Efficacy beliefs in geriatric rehabilitation

Relationship between the social support and self-efficacy for function ability in patients undergoing primary hip replacement

Background

The World Health Organization (WHO) reported that nearly 25% of people will suffer from physical disability owing to the bone and joint problems until 2050. The condition of patients with this type of difficulty could be improved by increasing positive self-efficacy and instigating suitable medical treatment to implement self-efficacy for functional ability (SEFA) and physical functional ability self-care. In this study, we aim to evaluate the influence of social support on SEFA in patients after total hip arthroplasty.

Methods

This cross-sectional study used structural questionnaires, telephone appointments, and data collection to obtain patient characteristics, such as gender, age, educational level, and marital status. Questionnaires about social support and self-efficacy for functional ability (SEFA) were sent to 200 patients at 3 months following a primary total hip replacement from September 2011 to December 2014. Factor analysis was used to categorize the dimensions of social support; the t test, analysis of variance (ANOVA), and correlation analysis were applied to screen factors influencing SEFA. Multiple regression analysis was employed to ascertain the relationships between patient characteristics, social support, and SEFA.

Results

In total, 134 patients responded to the questionnaires. Lower SEFA scores were observed in patients of an older age, unmarried patients, and those with a low level of education. Correlation analysis showed that emotional information and appraisal support, instrumental support, and SEFA were positively correlated. Multiple regression analysis was applied to ascertain the relationships between patient characteristics, social support, and SEFA. We identified significant coefficient values of − 0.187 for age, 5.344 for emotional information and appraisal support, and 1.653 for instrumental support.

Conclusion

The results of this study demonstrated that in patients undergoing primary hip replacement, positive impacts on SEFA were observed in relation to emotional information, appraisal support and instrumental support. The results indicated that enhancing emotional information and appraisal support could improve a patient’s self-efficacy for functional ability.

A pilot exploration of the effect of designated Function Focused Care on mobility, functional dependence and falls frequency in Dutch nursing home residents

In recent years, there has been a gradual change in nursing home care from care providers doing as many things as possible for residents to a philosophy where patients are encouraged to become more involved in their care and activities of daily living. Function Focused Care (FFC) is a methodology to stimulate the involvement of residents on a daily basis that has shown to be safe and effective in improving ADL-functioning. We implemented FFC in four nursing homes with 53 residents. This first pilot project in Dutch nursing homes has replicated the finding that FFC inspires functional independence, but also revealed a reduction in the number of falls among fallers.

The Self-Efficacy for Functional Abilities Scale for older adults in long-term care: two-level exploratory and confirmatory factor analysis

BACKGROUND AND PURPOSE

This study examines the underlying factor structure of the Self-Efficacy for Functional Abilities (SEFA) scale among older adults in long-term care settings.

METHODS

A secondary analysis of SEFA data for 568 residents in 16 long-term care facilities was applied. The sample was randomly split into 2 subsamples. A 2-level exploratory and confirmatory factor analysis adjusting for clustering effect of facilities was used to identify and determine the factor structures respectively.

RESULTS

There were 1- and 2-factor models that were identified. Both models demonstrated acceptably mixed model fit. The 2-factor model had poor discriminant validity with high correlation between factors (r = .92, p < .001). The single-factor model was considered valid with moderate correlation with function (r = .301, p < .001).

CONCLUSIONS

The SEFA scale demonstrated a unidimensional construct among older adults in long-term care settings. Future testing is needed among other older adult populations.

A Meta-Synthesis of Health-Related Self-Efficacy Instrumentation: Problems and Suggestions

Background and Purpose: Self-efficacy, a central construct in health interventions, has been measured in various contexts. The absence of any published meta-review of self-efficacy instrumentation led to the current meta-synthesis that reports and evaluates the instrumentation processes. Methods: A systematic search resulted in 39 self-efficacy instrumentation studies, which were evaluated for the aspects of conceptual bases, health contexts, operational definition, instrumentation procedures, reliability and scale length, and item content. Results: Primarily based in Bandura’s social cognitive theory, these studies reported self-efficacy instrumentation for developing new scales and modifying/validating measures for illness management, healthy behavior adoption/maintenance, disease/risk prevention, and aging management. Trait-like, specific-domain, and situation approaches were used for generating item content. Problems in some studies include non-efficacy items, a lack of systematic instrumentation procedures, item content too general for specific-domain self-efficacy, and measurement inefficiency. Conclusions: The piecemeal fashion of self-efficacy instrumentation has resulted in incomparable self-efficacy measures of similar domains of health functioning. A trans-domain framework, thus, is warranted. Suggestions are provided for solving other problems in self-efficacy instrumentation.

Impact of nursing care services on self-efficacy perceptions and healthy lifestyle behaviors of nursing home residents

The purpose of this study was to evaluate the impact of tailored individualized nursing care services on the self-efficacy perceptions and healthy lifestyle behaviors of older adults living in a nursing home in Turkey. This outcomes evaluation research used a quasi-experimental study design in which outcomes evaluations were repeated within time intervals in a single group. The study sample included 30 older adults. Nursing diagnoses and interventions were identified using the Omaha System. The impact of implemented nursing care services was evaluated using the Self-Efficacy Scale and Healthy Life-Style Behaviours Scale II. A total of 3,024 nursing interventions were performed, and self-efficacy perceptions and healthy lifestyle behaviors of older nursing home residents were significantly increased in a positive manner (p < 0.05). The results suggest that nurses should assess self-efficacy perceptions and healthy lifestyle behaviors of older adults and that nursing care services directed at health promotion of older adults should be maintained.

Exploring expectations for upper-extremity motor treatment in people after stroke: a secondary analysis

OBJECTIVE

We explored expectations for outcomes during a research intervention for people with stroke.

METHOD

Twelve people with chronic stroke participated in this secondary analysis from a pilot trial of a high-repetition, task-specific, upper-extremity intervention. First, we examined relationships between individual expectancy and session-by-session achievement of high numbers of repetitions. Second, we examined the relationship between expectancy for the intervention as a whole and improvements in upper-extremity motor function. We used Spearman rank-order correlation coefficients to evaluate the relationships.

