Measures of self-regulation used in adult rehabilitation populations: A systematic review and content screening

Efficient integration of personal factors into the international classification of functioning, disability, and health (ICF): the importance of emotional and motivational aspects in goal pursuit

The International Classification of Functioning, Disability, and Health (ICF) is a widely used framework in rehabilitation that provides standardized measures to describe health and health-related states of people. The strength of the ICF lies in its provision of a common language for describing rehabilitation progress. However, personal factors are not classified within the ICF due to their significant variability across cultures, which may render it not adequately capturing the subjective and social dimensions of disability. Our objective in this research was to propose theoretical frameworks that could help identify relevant personal factors for inclusion in the ICF. We discuss the Personality Systems Interaction (PSI) Theory to identify personal variability in goal pursuit, highlighting the importance of emotions like negative and positive affect in handling adverse situations and managing habitual behaviors. Additionally, the theory helps to determine personality factors relevant to patients, facilitating the resolution of potential issues that may emerge during the goal achievement process. We also emphasize the role of goal setting in rehabilitation and suggest the Goal-Oriented Action Linking (GOAL) model as a useful tool for understanding how motivational values change over time, distance, and progress. Following from this, we discuss the importance of self-efficacy and its relationship to effort and goal achievement, while noting potential issues in its assessment. Finally, we propose viable assessment methods for measuring the potential components to be incorporated as personal factors.

Development of the self-regulation assessment and content validation using cognitive interviews in a multicultural post-rehabilitation population

Aim

Self-regulation is one of the main goals of medical rehabilitation. Four themes of self-regulation were identified by former patients and rehabilitation physicians in a previous study. Based on these themes, a measure for self-regulation, the self-regulation assessment (SeRA), was developed. This study aimed to establish the content validity of the SeRA in a multicultural and multi-diagnostic post-rehabilitation population.

Methods

The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology was applied. First, cognitive interviews were held with eight former rehabilitation patients. Feedback was obtained on relevance, comprehensibility, and comprehensiveness of the items. Items with problems were revised. Then, a second series of cognitive interviews was held with 16 former rehabilitation patients with non-Western migration backgrounds. Again, feedback was obtained on relevance, comprehensibility, and comprehensiveness of the items.

Results

The first series of cognitive interviews revealed good comprehensiveness, and also comprehensibility or relevance problems with 12 of the 25 items. These items were revised or deleted. Two missing concepts were identified and these were added. There was no need to revise the items based on the results of the second series of cognitive interviews.

Conclusion

The final version of the SeRA demonstrated content validity for the studied population. The measure is ready for psychometric analyses in subsequent validation studies.

Using Self-Regulation Assessment to Explore Associations between Self-Regulation, Participation and Health-Related Quality of Life in a Rehabilitation Population

OBJECTIVE

Self-regulation, participation and health-related quality of life are important rehabilitation outcomes. The aim of this study was to explore associations between these outcomes in a multi-diagnostic and heterogenic group of former rehabilitation patients.

METHODS

This cross-sectional survey used the Self-Regulation Assessment (SeRA), Utrecht Scale for Evaluation of Rehabilitation-participation (USERParticipation) and the Patient-Reported-Outcome-Measurement-System (PROMIS) ability and PROMIS satisfaction with participation in social roles, and the EuroQol-5L-5D and PROMIS-10 Global Health. Regression analyses, controlling for demographic and condition-related factors, were performed.

RESULTS

Respondents (n = 563) had a mean age of 56.5 (standard deviation (SD) 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. In addition to demographic and condition-related factors, self-regulation subscales explained 0-15% of the variance in participation outcome scores, and 0-22% of the variance in HRQoL outcome scores. Self-regulation subscales explained up to 22% of the variance in satisfaction subscales of participation (USER-Participation and PROMIS) and the mental health subscale of the PROMIS-10. Self-regulation subscales explained up to 11% of the restriction and frequency subscales of participation (USER-Participation) and the physical health subscale of the PROMIS-10.

CONCLUSION

Self-regulation is more strongly associated with outcomes such as satisfaction with participation and mental health compared with outcomes such as restrictions in participation and physical health.