Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland.

Background: The competence of the person delivering person-to-person behaviour change interventions may influence the effectiveness of the intervention. However, we lack a framework for describing the range of competences involved. The objective of the current work was to develop a competency framework for health behaviour change interventions.

Method: A preliminary framework was developed by two judges rating the relevance of items in the competency framework for cognitive behaviour therapies; adding relevant items from reviews and other competency frameworks; and obtaining feedback from potential users on a draft framework. The Health Behaviour Change Competency Framework (HBCCF) was used to analyse the competency content of smoking cessation manuals.

Results: Judges identified 194 competency items as relevant, which were organised into two domains: foundation (12 competency topics comprising 56 competencies) and behaviour change (12 topics, 54 competencies); several of the 54 and 56 competencies were composed of sub-competencies (84 subcompetencies in total). Smoking cessation manuals included 14 competency topics from the foundation and behaviour change competency domains.

Conclusion: The HBCCF provides a structured method for assessing and reporting competency to deliver behaviour change interventions. It can be applied to assess a practitioner's competency and training needs and to identify the competencies needed for a particular intervention. To date, it has been used in self-assessments and in developing training programmes. We propose the HBCCF as a practical tool for researchers, employers, and those who design and provide training. We envisage the HBCFF maturing and adapting as evidence that identifies the essential elements required for the effective delivery of behaviour change interventions emerges.
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http://dx.doi.org/10.1007/s12529-020-09920-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121720PMC
June 2021

Content validity of measures of theoretical constructs in health psychology: Discriminant content validity is needed.

Br J Health Psychol 2019 09 7;24(3):477-484. Epub 2019 May 7.

Institute of Health Sciences, University of Aberdeen, UK.

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http://dx.doi.org/10.1111/bjhp.12373DOI Listing
September 2019

The Psychological Predictors of Acute and Chronic Pain in Women Following Breast Cancer Surgery: A Systematic Review.

Clin J Pain 2019 03;35(3):261-271

School Psychological Sciences and Health, University of Strathclyde.

Objectives: Numerous psychological factors have been found to be associated with acute and chronic pain following breast cancer surgery. However, individual studies tend to be limited to a small number of predictors and many fail to employ prospective designs. This study aimed to identify a broader range of psychological predictors of acute and chronic pain following breast cancer surgery through a systematic review of relevant prospective studies.

Methods: Web of Science, psychINFO, PubMed, and MEDLINE databases were searched to identify relevant prospective cohort studies. Studies were included if women were to undergo mastectomy or wide local excision, if psychological factors were assessed before surgery, and pain assessed after surgery.

Results: Twelve studies (representing 11 independent cohorts) met the inclusion criteria and described 10 psychological predictors. Anxiety and depression were the most frequently assessed psychological factors, and were measured in 9 of the 12 studies. Anxiety and psychological robustness emerged as significant predictors of acute pain. Distress was the strongest predictor of chronic pain. The relationship between depression and chronic postsurgical pain was, at best, mixed.

Discussion: This review has identified a range of psychological predictors of acute and chronic pain following breast cancer surgery; however, the evidence was conflicting and limited. Future studies should demonstrate adequate power and take account of known confounders.
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http://dx.doi.org/10.1097/AJP.0000000000000672DOI Listing
March 2019

Is Use of a Psychological Workbook Associated With Improved Disabilities of the Arm, Shoulder and Hand Scores in Patients With Distal Radius Fracture?

Clin Orthop Relat Res 2018 04;476(4):832-845

S. Goudie, M. McQueen, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK D. Dixon, G. McMillan, Department of Psychology, University of Strathclyde, Glasgow, UK D. Ring, Dell Medical School, University of Texas at Austin, Austin, TX, USA.

Background: Symptom intensity and magnitude of limitations correlate with stress, distress, and less effective coping strategies. It is unclear if interventions to target these factors can be used to improve outcomes after distal radius fracture in either the short- or longer term.

Questions/purposes: (1) Are there any factors (including the use of a workbook aimed at optimizing psychological response to injury, demographic, radiographic, medical, or psychosocial) associated with improved Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Rating Scale pain (NRS pain) scores at 6 weeks after management of distal radius fracture? (2) Are any of these factors associated with improved DASH and NRS pain scores at 6 months after management of distal radius fracture?