RESULTS

Correlations between individual expectancy and session-by-session achievement ranged from 0 to .84. Expectancy for improvement from the intervention was good (average = 7 of 10) but had a low correlation (.17) with actual improvement.

CONCLUSION

Individual expectancy ratings were inconsistently related to session-by-session achievement. Expectancy for the invention as a whole was not related to improvement in upper-extremity motor function.

The Chinese version of the Outcome Expectations for Exercise scale: validation study

BACKGROUND

Estimates of the reliability and validity of the English nine-item Outcome Expectations for Exercise (OEE) scale have been tested and found to be valid for use in various settings, particularly among older people, with good internal consistency and validity. Data on the use of the OEE scale among older Chinese people living in the community and how cultural differences might affect the administration of the OEE scale are limited.

AIM

To test the validity and reliability of the Chinese version of the Outcome Expectations for Exercise scale among older people.

METHODS

A cross-sectional validation study was designed to test the Chinese version of the OEE scale (OEE-C). Reliability was examined by testing both the internal consistency for the overall scale and the squared multiple correlation coefficient for the single item measure. The validity of the scale was tested on the basis of both a traditional psychometric test and a confirmatory factor analysis using structural equation modelling. The Mokken Scaling Procedure (MSP) was used to investigate if there were any hierarchical, cumulative sets of items in the measure.

RESULTS

The OEE-C scale was tested in a group of older people in Taiwan (n=108, mean age=77.1). There was acceptable internal consistency (alpha=.85) and model fit in the scale. Evidence of the validity of the measure was demonstrated by the tests for criterion-related validity and construct validity. There was a statistically significant correlation between exercise outcome expectations and exercise self-efficacy (r=.34, p<.01). An analysis of the Mokken Scaling Procedure found that nine items of the scale were all retained in the analysis and the resulting scale was reliable and statistically significant (p=.0008).

CONCLUSION

The results obtained in the present study provided acceptable levels of reliability and validity evidence for the Chinese Outcome Expectations for Exercise scale when used with older people in Taiwan. Future testing of the OEE-C scale needs to be carried out to see whether these results are generalisable to older Chinese people living in urban areas.

Perceptions and performance of function and physical activity in assisted living communities

OBJECTIVE

The purpose of this study was to describe residents' self-efficacy and outcome expectations with regard to function and physical activity (PA); to measure functional performance and time in PA; to evaluate the fit between the resident and the environment; and to evaluate knowledge, beliefs, and care behaviors of nursing assistants (NAs) in 4 different assisted living (AL) communities.

DESIGN

This was a descriptive study using baseline data from an ongoing intervention study, Testing the Impact of a Function Focused Care Intervention, Res-Care-AL.

SETTING

Four assisted living communities in Maryland.

PARTICIPANTS

A total of 171 residents and 96 NAs consented, passed eligibility, and were included in this study.

MEASUREMENTS

Descriptive data were obtained from NAs and residents. Resident data also included self-efficacy and outcome expectations associated with functional tasks and exercise, social support for exercise, and subjective and objective information about function and physical activity. NA data included self-efficacy and outcome expectations, knowledge, and performance of function-focused care.

RESULTS

Residents were mostly female, white, and widowed; needed some assistance with activities of daily living; and engaged in very little PA based on subjective and objective reports. NAs were mostly female and black, had more than a decade of nursing experience, strong confidence but limited knowledge of function-focused care, and performed this care in 76% of observed care interactions. There were no site-specific differences among NAs with regard to beliefs, knowledge, or performance of function-focused care. There were site-specific differences in residents with regard to self-efficacy for functional ability; functional performance; social supports for exercise from experts; and from family, person-environment fit, and PA based on subjective surveys. There were no differences noted based on actigraphy.

CONCLUSION

Residents in AL communities engage in very limited amounts of PA and staff in these sites could benefit from ongoing education about how to increase PA among residents and help them adhere to current guidelines for PA so as to optimize overall health status.

Effect of a motivational group intervention upon exercise self efficacy and outcome expectations for exercise in Schizophrenia Spectrum Disorders (SSDs)

BACKGROUND

Persons with SSDs contend with multiple barriers to exercise. Interventions are needed to enhance attitudes theoretically linked to exercise behavior.

OBJECTIVE

Examine effect of Walk, Address Sensations, Learn About Exercise, Cue Exercise for SSDs (WALC-S) intervention upon exercise self efficacy (SEE) and outcome expectations (OEES) in 97 outpatients with SSDs.

DESIGN

Experimental, pre test posttest. Randomization to experimental (WALC-S) or time-and-attention control (TAC) after baseline SEE and OEES measures. Measures repeated after WALC-S or TAC.

RESULTS

N = 97, 46% female, 43% African American, average age 46.9 years (SD = 2.0). Mean SEE scores were significantly higher in WALC-S participants after intervention (F ((1,95)) = 5.92, p = 0.0168), however, mean OEES scores were significantly higher in control participants after intervention (F ((1,95)) = 5.76, p = 0.0183.

CONCLUSION

This is the first study to examine SEE and OEES in SSDs. Interventions to enhance exercise attitudes are a critical first step toward the ultimate goal of increasing exercise participation.

Cognitive and affective predictors of rehabilitation participation after stroke

OBJECTIVE

To examine associations between cognitive and affective impairments and rehabilitation participation during stroke rehabilitation.

DESIGN

Secondary analyses of stroke patients who received acetylcholinesterase inhibitors during inpatient rehabilitation.

SETTING

University-affiliated inpatient rehabilitation facilities.

PARTICIPANTS

Patients (N=44) admitted to inpatient stroke rehabilitation with impairment in attention, memory, or executive functions.

INTERVENTIONS

Secondary analysis of patients receiving inpatient stroke rehabilitation care plus random assignment to one of two acetylcholinesterase inhibitors or no drug at rehabilitation admission.

