The Impact of Work Incentives Benefits Counseling on Employment Outcomes: A National Vocational Rehabilitation Study

BACKGROUND

Millions of Americans receiving Social Security Administration (SSA) disability benefits aspire to work and reduce reliance on disability benefits, but find the rules about entering or rejoining the workforce too complex or confusing and fear that working will cause loss of important benefits.

PURPOSE

A case control study was conducted to investigate the impact of receiving work incentives benefits counseling (WIBC) on employment outcomes, and its relationship with demographic covariates for U.S. vocational rehabilitation (VR) clients who are SSA disability benefit recipients.

METHOD

Data for this study were extracted from the Rehabilitation Service Administration (RSA-911) database. Mahalanobis distance matching procedures were used to match clients who received WIBC with those who did not receive it. Chi-square independence tests and independent samples t tests were used to compare receipt of WIBC and employment outcomes based on the demographic variables. Additionally, chi squared automatic interaction detection (CHAID) analysis was used to divide VR clients into homogeneous groups based on the covariates.

RESULTS

Clients who received WIBC were more likely to obtain competitive integrated employment (CIE). Impairment type, referral source, long-term employment and education level were significantly associated with CIE for clients who received WIBC. Additionally, VR clients with sensory/communicative impairments and low-income status were less likely to receive WIBC.

CONCLUSION

Modifying VR structure to be more inclusive; understanding of stigma; and increasing the functioning, psychological well-being and self-efficacy of VR clients might improve employment outcomes.

Leadership, Leading, and Influencing Change in Cancer Education: Development and Assessment of a Pilot Leadership Workshop in Cancer Education for Interdisciplinary Healthcare Staff

Effective leaders in healthcare settings create a motivating work environment, initiate changes in practice, and facilitate interdisciplinary collaboration to advance patient-centered care. Health professionals in cancer education need leadership development to meet the continued rise in cancer cases and to keep up with the rapid biomedical and technological advances in global cancer care. In addition, leadership development in cancer education supports interprofessional collaboration, optimizes patient engagement, and provides mentorship opportunities necessary for career advancement and skill development. The identified benefits from leadership development in cancer education led to the creation of an interactive pilot leadership workshop titled "Essential Skills in Cancer Education: Leadership, Leading, and Influencing Change in Cancer Education," held at the International Cancer Education Conference in October 2020. The workshop was led by global leaders in cancer education and utilized lectures, mentorship opportunities, interactive case studies, and individual learning projects to develop leadership skills in multidisciplinary oncology professionals. Fifteen attendees from diverse educational backgrounds and levels of experience participated in the virtual leadership workshop and mentorship program. Following the workshop, participants reported an increase in knowledge regarding how to use different leadership styles, initiate changes in practice, and apply leadership skills in their career development and at their institutions. The feedback received from participants through post-workshop evaluations was overall positive and demonstrated an interest for more leadership development opportunities in cancer education. This pilot workshop shows that leadership is a valuable and teachable skill that will benefit both healthcare professionals and patients in the field of cancer education.

Fortune Favors the Bold: Introduction to the Special Series of the Vocational Rehabilitation Technical Assistance Center for Quality Employment

This editorial provides an overview of the special series developed by the Vocational Rehabilitation Technical Assistance Center (VRTAC) for Quality Employment, H264K200003, and VRTAC-Targeted Communities (H264F15003) from the U.S. Department of Education, and in collaboration with the National Institute on Disability, Independent Living, and Rehabilitation Research project of Rehabilitation Research and Training Center (RRTC) on Employer Practices (#90RT5041), RRTC on Employment of Transition-Age Youth with Disabilities (#90RTEM0002), RRTC on Employment of Individuals with Intellectual and Developmental Disabilities (#90RTEM0003), and Disability Rehabilitation and Research Project on Customized Employment (#90DP0085). The special series consists of 26 articles appearing across four different journals: Journal of Vocational Rehabilitation; Rehabilitation Counselors and Educators Journal; Rehabilitation Research, Policy, and Education; and Rehabilitation Counseling Bulletin.

Vocational rehabilitation service delivery: Technical assistance needs of vocational rehabilitation professionals

BACKGROUND: Americans with disabilities have historically faced substantial barriers to employment participation. The state-federal vocational rehabilitation (VR) program has played an important role in increasing the employment opportunities of Americans with disabilities through the provision of services and supports designed to lead to high-quality employment, independence, self-sufficiency, and full integration into the community. OBJECTIVE: The Vocational Rehabilitation Technical Assistance Center for Quality Employment (VRTAC–QE) was designed to bring together the broad range of existing quality employment strategies and supporting practices, identify and implement new ones, and incorporate them into an integrated training and technical assistance plan, consistent with the circumstances and priorities of each State VR agency that requests technical assistance. METHOD: In the present paper, we present the results of a needs assessment survey conducted among State VR rehabilitation counselors and professionals in cooperating rehabilitation agencies and services. RESULTS: The purpose of the present study was to determine technical assistance and training needs of state VR counselors in four practice domains: (a) outreach services, (b) pre-employment transition services, (c) vocational rehabilitation services, and (d) employment services. CONCLUSION: Implications and future directions are also discussed.

The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study

BACKGROUND

Quality of life is considered the most overarching psychosocial adaptation outcome following the rehabilitation of persons with spinal cord injury. Literature suggests that the quality of life of persons with spinal cord injury is determined by many personal and psychological factors, including mindfulness. This study aimed to identify the direct and indirect effect of mindfulness on the quality of life of persons living with spinal cord injury.