Methods: We conducted a double-blind randomized controlled trial comparing a workbook designed to optimize rehabilitation by improving psychological response to injury using recognized psychological techniques (the LEARN technique and goal setting) versus a workbook containing details of stretching exercises in the otherwise routine management of distal radius fracture. Patients older than 18 years of age with an isolated distal radius fracture were recruited within 3 weeks of injury from a single academic teaching hospital between March and August 2016. During recruitment, 191 patients who met the inclusion criteria were approached; 52 (27%) declined participation and 139 were enrolled. Eight patients (6%) were lost to followup by 6 weeks. The remaining cohort of 129 patients was included in the analysis. DASH scores and NRS pain scores were recorded at 6 weeks and 6 months after injury. Multivariable regression analysis was used to identify factors associated with outcome scores.

Results: At 6 weeks after distal radius fracture, when compared with an information-only workbook, use of a psychologic workbook was not associated with improved DASH (workbook DASH: 38 [range, 21-48]; control DASH: 35 [range, 21-53]; difference of medians: 3; p = 0.949) nor NRS pain scores (workbook NRS: 3 [range, 1-5]; control NRS: 2 [range, 1-4]; difference of medians: 1; p = 0.128). Improved DASH scores were associated with less radial shortening (β = 0.2, p = 0.009), less dorsal tilt (β = 0.2, p = 0.035), and nonoperative treatment (β = 0.2, p = 0.027). Improved NRS pain scores were associated with nonoperative treatment (β = 0.2, p = 0.021) and no posttraumatic stress disorder (PTSD) (β = 0.2, p = 0.046). At 6 months, use of a psychologic workbook was not associated with improved DASH (workbook DASH: 11 [range, 5-28]; control DASH: 11 [range, 3-20]; difference of medians: 0; p = 0.367) nor NRS pain scores (workbook NRS: 1 [range, 0-2]; control NRS: 1 [range, 0-2]; difference of medians: 0; p = 0.704). Improved DASH score at 6 months was associated with having fewer medical comorbidities (β = 0.3, p < 0.001) and lower enrollment PTSD (β = 0.3, p < 0.011). Lower NRS pain scores at 6 months were associated with having fewer medical comorbidities (β = 0.2, p = 0.045), lower enrollment PTSD (β = 0.3, p = 0.008), and lower enrollment Tampa Scale for Kinesiophobia (β = 0.2, p = 0.042).

Conclusions: Our study demonstrates that there is no benefit from the untargeted use of a psychological workbook based on the LEARN approach and goal-setting strategies in patients with distal radius fracture. Future research should investigate if there is a subgroup of patients with a negative psychological response to injury that benefits from psychological intervention and, if so, how best to identify these patients and intervene.

Level Of Evidence: Level II, therapeutic study.
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http://dx.doi.org/10.1007/s11999.0000000000000095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260104PMC
April 2018

Clinical Utility of Select Neuropsychological Assessment Battery Tests in Predicting Functional Abilities in Dementia.

Arch Clin Neuropsychol 2018 Aug;33(5):530-540

Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA.

Objective: Neuropsychological test performance can provide insight into functional abilities in patients with dementia, particularly in the absence of an informant. The relationship between neuropsychological measures and instrumental activities of daily living (IADLs) is unclear due to hetereogeneity in cognitive domains assessed and neuropsychological tests administered. Practical and ecologically valid performance-based measures of IADLs are also limited. The Neuropsychological Assessment Battery (NAB) is uniquely positioned to provide a dual-purpose assessment of cognitive and IADL function, as it includes Daily Living tests that simulate real-world functional tasks. We examined the utility of select NAB tests in predicting informant-reported IADLs in mild cognitive impairment and dementia.

Methods: The sample of 327 participants included 128 normal controls, 97 individuals with mild cognitive impairment, and 102 individuals with Alzheimer's disease dementia from the Boston University Alzheimer's Disease Center research registry. Informants completed the Lawton Brody Instrumental Activities of Daily Living Scale, and study participants were administered selected NAB tests that were complementary to the existing protocol.

Results: ROC curves showed strongest prediction of IADL (AUC > 0.90) for memory measures (List Learning delayed recall and Daily Living Memory delayed recall) and Daily Living Driving Scenes. At a predetermined level of specificity (95%), List Learning delayed recall (71%) and Daily Living Memory delayed recall (88%) were the most sensitive. The Daily Living Memory and Driving Scenes tests strongly predicted IADL status, and the other Daily Living tests contributed unique variance.