MAIN OUTCOME MEASURES

Correlations between measures of cognitive (Digit Span, Hopkins Verbal Learning Test, Executive Interview) and affective impairments (Hamilton Rating Scale for Depression, Apathy Evaluation Scale) and participation (Pittsburgh Rehabilitation and Participation Scale) were examined. Significant correlates of participation were examined in a linear multiple regression model.

RESULTS

Executive functions and depressive symptoms were significant correlates of participation. After controlling for baseline disability, executive functions predicted participation, but depressive symptoms did not (F(4,32)=9.35; R(2)=.54, P<.001).

CONCLUSIONS

These findings are an important first step toward understanding potentially modifiable clinical factors that contribute to rehabilitation participation and overall functional status after rehabilitation. A better understanding of cognitive impairment and rehabilitation participation may be used to develop strategies for improving functional outcomes after stroke.

The Impact of Anemia on Nursing Home Residents

The purpose of this secondary data analysis was to describe the prevalence and treatment of anemia and test the impact of anemia on physical and psychosocial outcomes at baseline and following restorative care interventions. A total of 451 residents from 12 nursing homes participated in this study. The average age of the participants was 83.74 ( SD = 8.24), the majority were female (79%), White (66%), and unmarried (90%). A total of 245 (54%) residents were anemic, and 66% were treated with at least one medication. Physical performance was worse in those with anemia, and those with anemia associated with chronic kidney disease had lower self-efficacy and outcome expectations for functional activities than those without anemia. There was no time by treatment interaction between those with and without anemia. The findings provide some additional support for the prevalence of anemia and suggest that those with anemia associated with chronic kidney disease are less motivated to engage in functional activities.

Convergent validation of the Kohlman Evaluation of Living Skills as a screening tool of older adults' ability to live safely and independently in the community

OBJECTIVE

To evaluate the convergent validity of the Kohlman Evaluation of Living Skills (KELS) to screen older adults' ability to live safely and independently.

DESIGN

Cross-sectional study correlating KELS with components of a Comprehensive Geriatric Assessment.

SETTING

Participants' homes.

PARTICIPANTS

Community-dwelling older adults (N=200) 65 years and older including 100 persons referred by Adult Protective Services (APS) and 100 ambulatory patients matched on age, race, sex, and socioeconomic status.

INTERVENTIONS

In-home comprehensive assessment.

MAIN OUTCOME MEASURES

KELS, Geriatric Depression Scale (GDS), modified Physical Performance Test (mPPT), Mini-Mental State Examination (MMSE), Knee Extensor Break Test, Executive Cognitive Test (EXIT25), executive clock-drawing test (CLOX) 1 and 2, and an 8-foot walk test.

RESULTS

Older adults with abnormal KELS scores performed significantly worse on all tests except for the Knee Extensor Break Test. Accordingly, among the entire group, the KELS correlated with measures of executive function (EXIT25, r=.705, P<.001; CLOX 1, r=-.629, P<.001), cognitive function (MMSE, r=-.508, P<.001), affect (GDS, r=.318, P<.001), and physical function (mPPT, r=-.472, P<.001) but did not correlate with the Knee Extensor Break Test (r=-.068, P=.456). Among those referred by APS, the KELS failed to correlate with only the 8-foot walk test (r=.175, P=.153) and GDS (r=.080, P=.450).

CONCLUSIONS

This study demonstrated the convergent validity of KELS with a battery of cognitive, affective, executive, and functional measures often used to determine older adults' ability to live safely and independently in the community. KELS may be a valid and pragmatic alternative to screen for the capacity to live safely and independently among older adults.

Nursing home resident outcomes from the Res-Care intervention

OBJECTIVES

To test the effectiveness of a restorative care (Res-Care) intervention on function, muscle strength, contractures, and quality of life of nursing home residents, with secondary aims focused on strengthening self-efficacy and outcome expectations.

DESIGN

A randomized controlled repeated-measure design was used, and generalized estimating equations were used to evaluate status at baseline and 4 and 12 months after initiation of the Res-Care intervention.

SETTING

Twelve nursing homes in Maryland.

PARTICIPANTS

Four hundred eighty-seven residents consented and were eligible: 256 from treatment sites and 231 from control sites. The majority were female (389, 80.1%) and white (325, 66.8%); 85 (17.4%) were married and the remaining widowed, single, or divorced/separated. Mean age was 83.8 +/- 8.2, and mean Mini-Mental State Examination score was 20.4 +/- 5.3.

INTERVENTION

Res-Care was a two-tiered self-efficacy-based intervention focused on motivating nursing assistants and residents to engage in functional and physical activities.

MEASUREMENTS

Barthel Index, Tinetti Gait and Balance, grip strength, Dementia Quality-of-Life Scale, self-efficacy, and Outcome Expectations Scales for Function.

RESULTS

Significant treatment-by-time interactions (P<.05) were found for the Tinetti Mobility Score and its gait and balance subscores and for walking, bathing, and stair climbing.

CONCLUSION

The findings provide some evidence for the utility and safety of a Res-Care intervention in terms of improving function in NH residents.

Impact of intensity of practice after stroke: Issues for consideration

PURPOSE

The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the paper raises the question of what it is that patients actually learn when they improve their functional skills. Search strategy. For this purpose articles from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE and PiCarta and references presented in relevant publications were examined.

DISCUSSION AND CONCLUSION

Although, there is strong evidence that early augmented exercise therapy time (expressed as time dedicated to practice) may enhance functional recovery, there is a discrepancy between the evidence for the benefits of intensive practice, on the one hand, and, the implementation of intensive rehabilitation treatment programmes in the current healthcare system on the other. Further emphasis should be given on a better understanding of the time-dependency of prognostic factors that determine the effectiveness of intensive practice in patients with stroke. In addition, a better understanding is needed of the neurophysiological and biomechanical mechanisms that underlie compensation-related learning of functional tasks after stroke.