METHODS

Participants consisted of 231 members of three spinal cord injury organizations in the United States: United Spinal Association, North American Spinal Cord Injury Consortium, and Paralyzed Veterans of America-Wisconsin Chapter. The participants completed a set of standardized self-report questionnaires in an online Qualtrics survey. A hierarchical regression analysis was performed to identify the contribution of mindfulness to quality of life, controlling for sociodemographic and injury-related factors. A serial mediation analysis was performed to examine the indirect effect of mindfulness on quality of life.

RESULTS

In the hierarchical regression analysis, sociodemographic and injury-related factors (i.e., age, gender, race, marital status, education, employment, level and completeness of injury, comorbidities, frequency of hospitalization, pain intensity, and functional limitation) and mindfulness explained 59% variance on quality of life of the participants with spinal cord injury. Mindfulness uniquely contributed to the higher quality of life above and beyond sociodemographic and injury-related variables. In the serial mediation analysis, pain and functional limitation did not significantly mediate the relationship between mindfulness and quality of life. However, the indirect effects of mindfulness on functional limitation and quality of life through pain were significant.

CONCLUSION

The findings underscore the vital role of mindfulness in improving the quality of life of persons with spinal cord injury. Implications of these findings for future research and clinical practice are discussed.

The Time Is Ripe for Entrepreneurship in Vocational Rehabilitation: A Four-Pronged Approach

The field of rehabilitation has laid a great foundation for the monumental entrepreneurial changes that have occurred to the worldwide economy due to the COVID-19 pandemic. The use of self-employment as an outcome has fallen below 1% of Vocational Rehabilitation closures but can rise as the field takes a four-pronged approach to helping individuals become entrepreneurs. The idea of entrepreneurship fits rehabilitation philosophy and through training, legislation, and new vision many persons with disabilities can find successful careers as entrepreneurs.

An automated algorithm minimising ATP failure: re-initiation to enhance anti-tachycardia pacing efficacy

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council, UK

Background

Re-initiation is an important mechanism of anti-tachycardia pacing (ATP) failure, whereby VT is first terminated by the initial ATP application, before being re-initiated by successive pulses. Current ICD designs are able to measure and store electrograms (EGMs) for detecting and classifying arrhythmias, which contain information that may also be used during ATP application. Developing an algorithm that automatically processes EGMs during ATP, with the goal of detecting the initial VT termination and truncating subsequent ATP pulses (which has the potential to re-initiate), may thus increase ATP efficacy.

Purpose

To develop a proof-of-concept ATP detection algorithm: Early Termination Detection Algorithm (ETDA), to automatically sense the signs of early VT termination and cease further ATP pulses based on real-time sensed EGMs from implanted devices.

Methods

A cohort of 7 porcine infarcted ventricular computational models were subject to virtual induction protocols to induce sustained VTs. Functional model properties were adjusted to provide 73 unique VT episodes (260≤VT cycle length (CL)≤480ms). For each episode, burst ATP was delivered from typical pacing sites near the right ventricle (RV) septum to evaluate its efficacy. The ATP failures and their failure mechanisms were identified, accordingly. During ATP application, five common sensing EGM vectors from implanted devices were recovered from simulations including can-to-Superior vena cava (SVC) coil, can-to-RV ring, SVC coil-to-RV coil ring, RV coil tip-to-RV coil ring and LV coil at the lateral base-to-RV tip. Our proposed ETDA utilises those EGMs for VT termination detection. Specifically, correlation coefficients (CCs) of the EGMs between two successive ATP pulses were calculated and averaged to identify sudden changes in EGM morphology that indicate VT termination (Fig A). A discriminating threshold on the CCs was chosen by comparing all re-initiation cases with detailed analysis of the actual VT termination time observed from simulation results. ETDA was then applied to all cases to identify initial termination and improvement in efficacy.

Results

Before ETDA application, ATP terminated 42 cases (58%, Fig C), with re-initiation attributing to 11 (35%) of ATP failures. Application of ETDA accurately detected VT termination in 91% of re-initiated cases, 90% of terminated cases and 81% of not-terminated cases (Fig B), which enhanced the overall ATP efficacy to 71% (P=0.08) (Fig C).

Conclusions

The real-time EGMs measured from standard ICD/CRT-D devices may be used to improve ATP efficacy through an approach such as ETDA. ETDA detects signs of early termination automatically in real time which enables identification of successful VT termination, truncating subsequent pulses that may re-initiate the VT, which enhances overall ATP efficacy.

In silico study of anti-tachycardia pacing efficacy optimisation through scar-targeted stimulation

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council, UK

Background

Anti-tachycardia pacing (ATP) is a reliable electrotherapy to painlessly terminate ventricular tachycardia (VT). However, ATP is often ineffective, particularly for fast VTs, which is often due to the inability of paced wavefronts to reach the re-entrant circuit, because of functional or anatomical barriers. It is thought that efficacy may be enhanced by optimised delivery closer to the re-entrant circuit driving the VT.

Purpose

To quantitatively assess the dependence of ATP efficacy upon different delivery locations with respect to the re-entrant circuit.