Conclusions: NAB memory measures and Daily Living Tests may have clinical utility in detecting informant-rated functional impairment in dementia.
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http://dx.doi.org/10.1093/arclin/acx100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116785PMC
August 2018

Using participatory methods to design an mHealth intervention for a low income country, a case study in Chikwawa, Malawi.

BMC Med Inform Decis Mak 2017 Jul 5;17(1):98. Epub 2017 Jul 5.

Mfera Health Centre, Chikwawa, Malawi.

Background: mHealth holds the potential to educate rural communities in developing countries such as Malawi, on issues which over-burdened and under staffed health centres do not have the facilities to address. Previous research provides support that mHealth could be used as a vehicle for health education campaigns at a community level; however the limited involvement of potential service users in the research process endangers both user engagement and intervention effectiveness.

Methods: This two stage qualitative study used participatory action research to inform the design and development of an mHealth education intervention. First, secondary analysis of 108 focus groups (representing men, women, leadership, elderly and male and female youth) identified four topics where there was a perceived health education need. Second, 10 subsequent focus groups explored details of this perceived need and the acceptability and feasibility of mHealth implementation in Chikwawa, Malawi.

Results: Stage 1 and Stage 2 informed the design of the intervention in terms of target population, intervention content, intervention delivery and the frequency and timing of the intervention. This has led to the design of an SMS intervention targeting adolescents with contraceptive education which they will receive three times per week at 4 pm and will be piloted in the next phase of this research.

Conclusion: This study has used participatory methods to identify a need for contraception education in adolescents and inform intervention design. The focus group discussions informed practical considerations for intervention delivery, which has been significantly influenced by the high proportion of users who share mobile devices and the intervention has been designed to allow for message sharing as much as possible.
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http://dx.doi.org/10.1186/s12911-017-0485-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498888PMC
July 2017

Screening Utility of the King-Devick Test in Mild Cognitive Impairment and Alzheimer Disease Dementia.

Alzheimer Dis Assoc Disord 2017 Apr-Jun;31(2):152-158

*Department of Neurology, Brigham and Women's Hospital †Department of Neurology, Massachusetts General Hospital, Harvard Medical School ‡Boston University Alzheimer's Disease and CTE Center Departments of ∥Neurology ¶Pathology and Laboratory Medicine ‡‡Neurosurgery and Anatomy & Neurobiology, Boston University School of Medicine §Data Coordinating Center **Department of Biostatistics, Boston University School of Public Health #VA Boston Healthcare System, Boston, MA ††Departments of Neurology, Population Health and Ophthalmology, New York University School of Medicine, New York, NY.

The King-Devick (K-D) test is a 1 to 2 minute, rapid number naming test, often used to assist with detection of concussion, but also has clinical utility in other neurological conditions (eg, Parkinson disease). The K-D involves saccadic eye and other eye movements, and abnormalities thereof may be an early indicator of Alzheimer disease (AD)-associated cognitive impairment. No study has tested the utility of the K-D in AD and we sought to do so. The sample included 206 [135 controls, 39 mild cognitive impairment (MCI), and 32 AD dementia] consecutive subjects from the Boston University Alzheimer's Disease Center registry undergoing their initial annual evaluation between March 2013 and July 2015. The K-D was administered during this period. Areas under the receiver operating characteristic curves generated from logistic regression models revealed the K-D test distinguished controls from subjects with cognitive impairment (MCI and AD dementia) [area under the curve (AUC)=0.72], MCI (AUC=0.71) and AD dementia (AUC=0.74). K-D time scores between 48 and 52 seconds were associated with high sensitivity (>90.0%) and negative predictive values (>85.0%) for each diagnostic group. The K-D correlated strongly with validated attention, processing speed, and visual scanning tests. The K-D test may be a rapid and simple effective screening tool to detect cognitive impairment associated with AD.
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http://dx.doi.org/10.1097/WAD.0000000000000157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154783PMC
December 2017

The Essential Mindset.

Authors:
Diane L Dixon

Trustee 2015 Nov-Dec;68(10):32-3, 1

Today's health care trustees and executives need a "transorganizational" mindset to understand connections among different organizations and stakeholders.
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March 2016

Assessing clinicopathological correlation in chronic traumatic encephalopathy: rationale and methods for the UNITE study.

Alzheimers Res Ther 2015 Oct 12;7(1):62. Epub 2015 Oct 12.