A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults

BACKGROUND

Population ageing affects most undeveloped, developing and developed countries. Less than a quarter of older people undertake a level of physical activity worldwide that is sufficient to lead to health benefits. Understanding older people's confidence regarding engaging in exercise helps to structure physical activity interventions that motivate them to initiate and adhere to regular exercise. Estimates of the reliability and validity of the English version of the self-efficacy for exercise (SEE) scale has been widely tested and shown to be valid for use in various settings and among older people. The reliability and validity of a Chinese version of the SEE for older adults has not been tested.

AIM

To undertake a preliminary assessment of the reliability and validity of the SEE scale when applied to the older Chinese adults.

METHODS

The Chinese version of the self-efficacy for exercise (SEE-C) scale was tested on a sample of 192 older people from Taiwan with a mean age of 71.2 years recruited between October and December 2003.

RESULTS

There was acceptable internal consistency of the SEE-C scale. The fit of the measurement model to the data for the SEE-C scale was acceptable. There was evidence of validity of the measure based on hypothesis testing: health status predicted exercise self-efficacy, and exercise self-efficacy predicted physical activity. Those who exercised regularly (n=102) had a higher mean SEE-C score (5.3) than those who did not (2.9, n=90).

CONCLUSION

This preliminary validation study provided evidence for the reliability and validity of the Chinese version of the SEE scale. Future testing of the SEE-C scale needs to be carried out to see whether these results are generalisable to older Chinese people living in urban areas and with different characteristics. A test of the scale among younger adults for a wider use of the instrument is also warranted.

Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper

BACKGROUND

Only a fifth of older people undertake a level of physical activity sufficient to lead to health benefit. Misconceptions about the ageing process and beliefs about the costs and benefits of exercise in late life may result in unnecessary self-imposed activity restriction. Thus, adhering to a physical activity can be difficult particularly when the benefits of exercise are often not immediate. Many of the barriers to engaging in physical activity among older people are attitudinal. It is therefore important to take account of the non-physical aspects of physical activity intervention programmes, such as increasing confidence. Self-efficacy is a widely applied theory used to understand health behaviour and facilitate behavioural modification, such as the increase of physical activity.

AIM

This paper aims to examine the ways in which self-efficacy theory might be used in intervention programmes designed to overcome psychological barriers for increasing physical activity among older people.

CONCLUSION

A number of studies have demonstrated that exercise self-efficacy is strongly associated with the amount of physical activity undertaken. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of a physical activity intervention is beneficial. Physical activity interventions aimed at improving the self perception of exercise self-efficacy can have positive effects on confidence and the ability to initiate and maintain physical activity behaviour. There are a number of ways for nurses to facilitate older people to draw on the four information sources of self-efficacy: performance accomplishments, vicarious learning, verbal encouragement, and physiological and affective states. Research challenges that future studies need to address include the generalisability of exercise setting, the role of age as an effect modifier, and the need for more explicit reporting of how self-efficacy is operationalised in interventions.

Adherence to an Exercise Intervention Among Older Women Post Hip Fracture

The purpose of this study was to evaluate adherence to home-based exercise interventions among older women post hip fracture that were randomized to one of three exercise intervention groups or a routine care group. A total of 157 female hip fracture patients provided data for the intervention analysis. Factors evaluated baseline, 2, 6, and 12 months post hip fracture included demographic variables, adherence to treatment visits, self-efficacy, outcome expectations, stage of change for exercise, social support for exercise, mood, health status, pain, and fear of falling. The hypothesized model tested the direct and indirect impact of all study variables on adherence to exercise intervention sessions. Different factors appeared to influence adherence to visits across the recovery trajectory.

Self-care as a health resource of elders: an integrative review of the concept

AIM

To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource.

BACKGROUND

Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care.

METHOD

In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We interactively compared data and display matrices to describe self-care as a health resource.

RESULTS

Fifty-seven articles addressed health self-care and were integrated into a framework of self-care as a health resource of elders. Self-care was identified as a two-dimensional construct including action capabilities and processes for health in self-care practice. The capabilities consisted of fundamental capabilities, power capabilities and performance capabilities. The action processes included a process of life experience, a learning process and an ecological process.

CONCLUSION

This review offers insight into self-care as a significant health resource of elders with different health status. It suggests that an elder's self-care ability is determined by the interaction of various sub-resources and conditions and emphasizes the constantly evolving nature of self-care. The framework may be of use in clinical practice, policy-making and research into health care of frail or robust elders.

Testing the effectiveness of the exercise plus program in older women post-hip fracture

BACKGROUND

Exercise is an important strategy with potential to improve recovery in older adults following a hip fracture.

PURPOSE

The purpose of this study was to test the impact of a self-efficacy based intervention, the Exercise Plus Program, and the different components of the intervention, on self-efficacy, outcome expectations, and exercise behavior among older women post-hip fracture.

METHODS

Participants were randomized to one of four groups: exercise plus, exercise only, plus only (i.e., motivation), or routine care. Data collection was done at baseline (within 22 days of fracture), 2, 6, and 12 months post-hip fracture.

RESULTS

A total of 209 women were recruited with an average age of 81.0 years (SD=6.9). The majority was White (97.1%), was widowed (57.2%), and had a high school education (66.7%). Generalized Estimating Equations were used to perform repeated measures analyses. No differences in trajectories of recovery were observed for self-efficacy or outcome expectations. A statistically significant difference in the overall trajectory of time in exercise was seen (p<.001), with more time spent exercising in all three treatment groups.

CONCLUSIONS

The study demonstrated that it was possible to engage these women in a home-based exercise program and that the plus only, exercise only, and the exercise plus groups all increased exercise.