Methods

A cohort of 7 porcine ventricular infarct computational models were generated based on in vivo magnetic resonance imaging. Rapid-pacing protocols were applied to the cohort to induce VTs. Functional model parameters were adjusted to produce 73 episodes of sustained monomorphic VT, including 32 fast VTs (cycle length (CL)≤320ms) and 41 slow VTs (320ms-<VTCL≤<VTCL≤>480ms). Burst ATP (2 sequences of 8 pulses at 88% of VTCL) was separately delivered from 3 locations proximal to the re-entrant circuit (along the RV septum), specifically within the critical isthmus (CI), and at the Exit and Entrance sites, along with 3 locations distal to the circuit (lateral/posterior LV), based on multipolar implanted devices with LV epicardial leads, constituting 438 virtual scenarios and efficacy compared (Fig A).

Results

ATP efficacy was significantly higher for slow VTs than for fast VTs (65% vs 46%, P=0.00004) (Fig B). Separate analysis of slow VT cases revealed that delivering from distal locations to the re-entrant circuit was significantly more effective than delivering from proximal locations (72% vs 59%, P=0.04). However, for fast VT cases, the trend was reversed with proximal application (41%) being more effective than distal application (51%, P=0.15) (Fig B). Moreover, individual analysis on specific proximal locations revealed that in slow VT cases, delivering at the Exit site of VT was significantly less efficient than delivering at the Entrance site (46% vs 73%, P=0.01), with a similar (although non-significant) trend also being seen for fast VTs (44% vs 53%, P=0.5) (Fig C). Moreover, for fast VT cases, ATP delivery within the CI was overall the most effective (56%) than all other locations while this trend was not seen in slow VT cases.

Conclusions

ATP delivery proximal to the re-entrant circuit improves efficacy in fast VTs, but less so in slow VTs, where delivering from distal sites is superior. Specifically, for fast VTs, ATP delivery within the CI is the most effective. This work suggests that real-time alteration in applied ATP delivery site choice in a multipolar device (guided by the sensed VT rate by the device prior to therapy delivery) may be beneficial. Combined with the state-of-art leadless pacing technology, this also provides a clinical opportunity for patient-specific ATP delivery configuration and programming.

In-silico optimisation of ICD defibrillation efficacy by modifying lead/can configurations using a cohort of high-resolution whole-torso heart models

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council, UK

Background

ICD is an effective direct therapy against VT/VF by applying a strong electrical shock across the heart between the shocking coil and can. Conventionally, patients will have a shocking coil inside the right ventricle (RV) and a can at the upper left chest. However, due to infections or other conditions, the can may need to place towards the right chest. The placement of the RV coil may also vary in different cases, for example avoiding scar. However, it is unclear how defibrillation efficacy may be altered by these unavoidable modifications to conventional lead/can configurations and whether optimisation may be possible.

Purpose

To compare defibrillation efficacy of modifications of ICD configurations in a cohort of whole-torso models.

Methods

A cohort of 15 whole torso models was generated from high resolution CT data and contrast CT cardiac scans, including 5 dilated cardiomyopathy (DCM), 5 hypertrophic cardiomyopathy (HCM) and 5 structurally normal patients (Fig A). Transvenous ICDs were represented by a shocking coil inside the RV (near apex) and a (ground) can at the upper left chest as default settings. Configurations were then varied by moving the can to the right chest, moving the RV coil up the mid-septum or adding extra grounds (Superior Vena Cava (SVC) coil, coronary sinus (CS) coil (Fig A)). Defibrillation-strength shocks were applied to all models (Fig B). DFTs and mean electrical field were evaluated across the whole heart as well as specific LV, RV, RV insertion regions, along with overall impedance.

Results

Shifting the can from left to right significantly increased DFT for the whole heart (23 J vs 15 J, P=0.03) and LV (25 J vs 17 J, P=0.03) (Fig C) and reduced the mean electrical field. Moving the RV coil further up the septum did not significantly alter DFT (Fig D), but did reduce mean electrical field for all regions and reduce impedance significantly. Additional separate coils significantly reduced DFT for all regions (Fig D) by increasing mean electrical field, whilst adding both coils significantly reduced DFT the most (whole heart: 15 J vs 6 J, P=0.03) (Fig E). Impedance was increased significantly by adding SVC coil, but reduced significantly by adding CS coil. Adding both coils increased impedance slightly.

Conclusions

Although a right-sided can increases DFT by over 50%, additional leads (grounds) may mitigate this increase by increasing mean electrical field. Moving the RV coil closer to the mid-septum reduces DFT slightly, but also reduces mean electrical field and impedance significantly.

Interpolation of electrophysiology parameters using OpenEP: technology development and clinical application

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

Interpolation of data is common during clinical electrophysiology procedures. Applications include local activation mapping, voltage mapping and novel techniques including Sparkle and Coherence mapping. Nevertheless, underlying interpolation algorithms are proprietary and therefore challenging to reproduce. Importantly, direct comparison of electroanatomic datasets between system vendors is therefore not possible.

Purpose

We sought to (1) develop an open-source architecture for interpolation within the Open Electrophysiology Framework for Research (OpenEP; https://openep.io); (2) to provide three interpolation methods within this architecture and (3) to evaluate their performance against clinical data.

Method

The software architecture is shown in Figure 1A. The currently available methods are Radial Basis [1], Scattered Interpolant [2] and Local Smoothing [3]. Default parameters for each method are shown in Figure 1B.

The performance of each method was assessed using clinical left atrial mapping data, using the default options for each scheme. Following interpolation, a sample of 1000 activation/voltage points per mesh was used for analysis. For each interpolation method, correlation with clinical data was assessed using the intra-class correlation coefficient, whilst agreement was assessed using Bland Altman limits of agreement.