Alzheimer's Disease Center, Boston University School of Medicine, 72 East Concord Street, B-7800, Boston, MA, 02118, USA.

Introduction: Chronic traumatic encephalopathy (CTE) is a progressive neurodegeneration associated with repetitive head impacts. Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) is a U01 project recently funded by the National Institute of Neurological Disorders and Stroke and the National Institute of Biomedical Imaging and Bioengineering. The goal of the UNITE project is to examine the neuropathology and clinical presentation of brain donors designated as "at risk" for the development of CTE based on prior athletic or military exposure. Here, we present the rationale and methodology for UNITE.

Methods: Over the course of 4 years, we will analyze the brains and spinal cords of 300 deceased subjects who had a history of repetitive head impacts sustained during participation in contact sports at the professional or collegiate level or during military service. Clinical data are collected through medical record review and retrospective structured and unstructured family interviews conducted by a behavioral neurologist or neuropsychologist. Blinded to the clinical data, a neuropathologist conducts a comprehensive assessment for neurodegenerative disease, including CTE, using published criteria. At a clinicopathological conference, a panel of physicians and neuropsychologists, blinded to the neuropathological data, reaches a clinical consensus diagnosis using published criteria, including proposed clinical research criteria for CTE.

Results: We will investigate the validity of these clinical criteria and sources of error by using recently validated neuropathological criteria as a gold standard for CTE diagnosis. We also will use statistical modeling to identify diagnostic features that best predict CTE pathology.

Conclusions: The UNITE study is a novel and methodologically rigorous means of assessing clinicopathological correlation in CTE. Our findings will be critical for developing future iterations of CTE clinical diagnostic criteria.
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http://dx.doi.org/10.1186/s13195-015-0148-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601147PMC
October 2015

Using impairment and cognitions to predict walking in osteoarthritis: A series of n-of-1 studies with an individually tailored, data-driven intervention.

Br J Health Psychol 2016 Feb 31;21(1):52-70. Epub 2015 Jul 31.

School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.

Objectives: First, this study compares the ability of an integrated model of activity and activity limitations, the International Classification of Functioning, Disability and Health (ICF), and the Theory of Planned Behaviour (TPB) to predict walking within individuals with osteoarthritis. Second, the effectiveness of a walking intervention in these individuals is determined.

Design: A series of n-of-1 studies with an AB intervention design was used.

Methods: Diary methods were used to study four community-dwelling individuals with lower-limb osteoarthritis. Data on impairment symptoms (pain, pain on movement, and joint stiffness), cognitions (intention, self-efficacy, and perceived controllability), and walking (step count) were collected twice daily for 12 weeks. At 6 weeks, an individually tailored, data-driven walking intervention using action planning or a control cognition manipulation was delivered. Simulation modelling analysis examined cross-correlations and differences in baseline and intervention phase means. Post-hoc mediation analyses examined theoretical relationships and multiple regression analyses compared theoretical models.

Results: Cognitions, intention in particular, were better and more consistent within individual predictors of walking than impairment. The walking intervention did not increase walking in any of the three participants receiving it. The integrated model and the TPB, which recognize a predictive role for cognitions, were significant predictors of walking variance in all participants, whilst the biomedical ICF model was only predictive for one participant.

Conclusion: Despite the lack of evidence for an individually tailored walking intervention, predictive data suggest that interventions for people with osteoarthritis that address cognitions are likely to be more effective than those that address impairment only. Further within-individual investigation, including testing mediational relationships, is warranted.

Statement Of Contribution: What is already known on this subject? N-of-1 methods have been used to study within-individual predictors of walking in healthy and chronic pain populations An integrated biomedical and behavioural model of activity and activity limitations recognizes the roles of impairment and psychology (cognitions) Interventions modifying cognitions can increase physical activity in people with mobility limitations What does this study add? N-of-1 methods are suitable to study within-individual predictors of walking and interventions in osteoarthritis An integrated and a psychological model are better predictors of walking in osteoarthritis than a biomedical model There was no support for an individually tailored, data-driven walking intervention.
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http://dx.doi.org/10.1111/bjhp.12153DOI Listing
February 2016

Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities.

Disabil Rehabil 2016 18;38(6):605-12. Epub 2015 Jun 18.

b School of Psychological Sciences and Health, University of Strathclyde , Glasgow , UK.