The Relationship Between Psychosocial State and Exercise Behavior of Older Women 2 Months After Hip Fracture

Despite the potential benefits associated with exercise after hip fracture, those who have sustained hip fractures are among the least likely to engage in regular exercise (resistive or aerobic). This article describes the psychosocial state, specifically the self-efficacy expectations and outcome expectations related to exercise, mood, fear of falling, pain, and health status of older women who enrolled in either of two Baltimore Hip Studies (BHS), BHS-4 and BHS-5, and to test a self-efficacy-based model to explain exercise behavior after hip fracture. A total of 389 older women with hip fractures participated in these studies. The participants reported moderate confidence in their ability to exercise and a general belief in the benefits of exercise, high perceived health status, limited depressive symptoms, and some pain and fear of falling. Consistently across these two samples, age and mental status or depressive symptoms influenced outcome expectations, such that older women with more depressive symptoms or lower mental health status had weaker outcome expectations for exercise. Self-efficacy expectations consistently influenced exercise behavior across both samples. It was also consistent across both models that age, cognitive status, physical and mental health status, pain, fear, outcome expectations, and depressive symptoms did not directly influence exercise behavior.

Self-efficacy for health-related behaviors among deaf adults

The purpose of this quasi-experimental, pre-post-test study was to test the effectiveness of the Deaf Heart Health Intervention (DHHI) in increasing self-efficacy for health-related behaviors among culturally deaf adults. The DHHI targets modifiable risk factors for cardiovascular disease. A sample of 84 participants completed time-1 and time-2 data collection. The sign language version of the Self-Rated Abilities Scale for Health Practices (SRAHP) was used to measure self-efficacy for nutrition, psychological well-being/stress management, physical activity/exercise, and responsible health practices. Total self-efficacy scores were significantly higher in the intervention group than in the comparison group at time-2, controlling for scores at baseline (F [1, 81] = 26.02, p < .001). Results support the development of interventions specifically tailored for culturally deaf adults to increase their self-efficacy for health behaviors.

The effects of in-home rehabilitation on task self-efficacy in mobility-impaired adults: A randomized clinical trial

OBJECTIVES

To examine the effect on mobility self-efficacy of a multifactorial, individualized, occupational/physical therapy (OT/PT) intervention delivered via teletechnology or in-home visits.

DESIGN

Randomized, clinical trial.

SETTING

One Department of Veterans Affairs and one private rehabilitation hospital.

PARTICIPANTS

Sixty-five community-dwelling adults with new mobility devices. Thirty-three were randomized to the control or usual care group (UCG), 32 to the intervention group (IG).

INTERVENTION

Four, once-weekly, 1-hour OT/PT sessions targeting three mobility and three transfer tasks. A therapist delivered the intervention in the traditional home setting (trad group n = 16) or remotely via teletechnology (tele group n = 16).

MEASUREMENTS

Ten-item Likert-scale measure of mobility self-efficacy.

RESULTS

The IG had a statistically significantly greater increase in overall self-efficacy over the study period than the UCG (mean change: IG 8.8, 95% confidence interval (CI) = 3.8-13.7; UCG 1.2, 95% CI = -5.8-8.2). Descriptively, the IG exhibited positive changes in self-efficacy for all tasks and greater positive change than the UCG on all items with the exception of getting in and out of a chair. Comparisons of the two treatment delivery methods showed a medium standardized effect size (SES) in both the tele and trad groups, although it did not reach statistical significance for the tele group (SES: tele = 0.35, 95% CI = -2.5-0.95; trad = 0.54, 95% CI = 0.06-1.14).

CONCLUSION

A multifactorial, individualized, home-based OT/PT intervention can improve self-efficacy in mobility-impaired adults. The trend toward increased self-efficacy irrespective of the mode of rehabilitation delivery suggests that telerehabilitation can be a viable alternative to or can augment traditional in-home therapy.

Community neurorehabilitation: a synthesis of current evidence and future research directions

Over the past decade, community neurorehabilitation has emerged as a promising extension of neurological rehabilitation. The goal of community neurorehabilitation is to maximize functional ability and quality of life through multidimensional rehabilitation that occurs while the individual is living in a home versus acute or transitory care setting. Because of its multidisciplinary focus, many variations of community neurorehabilitation teams have been implemented. Critical gaps exist, however, in understanding of the influence of structural and procedural differences among programs, as well as patient level variables such as social support, on recovery. This paper examines the current evidence of the effectiveness of community neurorehabilitation through a review of the findings of systematic reviews and meta-analyses of four neurological conditions: stroke, multiple sclerosis, traumatic brain injury, and Parkinson's disease. It focuses in particular on the data regarding physical therapy and occupational therapy, which are two of the primary components of community neurorehabilitation programs.

Hip fracture and its consequences: differences between men and women

This article describes the state of knowledge regarding gender differences with respect to hip fracture and its subsequent outcomes. Most of the work to date investigating hip fracture patients has been done with women, yet some evidence from a few studies with a significant number of male hip fracture patients and from nonfracture samples suggests that women and men may be different at the time of fracture and will have a different course of recovery.

Pilot Testing of the Restorative Care Intervention: Impact on Residents

The purpose of this pilot study was to test the feasibility and effectiveness of a two-tiered motivational intervention, the Res-Care Intervention, on nursing home residents. Twenty-one residents consented to participate in the study. The residents were 88.3 (+/- 4.9) years of age, had lived in the facility 1.6 (+/- 3.4) years, were women (93%), White (93%), and unmarried (85%). Although there were some positiv trends, there was not a statistically significant difference in any of the resident outcomes following implementation of the Res-Care Intervention. The findings have been used to revise the Res-Care Intervention to include additional education needs for the nursing assistants, revisions in the motivational intervention for the nursing assistants and nurses, clarification of documentation and motivational techniques to improve documentation, and implementation of a more comprehensive treatment fidelity plan.

Reliability and validity of the Outcome Expectations for Exercise Scale-2

Development of a reliable and valid measure of outcome expectations for exercise for older adults will help establish the relationship between outcome expectations and exercise and facilitate the development of interventions to increase physical activity in older adults. The purpose of this study was to test the reliability and validity of the Outcome Expectations for Exercise-2 Scale (OEE-2), a 13-item measure with two subscales: positive OEE (POEE) and negative OEE (NOEE). The OEE-2 scale was given to 161 residents in a continuing-care retirement community. There was some evidence of validity based on confirmatory factor analysis, Rasch-analysis INFIT and OUTFIT statistics, and convergent validity and test criterion relationships. There was some evidence for reliability of the OEE-2 based on alpha coefficients, person- and item-separation reliability indexes, and R(2)values. Based on analyses, suggested revisions are provided for future use of the OEE-2. Although ongoing reliability and validity testing are needed, the OEE-2 scale can be used to identify older adults with low outcome expectations for exercise, and interventions can then be implemented to strengthen these expectations and improve exercise behavior.