Results

For activation mapping, radial basis interpolation resulted in a smoother field than local smoothing, whilst scattered interpolation required more filtering of extreme values. Correlations between interpolated and original activation times were excellent for all interpolation schemes (radial basis R=0.91, p<0.0001; local smoothing R=0.95, p<0.0001; scattered interpolant R=0.92, p<0.0001). Local smoothing resulted in the narrowest 95 percent limits of agreement (-19 to +20ms), compared to radial basis (-24 to +28ms) and scattered interpolation (-22 to +25ms).

For voltage mapping, the interpolation schemes resulted in similar appearances of low voltage areas, however correlations with clinical data were weaker than for activation mapping (radial basis R=0.84, p<0.0001; local smoothing R=0.82, p<0.0001; scattered interpolant R=0.79, p<0.0001). The 95 percent limits of agreement were wide as a proportion of the mean data values, ranging from 83% (-0.8 to +0.66mV) for local smoothing to 97% (-0.78 to +0.63mV) for radial basis interpolation.

Conclusion

An extensible architecture is provided for data interpolation in OpenEP together with three interpolation methods. The methods performed wellfor local activation time interpolation but variation compared to clinical data was greater for voltage mapping. This new architecture will permit the optimisation of interpolation methods against "gold standard" simulation or histological data and facilitate comparison of datasets between system vendors.

Identifying vocational rehabilitation outreach and service training priorities: A national survey from diverse perspectives

BACKGROUND: This article summarizes the results of a needs assessment survey project presented at the 2021 National APSE Virtual Conference. This research was conducted by the Vocational Rehabilitation Technical Assistance Center for Quality Employment (VRTAC-QE), a Technical Assistance Center funded by the Rehabilitation Services Administration, U.S. Department of Education. OBJECTIVE: The purpose of the survey was to determine technical assistance and training needs of state VR counselors in four practice domains: (a) outreach services, (b) pre-employment transition services, (c) vocational rehabilitation services, and (d) employment services. METHODS: A national survey was conducted among 229 SVRA professionals, including directors, staff, and VR counselors, and 92 professionals in community-based rehabilitation agencies, allowing a comparison of the relative importance ratings of the two groups. RESULTS: The ratings of both SVRA and CBRA professionals were generally aligned, but with some significant differences, as discussed in more detail in Tansey et al. (in press). CONCLUSIONS: The priorities identified through this survey will support the development and implementation of technical assistance activities that are responsive to the needs of SVRA professionals providing vocational rehabilitation to persons with disabilities and increasing the capacity of these agencies to promote quality employment outcomes.

Quality of life and experience with the national multiple sclerosis society strategic plan priorities for people with multiple sclerosis: Findings from a path analysis

BACKGROUND: The National Multiple Sclerosis Society (NMSS) strives to ensure that people affected by multiple sclerosis (MS) can live their best lives. This mission is reflected in the Society’s strategic plan, which establishes the roadmap for the Society’s continued commitment to a world free of MS. OBJECTIVE: The purpose of this article is to add to the understanding of both the scope and complexity of the impact of MS and MS-related supports on quality of life (QOL). METHODS: A national sample of people with MS (n = 748) participated in the study by completing validated surveys assessing their QOL, physical and mental health, MS self-efficacy, resilience, participation in NMSS, perceived stress, emotional support, and social roles and activities. A path model was used to examine how the frequently identified MS QOL predictors, including demographic, MS, psychosocial, and physical functional status variables relate to each other and to QOL. RESULTS: The model exhibited reasonable model fit with hypothesized paths being statistically significant and in the hypothesized direction. CONCLUSION: Findings revealed that the relationships among mental health, demographic factors, overall MS experiences, QOL, NMSS participation, and resonance with the mission of the NMSS are complex, highly nuanced, and yet strongly correlated. More importantly, the study highlights the strong influence of variables that are more readily amenable to change through programmatic and clinical intervention, and active self-management and participation.

The Intermediary Role of Optimism and Mental Health in the Relationship Between Disability-Related Stress and Life Satisfaction: A Serial Mediation Model

Although research has examined the relationship between stress and life satisfaction for individuals with multiple sclerosis (MS), less is known about the mechanism through which disability-related stress affects life satisfaction. The purpose of the study was to examine the intermediary role of optimism and mental health in the relationship between disability-related stress and life satisfaction in people with MS. In this cross-sectional study, the sample consisted of 373 adults with MS (mean age = 47.77 years; SD = 11.70). Descriptive statistics, correlation analyses, and a serial mediation analysis were conducted in this study. Our findings suggested that disability-related stress was inversely associated with optimism, mental health, and life satisfaction. Optimism was positively associated with mental health and life satisfaction. Mental health was positively associated with life satisfaction. The serial mediation analysis results suggested that disability-related stress was negatively associated with life satisfaction through optimism and mental health. Our findings provided implications for clinicians to facilitate optimism and mental health promotion for people with MS.