Purpose: This study investigated differences in impairment, activity limitation, participation restrictions and psychological distress between participants using ankle-foot orthoses (AFOs) as recommended, participants who did not use AFOs as recommended and participants who did not know recommendations for use.

Method: Adults (n = 157) fitted with an AFO by an NHS Orthotic Service in Scotland completed a postal questionnaire that measured impairment, activity limitations participation restrictions and psychological distress using scales from the RAND 36-Item Health Survey 1.0 and the Hospital Anxiety and Depression Scale (HADS).

Results: 41% of participants used their AFOs as recommended, 32% did not use their AFOs as recommended and 27% did not know the recommendations for use. Participants using AFOs as recommended reported lower levels of impairment and activity limitations, indicated by higher energy levels (p = 0.005), higher physical functioning (p = 0.005), lower role-limitations due to emotional problems (p = 0.001) and lower levels of anxiety (p = 0.003) compared to people not using AFOs as recommended.

Conclusion: Health professionals need to ensure whether patients understand the recommendations for use of their AFO. Additionally, the results of the study support the value of evaluating patients' psychological well-being to gain a better understanding of AFO use.

Implications For Rehabilitation: Participants who reported using AFOs as recommended had significantly lower levels of impairment, activity limitations and anxiety compared to those who did not use their AFO as recommended. In this study, 27% of participants did not know recommendations for use of AFOs. Health professionals should give consideration as to how information, regarding wearing instructions and use of AFOs, is provided to people who are prescribed AFOs. Psychological outcomes in orthotics are rarely assessed. However, this study demonstrates there is a value in measuring psychological outcomes in orthotic management.
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http://dx.doi.org/10.3109/09638288.2015.1055374DOI Listing
October 2016

Beta-amyloid deposition in chronic traumatic encephalopathy.

Acta Neuropathol 2015 Jul 6;130(1):21-34. Epub 2015 May 6.

VA Boston Healthcare System, Boston, MA, 02130, USA,

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive mild traumatic brain injury. It is defined pathologically by the abnormal accumulation of tau in a unique pattern that is distinct from other tauopathies, including Alzheimer's disease (AD). Although trauma has been suggested to increase amyloid β peptide (Aβ) levels, the extent of Aβ deposition in CTE has not been thoroughly characterized. We studied a heterogeneous cohort of deceased athletes and military veterans with neuropathologically diagnosed CTE (n = 114, mean age at death = 60) to test the hypothesis that Aβ deposition is altered in CTE and associated with more severe pathology and worse clinical outcomes. We found that Aβ deposition, either as diffuse or neuritic plaques, was present in 52 % of CTE subjects. Moreover, Aβ deposition in CTE occurred at an accelerated rate and with altered dynamics in CTE compared to a normal aging population (OR = 3.8, p < 0.001). We also found a clear pathological and clinical dichotomy between those CTE cases with Aβ plaques and those without. Aβ deposition was significantly associated with the presence of the APOE ε4 allele (p = 0.035), older age at symptom onset (p < 0.001), and older age at death (p < 0.001). In addition, when controlling for age, neuritic plaques were significantly associated with increased CTE tauopathy stage (β = 2.43, p = 0.018), co-morbid Lewy body disease (OR = 5.01, p = 0.009), and dementia (OR = 4.45, p = 0.012). A subset of subjects met the diagnostic criteria for both CTE and AD, and in these subjects both Aβ plaques and total levels of Aβ1-40 were increased at the depths of the cortical sulcus compared to the gyral crests. Overall, these findings suggest that Aβ deposition is altered and accelerated in a cohort of CTE subjects compared to normal aging and that Aβ is associated with both pathological and clinical progression of CTE independent of age.
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http://dx.doi.org/10.1007/s00401-015-1435-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529056PMC
July 2015

Developing an integrated biomedical and behavioural theory of functioning and disability: adding models of behaviour to the ICF framework.

Health Psychol Rev 2014 28;8(4):381-403. Epub 2013 Nov 28.

a Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , UK.