Implementation of efficacy enhancement nursing interventions with cardiac elders

Intervention strategies based on social cognitive theory and encompassing the bio-psycho-behavioral domains are proposed to enhance self-efficacy in men and women 65 years and older recovering from myocardial infarction and coronary artery bypass grafting. This paper describes a study in which the theory-based development of efficacy enhancement (EE) nursing interventions and their implementation and utilization with interventions from the Nursing Interventions Classification (NIC) were used with cardiac elders in the treatment group of the community-based randomized clinical, trial, "Improving Health Outcomes in Unpartnered Cardiac Elders." Advanced practice nurses (APNs) provided the nursing intervention to 110 participants (mean age = 76.2, SD = 6.0) for the first 12 weeks after discharge to home. After an initial introductory meeting in the acute-care setting, participant contacts by the APNs were made at a home visit and telephone calls at 2, 6, and 10 weeks. Results describe the number of participants receiving interventions at all contacts over 12 weeks, at specified contact points, and the intensity (nurse time) of the interventions. Verbal encouragement and mastery were EE interventions used with the greatest number of participants. Exercise promotion, energy management and active listening were NIC interventions used with the most participants. Variations in the use of interventions over 12 weeks and their intensities, suggest patterns of recovery in the elders. During rehabilitation EE interventions can be successfully implemented with men and women 65 years and older and individualized to the recovery trajectory. Nurses can integrate specific EE interventions with more general interventions from the bio-psycho-behavioral domains to enhance the recovery process for cardiac elders.

Motivating minority older adults to exercise

The purpose of this qualitative study was to explore with minority older adults their experience in the Senior Exercise Self-Efficacy Pilot Program (SESEP) and establish what aspects of the SESEP helped the participants engage in exercise and what decreased their willingness to exercise. A total of 148 older adults from 12 Senior Centers participated. The majority of the participants were African American (77%), and female (79%) and the average age was 72.9+/-8.0. Analysis of the semi-structured interviews revealed 36 codes which were categorized and reduced to 13 major themes. Eleven of these themes focused on factors that facilitated participation in exercise and two themes included factors that decreased willingness to participate in exercise. Findings support the use of the theory of self-efficacy to change behavior among minority older adults, and future research should focus on identifying culturally specific interventions that will strengthen these beliefs and thereby increase exercise behavior.

Reliability and validity of the self-efficacy for exercise and outcome expectations for exercise scales with minority older adults

Older African Americans and Latinos tend to exercise less than older Whites and are more likely to have chronic diseases that could benefit from exercise. Measurement of self-efficacy of exercise and exercise outcome expectations in this older population is required if exercise is to be monitored carefully and enhanced in this population. The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise Scale (SEE) and Outcome Expectations for Exercise Scale (OEE) in a sample of African American and Latino older adults. A total of 166 individuals, 32 males (19%) and 134 females (81%) with an average age of 72.8 +/- 8.4 years participated in the study. The SEE and OEE scales were completed using face-to-face interviews. There was evidence of internal consistency for both scales with alphas of .89 and .90 for the SEE scale and .72 and .88 for the OEE scale. There was some evidence of validity for both scales based on confirmatory factor analysis and hypothesis testing, because factor loadings were greater than .50 in all but two items in the OEE, and there were significant relationships between self-efficacy and outcome expectations and exercise behavior at all testing time-points. The measurement models showed a fair fit of the data to the models. The study provided some evidence for the reliability and validity of the SEE and OEE when used with minority older adults, and it provides some guidelines for future scale revisions and use.

Significance of poor patient participation in physical and occupational therapy for functional outcome and length of stay

OBJECTIVES

To determine the frequency of poor patient participation during inpatient physical (PT) and occupational therapy (OT) sessions and to examine the influence of poor participation on functional outcome and length of stay (LOS).

DESIGN

Prospective observational study.

SETTING

University-based, freestanding acute rehabilitation hospital.

PARTICIPANTS

Two hundred forty-two inpatients, primarily elderly (age range, 20-96y), with a variety of impairment diagnoses (eg, stroke), who were admitted for inpatient rehabilitation.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Pittsburgh Rehabilitation Participation Scale, the 13 motor items from the FIM instrument (FIM motor), LOS, and discharge disposition.

RESULTS

We categorized the sample into 3 groups: "good" participators were those for whom all inpatient PT and OT sessions were rated 4 or greater (n=139), "occasional poor" participators were those with less than 25% of scores rated below 4 (n=53), and "frequent poor" participators were those with 25% or more of scores rated below 4 (n=50). Change in FIM motor scores during the inpatient rehabilitation stay was significantly better for good and occasional poor participators, compared with frequent poor participators (mean FIM improvement: 23.2, 22.8, and 17.6, respectively; repeated-measures analysis of variance group by time interaction, P <.002). LOS was significantly longer for occasional poor participators, compared with good and frequent poor participators controlling for admission FIM differences (adjusted means: 13.9d, 11.0d, and 10.9d, respectively; analysis of covariance, P <.001).

CONCLUSIONS

Poor participation in therapy is common during inpatient rehabilitation and has important clinical implications, in terms of lower improvement in FIM scores and longer LOS. These results suggest that poor inpatient rehabilitation participation and its antecedents deserve further attention.