Workplace discrimination allegations and outcomes involving Caucasian Americans, African Americans, and Hispanic/Latinx Americans with multiple sclerosis: A causal comparative analysis

BACKGROUND: Although African Americans and Hispanic/Latinx Americans with multiple sclerosis (MS) frequently cite workplace discrimination as a major concern, the specific nature of this discrimination is not yet well understood. OBJECTIVE: The purpose of this study was to investigate racial/ethnic differences in allegations of workplace discrimination by Caucasian, African American, and Hispanic/Latinx American individuals with MS. METHODS: The United States Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database was used to describe and compare the frequency and characteristics of discrimination allegations filed by people with MS in the three race/ethnicity groups. Quantitative analyses, including a one-way analysis of variance and Chi-square tests, were used to examine 2009–2016 Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints. These complaints were received by the EEOC from people with MS who identified themselves as Caucasian, African American, and Hispanic/Latinx American (N = 3,770). RESULTS: Both African Americans and Hispanic/Latinx Americans tended to encounter discrimination at a younger age than Caucasian Americans. African American and Hispanic/Latinx American charging parties were more likely to be women than were Caucasian charging parties. The size and location of employers against whom allegations were filed varied significantly among the three racial/ethnic groups. The EEOC was more likely to resolve allegations in the charging parties’ favor when the allegations were filed by Caucasians. CONCLUSION: The present study revealed modest but significant differences in the workplace discrimination experiences of the three groups under study. More research is needed to determine why racial/ethnic status bears on the discrimination experiences of Americans with MS.

Evaluating the Psychometric Properties of the Psychological Capital Questionnaire (PCQ) in Patients with Parkinson's Disease

BACKGROUND

Positive personality resources have demonstrated the ability to positively impact health outcomes.

OBJECTIVE

To examine the psychometric properties of the original Psychological Capital Questionnaire (PCQ-24) in patients with Parkinson's disease (PD).

METHODS

A sample of 114 individuals with PD completed the PCQ-24, and via a latent factor modeling framework exploratory and confirmatory factor analyses were conducted to evaluate the psychometric properties in people with PD.

RESULTS

Exploratory factor analysis (EFA) revealed that both the efficacy and hope scales were reliable (Cronbach's alpha = 0.87 and 0.86, respectively) and had statistically acceptable validity with strong factor loadings all above the practical threshold of 0.60. The resilience and optimism scales were also reliable (Cronbach's alpha = 0.78 and 0.73, respectively) but had only moderately acceptable validity in part due to three reverse-scored items (i.e., No. 13, 20, & 23) with weak factor loadings of 0.26, 0.46, and 0.50, respectively. After excluding these at-risk items, the overall factor loadings for resilience and optimism were significantly improved at the acceptable above 0.60. The CFA results confirm a statistically acceptable model fit for the modified version (only 21-items) of the PCQ in the PD sample.

CONCLUSION

Both EFA and CFA analyses provide statistical evidence supporting the modified PCQ version and demonstrate better test validity and reliability in the PD population. The refined PCQ form is both effectively shorter and psychometrically superior to the original and has promise in investigating health outcomes in people with PD.

Exploration of the Effects of Protective Person–Environment Factors Between Functional Impairments and Stress in Individuals With Multiple Sclerosis: Mediation and Moderation Analyses

Functional impairments can lead to stress in individuals with multiple sclerosis (MS). The study examined protective person and environment factors (i.e., positive cognitive stress appraisal, core self-evaluations [CSE], resilience, hope, spirituality, social support, and environmental supports) as both mediators and moderators of this association to guide understanding of the experience of stress in this population. The sample consisted of 373 participants with MS. In simple mediation analyses, positive cognitive stress appraisal, CSE, resilience, hope, social support, and environmental supports served as a partial mediator between functional impairments and stress. In a parallel mediation analysis, significant unique indirect effects were observed for two of the seven hypothesized mediator variables (CSE and environmental supports). Separate moderator tests provided support for the CSE variable as a protective factor. The positive association between functional impairments and stress was weaker for persons reporting high CSE compared with those reporting low CSE. The findings provide implications for rehabilitation counseling practices by promoting CSE and environmental supports in improving rehabilitation and psychosocial outcomes for individuals with MS.

Personal, health and function, and career maintenance factors as determinants of quality of life among employed people with multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is an intrusive disease that significantly affects labor force participation.

OBJECTIVE

This study examined the extent to which factors at the personal, health and function, and environmental/career maintenance levels contribute to the predictability power for quality of life among employed people with MS.

METHOD

Participants consisted of 523 members of nine National Multiple Sclerosis Society chapters representing 21 states and Washington, DC. These individuals were employed at the time of the survey, and they were primarily middle age (average age of 48 years) and Caucasian (74%).

RESULTS

The final hierarchical multiple regression model explained 54 percent of the variability in participants' quality of life scores, although none of the hypothesized personal/demographic predictors were significant. Participants who perceived better overall health and lower levels of stress, who experienced less severe cognitive and mobility-related MS symptoms, and who expressed stronger job-person matches and higher levels of job satisfaction reported higher quality of life scores than did other participants.

CONCLUSIONS

The findings underscore the complexity involved in predicting perceived quality of life among employed people with MS. Implications of these findings for future research and clinical practice are discussed.

The employment impact of the COVID-19 pandemic on Americans with MS: Preliminary analysis

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has been associated with unprecedented social and economic impacts in the United States, including significant cuts to the labor force, beginning in the spring of 2020. OBJECTIVE: In this study we examined the employment effects of the pandemic on Americans with multiple sclerosis (MS), a population that has historically experienced low rates of employment relative to the general population. METHODS: Based on a survey of a convenience sample of 69 members of the National Multiple Sclerosis Society, we examined employment, health, and economic experiences between May and August, 2020. RESULTS: The results suggest potentially significant job loss. Specifically, in the present sample approximately 20% of participants who were previously employed reported losing employment as a result of the pandemic, and approximately 40% reported other work changes. At elevated risk for job loss were those with lower levels of education, African American workers, and workers reporting Hispanic, Latinx, or Spanish origin. Almost two-thirds of the participants reported that the pandemic had affected their financial status and over half (53.6%) reported that the pandemic had affected their ability to access their MS healthcare. CONCLUSION: We discuss the implications and potentially lasting effects of the current, complex employment situation faced by Americans living with MS, and the broader considerations for vocational rehabilitation professionals.