The International Classification of Functioning Disability and Health (ICF) offers an agreed language on which a scientific model of functional outcomes can be built. The ICF defines functional outcomes as activity and activity limitations (AL) and defines both in behavioural terms. The ICF, therefore, appears to invite explanations of AL as behaviours. Studies of AL find that psychological variables, especially perceptions of control, add to biomedical variables in predicting AL. Therefore, two improved models are proposed, which integrate the ICF with two psychological theories, the theory of planned behaviour (TPB) and social cognitive theory (SCT). These models have a sound evidence base as good predictors of behaviour, include perceived control constructs and are compatible with existing evidence about AL. When directly tested in studies of community and clinic-based populations, both integrated models (ICF/TPB and ICF/SCT) outperform each of the three basic models (ICF, TPB and SCT). However, when predicting activity rather than AL, the biomedical model of the ICF does not improve prediction of activity by TPB and SCT on their own. It is concluded that these models offer a better explanation of functional outcomes than the ICF alone and could form the basis for the development of improved models.
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http://dx.doi.org/10.1080/17437199.2013.855592DOI Listing
September 2015

Core outcome measures for exercise studies in people with multiple sclerosis: recommendations from a multidisciplinary consensus meeting.

Mult Scler 2014 Oct 17;20(12):1641-50. Epub 2014 Mar 17.

Department of Kinesiology, University of Georgia, USA.

Evidence shows that exercise is beneficial for people with multiple sclerosis (MS); however, statistical pooling of data is difficult because of the diversity of outcome measures used. The objective of this review is to report the recommendations of an International Consensus Meeting for a core set of outcome measures for use in exercise studies in MS. From the 100 categories of the International Classification of Function Core Sets for MS, 57 categories were considered as likely/potentially likely to be affected by exercise and were clustered into seven core groups. Outcome measures to address each group were evaluated regarding, for example, psychometric properties. The following are recommended: Modified Fatigue Impact Scale (MFIS) or Fatigue Severity Scale (FSS) for energy and drive, 6-Minute Walk Test (6MWT) for exercise tolerance, Timed Up and Go (TUG) for muscle function and moving around, Multiple Sclerosis Impact Scale (MSIS-29) or Multiple Sclerosis Quality of Life-54 Instrument (MSQoL54) for quality of life and body mass index (BMI) or waist-hip ratio (WHR) for the health risks associated with excess body fat. A cost effectiveness analysis and qualitative evaluation should be included where possible. Using these core measures ensures that future meta-analyses of exercise studies in MS are more robust and thus more effectively inform practice.
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http://dx.doi.org/10.1177/1352458514526944DOI Listing
October 2014

Discriminant content validity: a quantitative methodology for assessing content of theory-based measures, with illustrative applications.

Br J Health Psychol 2014 May 15;19(2):240-57. Epub 2014 Mar 15.

Institute of Applied Health Sciences, University of Aberdeen, UK.

Objectives: In studies involving theoretical constructs, it is important that measures have good content validity and that there is not contamination of measures by content from other constructs. While reliability and construct validity are routinely reported, to date, there has not been a satisfactory, transparent, and systematic method of assessing and reporting content validity. In this paper, we describe a methodology of discriminant content validity (DCV) and illustrate its application in three studies.

Methods: Discriminant content validity involves six steps: construct definition, item selection, judge identification, judgement format, single-sample test of content validity, and assessment of discriminant items. In three studies, these steps were applied to a measure of illness perceptions (IPQ-R) and control cognitions.

Results: The IPQ-R performed well with most items being purely related to their target construct, although timeline and consequences had small problems. By contrast, the study of control cognitions identified problems in measuring constructs independently. In the final study, direct estimation response formats for theory of planned behaviour constructs were found to have as good DCV as Likert format.

Conclusions: The DCV method allowed quantitative assessment of each item and can therefore inform the content validity of the measures assessed. The methods can be applied to assess content validity before or after collecting data to select the appropriate items to measure theoretical constructs. Further, the data reported for each item in Appendix S1 can be used in item or measure selection. Statement of contribution What is already known on this subject? There are agreed methods of assessing and reporting construct validity of measures of theoretical constructs, but not their content validity. Content validity is rarely reported in a systematic and transparent manner. What does this study add? The paper proposes discriminant content validity (DCV), a systematic and transparent method of assessing and reporting whether items assess the intended theoretical construct and only that construct. In three studies, DCV was applied to measures of illness perceptions, control cognitions, and theory of planned behaviour response formats. Appendix S1 gives content validity indices for each item of each questionnaire investigated. Discriminant content validity is ideally applied while the measure is being developed, before using to measure the construct(s), but can also be applied after using a measure.
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http://dx.doi.org/10.1111/bjhp.12095DOI Listing
May 2014

Exploring differential item functioning in the SF-36 by demographic, clinical, psychological and social factors in an osteoarthritis population.