Geriatric rehabilitation nursing: Developing a model

In this paper, we describe a geriatric rehabilitation nursing model developed on the basis of the nursing and rehabilitation literature. That literature comprised some 120 articles addressing the rehabilitation of elderly patients and the work done by nurses in that process, various philosophical questions and the results of geriatric rehabilitation. One-third of these articles has been evaluated on the strength of the articles' evidence, and these are discussed in this paper. The findings show that the main factors in geriatric rehabilitation nursing are the patient with health or functional problems and the nurse with professional values, knowledge and skills. The patient is part of a family and the nurse works as part of a multidisciplinary team. In the geriatric rehabilitation process, the patient and the nurse work in close interaction. The aims of rehabilitation depend upon the patient's commitment to the objective and upon the nurse's commitment to help the patient achieve that objective. A health orientation, goal-oriented work, nursing decision-making and a rehabilitative approach to work are all central to this effort. Work is organized in multidisciplinary teams where nurses have equal responsibilities with other professional staff. Testing and development of the model is ongoing.

Comparisons of motivation, health behaviors, and functional status among elders in residential homes in Korea

This study compared the changes in health behaviors, motivation, and functional status between motivation enhancement exercise-program participants and program dropouts over 6 months. A total of 73 older adults living in residential homes participated in the study. Face-to-face interviews were conducted at pretest and then at 10 weeks and 6 months in the program. The participants exercised using traditional Korean dance movements for 50 min, 4 times per week, for 6 months. The subjects were classified as participants or dropouts by using a cutoff attendance rate of 80%. Repeated ANOVA revealed the following results over 6 months: 1 The motivation to perform health behaviors, especially for perceived benefits, improved significantly for the participants than for the dropouts. 2 Significant differences in the performance of overall health behaviors and exercise-related behaviors were found between the participants and the dropouts. 3 The sickness impact profile (SIP) of the participants improved significantly, compared with the dropouts. Significant group differences were found for total SIP, physical dimensions, and enjoyment of recreation and pastimes. In conclusion, the study found that the 6-month motivation enhancement program was effective in motivating older adults to perform health behaviors and to improve their functional status.

Encouraging exercise in older adults with congestive heart failure

Congestive heart failure (CHF) is a chronic medical problem commonly found in older adults. Management of CHF ideally should combine lifestyle modifications and medication management. Exercise prescriptions and encouraging patients with CHF to exercise can have a significant impact on management of symptoms as well as exacerbation of further disease. The recommended exercise program should ideally incorporate 10 to 15 minutes of warm-up with exercise durations of 20 to 30 minutes and a cool-down period generally repeating the warm up exercises. Exercise should be done at least 3 to 5 days per week and should include a combination of aerobic and resistance exercise. The HEART approach provides a useful guide to help motivate older adults with CHF to exercise regularly. In so doing, older adults with CHF will be helped to improve and maintain cardiac status, decrease the symptoms of CHF, and improve overall quality of life.

Development of a conceptual framework for the assessment of geriatric rehabilitation outcomes

The objective of the study was to develop a conceptual framework of key assessment areas for the evaluation of rehabilitation outcomes in older persons. The study was designed in four stages. First, a review of the literature generated a list of 84 potential outcome variables. Second, semi-structured interviews were conducted with older adults informants (n = 19) to record their thoughts about important rehabilitation outcomes. From the analyses of the transcripts, 20 recurrent themes became apparent. Third, relevant assessment areas were determined based on the merged data from the literature and the interviews. Fourth, a focus group was held with a panel of eight interdisciplinary experts with strong involvement in geriatric rehabilitation to evaluate, improve, and validate the preliminary work. As a result of the study, the conceptual framework for the assessment of geriatric rehabilitation outcomes (FAGRO) is composed of four primary outcome domains related to important activities for community-living older persons: mobility activities, basic activities of daily living, activities of independent living, and leisure activities. The models also allows for four brief evaluations of underlying functioning components, including: physical functioning, psychological functioning, social functioning, and factors related to the caregiver status and available resources. The model has the potential to become a valuable additional tool for outcome assessment, researched and developed specifically for geriatric rehabilitation.

The Pittsburgh Rehabilitation Participation Scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation

OBJECTIVE

To demonstrate interrater reliability and predictive validity of the Pittsburgh Rehabilitation Participation Scale (PRPS), a clinician-rated 6-point Likert-type item measuring patient participation in inpatient rehabilitation sessions.

DESIGN

Prospective measurement of patient participation in physical and occupational therapy sessions during inpatient rehabilitation.

SETTING

University-based, freestanding acute rehabilitation hospital.

PARTICIPANTS

Two hundred forty-two inpatients, primarily elderly, with a variety of impairment diagnoses (eg, stroke), who were admitted for inpatient rehabilitation.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Change in the 13 motor items from the FIM trade mark instrument, from admission to discharge.

RESULTS

The PRPS had high interrater reliability (intraclass correlation coefficient [ICC]=.91 for occupational therapists; ICC=.96 for physical therapists). The subjects had mean PRPS scores +/- standard deviation of 4.73+/-0.76. Mean PRPS scores predicted rehabilitation outcome (N=242, r=.32, P<.0001), as measured by change in motor FIM. The strength of this association did not change in a multivariate model that controlled for age, gender, race, impairment group, medical comorbidity count, length of stay, and admission FIM.

CONCLUSIONS

Patient participation during acute inpatient rehabilitation can be easily and reliably measured, and PRPS scores predict functional outcome. The PRPS may have applicability in clinical and research outcome measurement.

Functional and self-efficacy changes of patients admitted to a Geriatric Rehabilitation Unit

BACKGROUND

Geriatric Rehabilitation Units (GRUs) have been established to restore functional abilities of older hospitalized patients. Although considerable health care resources have been allocated to these units, few outcome-based research studies have been reported on Canadian GRUs.

AIM

The aim of this paper is to report a study examining the effect of admission to a GRU on changes in patients' functional ability and self-efficacy in performing everyday activities at home.

METHODS

Following Institutional Review Board approval, data were collected from 40 patients age 65-101 years (mean 83.8, sd 6.57) admitted to a 21-bed interdisciplinary GRUs over a 7-month period. All were living independently prior to hospital admission. Data were collected on admission to the unit and on discharge using two instruments: the Functional Independence Measure and Falls Efficacy Scale.