The Relationship Among Demographic Factors, Transition Services, and Individual Development Account (IDA) Saving Participation Among Transition-Age Youth With Disabilities

Saving participation in adolescence is crucial for young adults to achieve financial well-being over their lifetime. Yet, very little is known about the factors that encourage saving participation among youth with disability, including youth who receive supplemental security income (SSI). This study examines relationships between personal and family factors, transition services, and participation in Wisconsin Promoting Readiness of Minors in Supplemental Security Income (PROMISE) individual development account (IDA), within a sample of youth with disabilities who receive SSI. Results of the hierarchical binary logistic and hierarchical multiple regression analyses suggests that the PROMISE interventions variable sets emerged as the most frequent predictors of IDA saving participation among youth receiving SSI. Specifically, work incentive benefits consultation services, financial capability-focused financial coaching services, and self-advocacy training were significant predictors of a youth’s IDA saving participation. This study’s findings offer important implications for transition planning and building financial capability.

A Population-Based Investigation of Health-Care Needs and Preferences in American Adults With Multiple Sclerosis

Background

Comprehensive and effective multiple sclerosis (MS) health care requires understanding of patients' needs, preferences, and priorities.

Objective

To evaluate priorities of patients with MS for their MS care.

Methods

Participants included 3003 Americans with MS recruited through the National MS Society and the North American Research Committee on Multiple Sclerosis patient registry. Participants completed a comprehensive questionnaire on aspects of their health-care experiences.

Results

Participants identified the top 3 health-care priorities as (1) the affordability of MS health care, (2) ensuring that non-MS health-care providers have more education about MS and how it can interact with other conditions, and (3) access to an MS center or specialized MS clinic with MS health-care professionals together in one place. Participants receiving care in an MS center rated the quality and their satisfaction with care higher than those receiving care in other settings. Although having the opportunity to evaluate their health-care quality was important to the participants, only 36.4% had been provided the opportunity in the past year.

Conclusions

This study identifies health-care priorities and concerns for Americans with MS.

Working Alliance and Stages of Change for Employment: The Intermediary Role of Autonomous Motivation, Outcome Expectancy and Vocational Rehabilitation Engagement

Purpose Working alliance is one of the most important common factors for successful counseling/psychotherapy outcomes. Based on the empirical literature about working alliance, it seems that self-determination and self-efficacy theory (SDT/SET) can potentially be used as a motivational model to explain the relationship between working alliance and vocational rehabilitation (VR) outcomes. The purpose of this study is to evaluate three primary SDT/SET constructs, autonomous motivation, expectancy and engagement, as mediators for the relationship between working alliance and stages of change (SOC) for employment. Methods A serial multiple mediation analysis (SMMA) was computed to evaluate autonomy, outcome expectancy, and VR engagement as mediators of the relationship between working alliance and SOC for employment in a sample of 277 people with chronic illness and disability (CID) receiving services from state VR agencies in the United States. Results The SMMA results indicated that working alliance was positively associated with SOC for employment (total effect), while the direct effect between working alliance and SOC for employment was not significant after controlling for the effects of the mediators, indicating significant mediation effects. The mediation effects were estimates of the indirect effects for working alliance on SOC for employment through (a) autonomous motivation, (b) outcome expectancy, (c) VR engagement, and (d) autonomous motivation, outcome expectancy and VR engagement together. Conclusions The results indicated that a strong working alliance has the benefit of helping consumers develop autonomous motivation to work and increasing their vocational outcome expectancy and engagement in VR services, leading to employment.

Empirically Derived Test Specifications for the Certified Rehabilitation Counselor Examination: Revisiting the Essential Competencies of Rehabilitation Counselors

The purpose of this article is to examine the results of the certified rehabilitation counselor (CRC) knowledge validation study conducted in collaboration with the Commission on Rehabilitation Counselor Certification (CRCC). The research design for the present study includes both descriptive and ex post facto approaches. Three hundred ninety-four CRCs completed the Knowledge Validation Inventory–Revised (KVI-R) survey. Factor analysis results revealed six knowledge domains: (a) rehabilitation and mental health counseling, (b) employer engagement and job placement, (c) case management, (d) medical and psychosocial aspects of chronic illness and disability, (e) research methodology and evidence-based practice, and (f) group and family counseling. The findings of this study provide important information for CRCC to examine and develop test and item specifications that will guide future versions of the CRC examination. The findings also inform the description of the knowledge base underlying the practice of rehabilitation counseling and contribute further empirical evidence regarding the knowledge domains identified in this replication and extension of the previous study completed in 2012.

Barriers to the Accessibility and Continuity of Health-Care Services in People with Multiple Sclerosis: A Literature Review

Background

Individuals with multiple sclerosis (MS) face a range of barriers to accessing and using health-care services. The aim of this review was to identify specific barriers to accessing and using health-care services based on a continuum of the health-care delivery system.

Methods

Literature searches were conducted in the PubMed, PsycINFO, CINAHL, and Web of Science databases. The following terms were searched as subject headings, key words, or abstracts: health care, access, barriers, physical disability, and multiple sclerosis. The literature search produced 361 potentially relevant citations. After screening titles, abstracts, and citations, eight citations were selected for full-text review.