BMC Musculoskelet Disord 2013 Dec 11;14:346. Epub 2013 Dec 11.

Aberdeen Health Psychology Group, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.

Background: The SF-36 is a very commonly used generic measure of health outcome in osteoarthritis (OA). An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items work in the same way across subgroup of a population. That is, if respondents have the same 'true' level of outcome, does the item give the same score in different subgroups or is it biased towards one subgroup or another. Differential item functioning (DIF) can identify items that may be biased for one group or another and has been applied to measuring patient reported outcomes. Items may show DIF for different conditions and between cultures, however the SF-36 has not been specifically examined in an osteoarthritis population nor in a UK population. Hence, the aim of the study was to apply the DIF method to the SF-36 for a UK OA population.

Methods: The sample comprised a community sample of 763 people with OA who participated in the Somerset and Avon Survey of Health. The SF-36 was explored for DIF with respect to demographic, social, clinical and psychological factors. Well developed ordinal regression models were used to identify DIF items.

Results: DIF items were found by age (6 items), employment status (6 items), social class (2 items), mood (2 items), hip v knee (2 items), social deprivation (1 item) and body mass index (1 item). Although the impact of the DIF items rarely had a significant effect on the conclusions of group comparisons, in most cases there was a significant change in effect size.

Conclusions: Overall, the SF-36 performed well with only a small number of DIF items identified, a reassuring finding in view of the frequent use of the SF-36 in OA. Nevertheless, where DIF items were identified it would be advisable to analyse data taking account of DIF items, especially when age effects are the focus of interest.
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http://dx.doi.org/10.1186/1471-2474-14-346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029744PMC
December 2013

Does the impact of osteoarthritis vary by age, gender and social deprivation? A community study using the International Classification of Functioning, Disability and Health.

Disabil Rehabil 2014 29;36(17):1445-51. Epub 2013 Oct 29.

Aberdeen Health Psychology Group, University of Aberdeen , Aberdeen , UK and.

Unlabelled: Abstract Purpose: The aim of the study was to explore if the impact of osteoarthritis varies with respect to age, gender and social deprivation. Impact was defined as impairment, activity limitations and participation restriction (International Classification of Functioning, Disability and Health (ICF)). Investigating the functioning of the ICF model for subgroups is important both practically and theoretically.

Method: The sample comprised a community sample of 763 people diagnosed with osteoarthritis. Uncontaminated measures of the ICF constructs were developed using discriminant content validity from a pool of 134 items, including the WOMAC and SF-36. Multigroup Structural Equation Modelling was used to explore if the same pathways exist for subgroups of gender, age and social deprivation.

Results: Different significant paths were found for gender and social deprivation: impairment did not predict participation restriction for women and those most deprived, whereas these paths were significant for men and those less deprived. No difference in the paths was found for age.

Conclusions: The impact of osteoarthritis appears to vary with respect to gender and social deprivation but not age. This suggests both that osteoarthritis per se does not adequately explain the health outcomes observed and that different clinical approaches may be appropriate for people of different gender and levels of deprivation. Implications of Rehabilitation The ICF model appears to vary with respect to gender and social deprivation for people with osteoarthritis. The ICF model did not appear to vary with respect to age for people with osteoarthritis. Different treatments and interventions for osteoarthritis may need to be targeted for specific gender and social deprivation groups.
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http://dx.doi.org/10.3109/09638288.2013.847123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196505PMC
May 2015

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation.

BMC Health Serv Res 2013 May 24;13:190. Epub 2013 May 24.

Background: Goal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.

Methods: G-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.

Results: G-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient's well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.

Conclusions: G-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.
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http://dx.doi.org/10.1186/1472-6963-13-190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671148PMC
May 2013

Consultation and illness behaviour in response to symptoms: a comparison of models from different disciplinary frameworks and suggestions for future research directions.

Soc Sci Med 2013 Jun 19;86:79-87. Epub 2013 Mar 19.

Institute of Health and Wellbeing, University of Glasgow, 27 Bute Gardens, Glasgow G12 8RS, Scotland, United Kingdom.