RESULTS

Statistically significant improvements were found in functional ability and self-efficacy following admission to the GRUs.

CONCLUSIONS

Although functional level and feelings of self-efficacy on admission to the unit were at levels which may have prevented participants from returning home, the majority were discharged to the community. Results suggest that admission to a GRU helps prepare patients to return to community living.

Adaptation to disability in chronic obstructive pulmonary disease: neglected relationships to older adults' perceptions of independence

PURPOSE

This study extends understanding of the relationship between disability and independence in older adults with COPD.

METHODS

An interviewer-administered questionnaire was used to examine disability, adaptation, perceptions of independence, and self-efficacy in a sample of 50 community-dwelling older adults. Odds ratios were used to investigate relationships between variables.

RESULTS

Participants used a wide range of behavioural strategies to adapt to their disability including: limiting activities, optimizing performance (e.g. taking rests), compensating for lost function (e.g. using equipment), and obtaining help from others. The relative use of these adaptations varied across five domains of activity: personal care, in-home mobility, household activities, community mobility, and valued activities. Most participants felt very or extremely independent in all domains. In personal care, those who reported greater disability (O.R. = 0.26), more frequent attempts to optimize performance (O.R. = 0.57), or greater reliance on help from others (O.R. = 0.79) were significantly (p < 0.05) less likely to feel very or extremely independent.

CONCLUSIONS

The relationship between disability and perceptions of independence depends on the nature of the activity and is influenced by factors that are amenable to study and intervention. In particular, the vast array of behavioural strategies available to older adults with COPD enables them to feel highly independent despite disability.

State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment

OBJECTIVES

To increase recognition of geriatric rehabilitation and to provide recommendations for practice and future research.

DATA SOURCES

A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database.

STUDY SELECTION

One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports.

DATA EXTRACTION

The following major geriatric rehabilitation subtopics were identified: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in geriatric rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies.

DATA SYNTHESIS

Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references.

CONCLUSIONS

Frail elderly patients should be screened for rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to geriatric rehabilitation should be interdisciplinary and use a comprehensive geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of geriatric rehabilitation are most effective, screening, and what outcomes are sustainable.

Concepts in health promotion. Perceived self-efficacy and barriers in older adults

Many older adults have reached later life in apparent good health while others' lack of self-care activities has greatly accelerated the process of aging. In this article, self-efficacy and perceived barriers are explored as significant concepts that influence the self-care activities of elderly individuals. A conceptual model is presented depicting perceived self-efficacy and barriers as determinants of self-care activities. This conceptual model differs from earlier health promotion models because it is specific for older adults. Based on empirical studies, this conceptual model demonstrates that the variables of perceived self-efficacy and barriers have a profound effect on an older adult's participation in self-care activities. Testing of this model is needed to provide a knowledge base for designing health promotion strategies, maximizing cost containment strategies, and contributing to Healthy People 2010 objectives of increasing quality of life for all older adults.

Testing the effect of the WALC intervention on exercise adherence in older adults

The purpose of this study was to test the feasibility of the WALC intervention (Walk; Address pain, fear, fatigue during exercise; Learn about exercise; Cue by self-modeling), and determine its effects on self-efficacy and outcome expectations, exercise activity and free living activity, physical and mental health status, and falls and fall-related injuries. A total of 17 sedentary older women with a mean age of 88 +/- 3.7 years were randomly assigned to receive either the WALC intervention or routine care. Ninety percent of those in the treatment group initiated and engaged in a regular exercise program during the 6 months of the study. There was a statistically significant difference in self-efficacy expectations, exercise behavior, and overall activity between the two groups. Those in the treatment group had stronger self-efficacy expectations related to exercise; engaged in more exercise and more free living activity; and although not statistically significant, had stronger outcome expectations following exposure to the WALC intervention when compared with those who received routine care. To help older adults initiate and adhere to an exercise program, nurses can easily implement the WALC intervention in a variety of settings.

Model testing for reliability and validity of the Outcome Expectations for Exercise Scale

BACKGROUND

Development of a reliable and valid measure of outcome expectations for exercise appropriate for older adults will help establish the relationship between outcome expectations and exercise. Once established, this measure can be used to facilitate the development of interventions to strengthen outcome expectations and improve adherence to regular exercise in older adults.

OBJECTIVES

Building on initial psychometrics of the Outcome Expectation for Exercise (OEE) Scale, the purpose of the current study was to use structural equation modeling to provide additional support for the reliability and validity of this measure.

METHODS

The OEE scale is a 9-item measure specifically focusing on the perceived consequences of exercise for older adults. The OEE scale was given to 191 residents in a continuing care retirement community. The mean age of the participants was 85 +/- 6.1 and the majority were female (76%), White (99%), and unmarried (76%). Using structural equation modeling, reliability was based on R2 values, and validity was based on a confirmatory factor analysis and path coefficients.

RESULTS

There was continued evidence for reliability of the OEE based on R2 values ranging from .42 to .77, and validity with path coefficients ranging from .69 to .87, and evidence of model fit (X2 of 69, df = 27, p < .05, NFI = .98, RMSEA = .07).

CONCLUSION

The evidence of reliability and validity of this measure has important implications for clinical work and research. The OEE scale can be used to identify older adults who have low outcome expectations for exercise, and interventions can then be implemented to strengthen these expectations and thereby improve exercise behavior.

Pain management 1: psychological and social aspects of pain

This two-part article presents psychological and social factors which affect pain perception and response and the implications of these for nursing practice. In this article, the complex interactions between neurophysiological and psychological factors are outlined and theories of pain perception and ways in which the pain experience can be modulated are presented. The role of psychological factors, attitudes, beliefs and expectations of both patient and practitioner, pain behaviours and ability to cope are discussed. In the second part, these are further elaborated with particular reference to the nurse-patient interaction. The use of psychological approaches to augment clinical practice, such as education, reduction of anxiety and improving coping ability, are suggested. Finally, the importance of communication skills in pain management is addressed.