Results

Health-care barriers were divided into three continuous phases of receiving health care. In the before-visit phase, the most commonly identified barrier was transportation. In the during-visit phase, communication quality was the major concern. In the after-visit phase, discontinued referral was the major barrier encountered.

Conclusions

There are multiple interrelated barriers to accessing and using health-care services along the health-care delivery continuum for people with MS and its associated physical disabilities, ranging from complex and long-recognized barriers that will likely require extended advocacy to create policy changes to issues that can and should be addressed through relatively minor changes in health-care delivery practices, improved care coordination, and increased provider awareness, education, and responsiveness to patients' needs.

Prevalence of pain in the departments of surgery and oncohematology of a paediatric hospital that has joined the project "Towards pain free hospital"

BACKGROUND

Among hospitalized adults and children pain is undertreated. This study wants to assess the effectiveness of pain therapy in two departments of a large children's hospital.

MATERIALS AND METHODS

During a single day work three committees, administering a questionnaire to patients or parents, have evaluated the adherence to international recommendations (JCI and WHO) in the management of analgesic therapy. Patient demographics, prevalence and intensity (moderate and/or severe) of pain (during hospitalization, 24 hours before and at the time of the interview), analgesia (type, route, duration and frequency of administration) and Pain Management Index (=analgesic score-pain score) were recorded.

RESULTS

75 patients participated in the study (age: 2 months up to 24 years, mean 7.8 ± 6). During hospitalization 43 children (57%) had no pain while 32 (43%) have experienced pain. 22 children (29 %) had pain 24 hours before and 12 (16%) at the time of the interview. The average value of the PMI was -0.8±1.3 with a minimum of -3 and a maximum of +2: 60% (19) of the children had a PMI less than 0 (undertreated pain) while 40% (13) had a value=or>0. Out of 32 patients who needed an analgesic therapy 14 (44%) received an around-the-clock dosing, 8 (25%) an intermittent therapy and 10 (31%) no treatment.17 (77 %) were the single drug therapy and 5 (23%) the multimodal ones.

CONCLUSIONS

The prevalence of pain in the two departments is high. The main cause is that knowledge is not still well translated into clinical practice.

Wellness and multiple sclerosis: The National MS Society establishes a Wellness Research Working Group and research priorities

Background:

People with multiple sclerosis (MS) have identified “wellness” and associated behaviors as a high priority based on “social media listening” undertaken by the National MS Society (i.e. the Society).

Objective:

The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda.

Method:

The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness.

Results:

That process informed a group-mediated activity for developing and prioritizing research goals for wellness in MS. This served as a background for articulating the mission and objectives of the Society’s Wellness Research Working Group.

Conclusion:

The primary mission of the Wellness Research Working Group is the provision of scientific evidence supporting the application of lifestyle, behavioral, and psychosocial approaches for promoting optimal health of mind, body, and spirit (i.e. wellness) in people with MS as well as managing the disease and its consequences.

Quality of life among people with multiple sclerosis: Replication of a three-factor prediction model

BACKGROUND

This article presents a replication of Rumrill, Roessler, and Fitzgerald's 2004 analysis of a three-factor model of the impact of multiple sclerosis (MS) on quality of life (QOL). The three factors in the original model included illness-related, employment-related, and psychosocial adjustment factors.

OBJECTIVE

To test hypothesized relationships between QOL and illness-related, employment-related, and psychosocial variables using data from a survey of the employment concerns of Americans with MS (N = 1,839).

METHODS

An ex post facto, multiple correlational design was employed incorporating correlational and multiple regression analyses.

RESULTS

QOL was positively related to educational level, employment status, job satisfaction, and job-match, and negatively related to number of symptoms, severity of symptoms, and perceived stress level. The three-factor model explained approximately 37 percent of the variance in QOL scores.

CONCLUSIONS

The results of this replication confirm the continuing value of the three-factor model for predicting the QOL of adults with MS, and demonstrate the importance of medical, mental health, and vocational rehabilitation interventions and services in promoting QOL.

Determinants of Employment Status Among a Community-Based Sample of People with Epilepsy

People with epilepsy may face a number of complex and interacting problems and barriers related to employment. Understanding these barriers is an important step toward implementing effective rehabilitation interventions. This article explores the factors that predicted employment status among a community-based sample of adults with epilepsy. Data for the analysis were collected from 146 adults with epilepsy through Epilepsy Foundation chapters in Wisconsin, Kentucky, and Ohio. Several demographic and epilepsy-related variables were analyzed to explore the determinants of employment status. Results of a binary logistic regression analysis suggest that gender, number of antiepilepsy medications used, seizure frequency, and reported interference in daily functioning created by seizures were the best predictors of employment. Additional analyses suggested that the possession of a driver's license was also associated with employment status. The results are discussed in terms of their implications for rehabilitation-based intervention.

Quality of Life Among Adults with Epilepsy

The last 20 years has seen an increased interest in identifying the factors that affect quality of life for individuals with epilepsy. The great majority of this research has focused on the impact of medical interventions on quality of life. At the same time, increased understanding has developed regarding the significant impact that physical, social, and psychological factors make on the quality of life and life satisfaction of people with epilepsy. In an effort to better understand the relationships of the physical and psychosocial factors to each other and to quality of life among people with epilepsy, the authors developed and evaluated an exploratory model. The results have implications for rehabilitation professionals who work with people with epilepsy.