We all get ill and social scientific interest in how we respond - the study of illness behaviour - continues unabated. Existing models are useful, but have been developed and applied within disciplinary silos, resulting in wasted intellectual and empirical effort and an absence of accumulation of knowledge across disciplines. We present a critical review and detailed comparison of three process models of response to symptoms: the Illness Action Model, the Common Sense Model of the Self-Regulation of Health and Illness and the Network Episode Model. We suggest an integrated framework in which symptoms, responses and actions are simultaneously interpreted and evaluated in the light of accumulated knowledge and through interactions. Evaluation may be subconscious and is influenced by the extent to which the symptoms impose themselves, expectations of outcomes, the resources available and understanding of symptoms' salience and possible outcomes. Actions taken are part of a process of problem solving through which both individuals and their immediate social network seek to (re)achieve 'normality'. Response is also influenced by social structure (directly and indirectly), cultural expectations of health, the meaning of symptoms, and access to and understandings of the legitimate use of services. Changes in knowledge, in embodied state and in emotions can all be directly influential at any point. We do not underestimate the difficulty of operationalising an integrated framework at different levels of analysis. Attempts to do so will require us to move easily between disciplinary understandings to conduct prospective, longitudinal, research that uses novel methodologies to investigate response to symptoms in the context of affective as well as cognitive responses and interactions within social networks. While challenging such an approach would facilitate accumulation of knowledge across disciplines and enable movement beyond description to change in individual and organisational responses.
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http://dx.doi.org/10.1016/j.socscimed.2013.03.007DOI Listing
June 2013

Content validity of the Dutch version of the Neck Bournemouth Questionnaire.

Man Ther 2013 Oct 19;18(5):386-9. Epub 2013 Feb 19.

SOMT, Institute for Master Education in Manual Therapy, Softwareweg 5, 3821 BN Amersfoort, The Netherlands.

Objective: Mechanical neck pain is a common human phenomenon. In most cases, no patho-anatomical lesion can be identified with the limitations of current radiological imaging. Therefore it is preferable to assess patients with neck pain with a focus on functioning and health, within a biopsychosocial model. The Neck Bournemouth Questionnaire aims to assess biopsychosocial aspects of neck pain. However, the content validity of the Neck Bournemouth Questionnaire Dutch language version (NBQ-NL) in relation to the International Classification of Functioning, Disability and Health (ICF) is unknown. The purpose of the study was to examine the content validity of the NBQ-NL in relation to the health components of the ICF.

Method: Content validity was assessed in relation to the ICF, by means of Discriminant Content Validity (DCV).

Results: The results indicate that the NBQ-NL measures four components of the five ICF (impairment, activity, participation and personal factors).

Conclusion: The NBQ is a multidimensional questionnaire, representing four of the five components of the ICF.
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http://dx.doi.org/10.1016/j.math.2013.01.004DOI Listing
October 2013

Exploring differential item functioning in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

BMC Musculoskelet Disord 2012 Dec 29;13:265. Epub 2012 Dec 29.

Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK.

Background: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a widely used patient reported outcome in osteoarthritis. An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items exhibit differential item functioning (DIF). That is, if respondents have the same underlying level of an attribute, does the item give the same score in different subgroups or is it biased towards one subgroup or another. The aim of the study was to explore DIF in the Likert format WOMAC for the first time in a UK osteoarthritis population with respect to demographic, social, clinical and psychological factors.

Methods: The sample comprised a community sample of 763 people with osteoarthritis who participated in the Somerset and Avon Survey of Health. The WOMAC was explored for DIF by gender, age, social deprivation, social class, employment status, distress, body mass index and clinical factors. Ordinal regression models were used to identify DIF items.

Results: After adjusting for age, two items were identified for the physical functioning subscale as having DIF with age identified as the DIF factor for 2 items, gender for 1 item and body mass index for 1 item. For the WOMAC pain subscale, for people with hip osteoarthritis one item was identified with age-related DIF. The impact of the DIF items rarely had a significant effect on the conclusions of group comparisons.

Conclusions: Overall, the WOMAC performed well with only a small number of DIF items identified. However, as DIF items were identified in for the WOMAC physical functioning subscale it would be advisable to analyse data taking into account the possible impact of the DIF items when weight, gender or especially age effects, are the focus of interest in UK-based osteoarthritis studies. Similarly for the WOMAC pain subscale in people with hip osteoarthritis it would be worthwhile to analyse data taking into account the possible impact of the DIF item when age comparisons are of primary interest.
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http://dx.doi.org/10.1186/1471-2474-13-265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582585PMC
December 2012