Patterns in workplace accommodations for people with multiple sclerosis to overcome cognitive and other disease-related limitations

BACKGROUND

Cognitive symptoms and other functional limitations associated with multiple sclerosis (MS) have a significant negative impact on employment status. Work accommodations positively impact the ability of a person with MS to obtain and retain employment, however, current understanding of the role of accommodations in the careers of adults with MS is limited.

OBJECTIVE

To analyze the percentage of American workers with MS who utilize workplace accommodations as per Title I of the ADA, the types of accommodations most frequently required, and differences in disease variables, job-related factors, and quality of life between workers using and not using work accommodations.

METHODS

Data from 746 employed adult members of the National MS Society surveyed about career concerns were analyzed. Descriptive and inferential statistics were used as appropriate to address the research questions.

RESULTS

Approximately 25% reported having requested accommodations, and 87.7% reported receiving the requested accommodation. Participants with progressive MS, cognitive impairment, higher number of MS symptoms and greater symptom severity were more likely to use work accommodations. Participants with accommodations reported poorer job match and career optimism than those using no accommodations.

CONCLUSION

This large-scale analysis addresses several outstanding questions concerning work accommodations among workers with MS. Cognitive symptoms and disease severity are strongly associated with need for accommodations, however accommodations do not appear to promote job satisfaction or longevity. The accommodation request process and the impact of accommodations on employment retention remain important research foci.

Home functioning profiles in people with multiple sclerosis and their relation to disease characteristics and psychosocial functioning

BACKGROUND

For people with multiple sclerosis (MS), limitations in performing activities of daily living can have a significant impact on personal independence, residential safety, and quality of life. In this study we explored the utility of the Home Functioning Scale in identifying home functioning profiles and generating rehabilitation interventions.

OBJECTIVE

The objective of this study was to determine whether distinctive and meaningful home functioning profiles could be identified among adults with MS based on Home Functioning Scale scores.

METHODS

Home Functioning Scale scores and additional data from a representative national sample of 3,834 adults were analyzed. We used cluster analysis and MANOVA to identify and evaluate group differences.

RESULTS

Three distinct home functioning profiles emerged in the analysis: (1) minimal impairment (31.1% of participants); (2) moderate impairment (52.4%); and (3) severe impairment (16.5%). The three groups exhibited significant differences on demographic and MS related characteristics, perceived cognitive function, perceived MS impact on physical and psychological function, and life satisfaction.

CONCLUSION

The profile characteristics of the identified groups are presented and the implications of the results for rehabilitation practitioners and the investigation of home functioning in activities of daily living are discussed.

No evidence of asymptomatic variant CJD infection in immunodeficiency patients treated with UK-sourced immunoglobulin

Surveillance of 75 immunodeficiency patients exposed to UK-sourced immunoglobulin, including batches derived from donors who went on to develop vCJD, has not detected any clinical cases of vCJD, or of asymptomatic infection in 15 patients with available tissue samples of sufficient quality for testing.

Cross-sectional analysis of the dermoscopic patterns and structures of melanocytic naevi on the back and legs of adolescents

BACKGROUND

Junctional (flat) naevi predominate on the extremities, whereas dermal (raised) naevi are found primarily on the head, neck and trunk. Few studies have investigated the anatomical site prevalence of melanocytic naevi categorized using dermoscopy.

OBJECTIVES

To identify the prevalence of dermoscopic patterns and structures of naevi from the back and legs of adolescents.

METHODS

Dermoscopic images of acquired melanocytic naevi were obtained from the back and legs of students from a population-based cohort in Framingham, Massachusetts. Naevi were classified into reticular, globular, homogeneous or complex dermoscopic patterns. Multinomial logistic regression modelling assessed the associations between dermoscopic pattern and anatomical location.

RESULTS

In total 509 participants (mean age 14 years) contributed 2320 back naevi and 637 leg naevi. Compared with homogeneous naevi, globular and complex naevi were more commonly observed on the back than the legs [odds ratio (OR) 29·39, 95% confidence interval (CI) 9·53-90·65, P < 0·001 and OR 6·8, 95% CI 2·7-17·14, P < 0·001, respectively], whereas reticular lesions were less likely to be observed on the back than on the legs (OR 0·67, 95% CI 0·54-0·84, P = 0·001). Naevi containing any globules were more prevalent on the back than on the legs (25% vs. 3·6%, P < 0·001). Naevi containing any network were more prevalent on the legs than on the back (56% vs. 40·6%, P < 0·001).

CONCLUSIONS

These findings add to a robust body of literature suggesting that dermoscopically defined globular and reticular naevi represent biologically distinct naevus subsets that differ in histopathological growth pattern, age- and anatomical-site-related prevalence, molecular phenotype and aetiological pathways.

Family Needs After Traumatic Brain Injury: Implications for Rehabilitation Counselling

Family involvement in the rehabilitation counselling process is increasingly being recognised as an important component of rehabilitation success. This may be particularly true for persons who have an acquired or traumatic brain injury (TBI). For such individuals the emotional and psychosocial functioning of their family and caregivers has been associated with a variety of functional, psychosocial, and employment outcomes. Addressing the needs of family members is an important component of providing effective rehabilitation counselling services, but one that has received little attention in the rehabilitation counselling literature. This article reviews current research on the frequently identified needs of families and caregivers of persons with TBI, the family and situational variables that have been explored for their relationship to family needs, and the extent to which these needs are met. Clinical and research implications for rehabilitation counsellors are identified.