An examination of the psychometric properties of the community integration questionnaire (CIQ) in spinal cord injury.

OBJECTIVE: To examine the psychometric properties of the Community Integration Questionnaire (CIQ) in large samples of individuals with spinal cord injury (SCI). DESIGN: Longitudinal 12-month survey study. SETTING: Nation-wide, community dwelling. PARTICIPANTS: Adults with SCI: 627 at Time 1, 494 at Time 2. INTERVENTIONS: Not applicable. OUTCOME MEASURES: The CIQ is a 15-item measure developed to measure three domains of community integration in individuals with traumatic brain injury: home integration, social integration, and productive activity. SCI consumer input suggested the need for two additional items assessing socializing at home and internet/email activity. RESULTS: Exploratory factor analyses at Time 1 indicated three factors. Time 2 confirmatory factor analysis did not show a good fit of the 3-factor model. CIQ scores were normally distributed and only the Productive subscale demonstrated problems with high (25%) ceiling effects. Internal reliability was acceptable for the Total and Home scales, but low for the Social and Productive activity scales. Validity of the CIQ is suggested by significant differences by sex, age, and wheelchair use. CONCLUSIONS: The factor structure of the CIQ was not stable over time. The CIQ may be most useful for assessing home integration, as this is the subscale with the most scale stability and internal reliability. The CIQ may be improved for use in SCI by including items that reflect higher levels of productive functioning, integration across the life span, and home- and internet-based social functioning.

Staying physically active after spinal cord injury: a qualitative exploration of barriers and facilitators to exercise participation.

BACKGROUND: While enhancing physical activity has been an essential goal of public health officials, people with physical impairments such as spinal cord injury (SCI) are more likely to live a sedentary lifestyle. Exercise has been shown to decrease the risk for many of the secondary conditions associated with SCI, including osteoporosis, cardiovascular disease, pressure ulcers, urinary tract infections, diabetes and arthritis, yet this population is rarely a target for health promotion efforts. This paper examines the self-reported exercise experiences of people with SCI using a qualitative-exploratory design. METHODS: We enrolled 26 individuals with SCI (15 self-described 'exercisers' and 11 'non-exercisers') from a non-random pool of survey responders. Semi-structured phone interviews were conducted to record participants' experiences with exercise pre/post injury, barriers and facilitators to being active and perceived health impact. RESULTS: Regardless of exercise status, all participants reported physical activity prior to injury and expressed interest in becoming active or maintaining an active lifestyle. Participants identified a range of both motivational and socio-environmental factors that were either facilitating or constraining of such a lifestyle. Non-exercisers identified barriers to exercise, including a perceived low return on physical investment, lack of accessible facilities, unaffordable equipment, no personal assistance and fear of injury. Exercisers identified facilitators, including personal motivation, independence, availability of accessible facilities and personal assistants, fear of health complications, and weight management. Exercisers associated a greater range of specific health benefits with being active than non-exercisers. CONCLUSION: Despite motivation and interest in being exercise active, people with SCI face many obstacles. Removal of barriers coupled with promotion of facilitating factors, is vital for enhancing opportunities for physical activity and reducing the risk of costly secondary conditions in this population.

Care Coordinators in Integrated Care: Burnout Risk, Perceived Supports, and Job Satisfaction.

INTRODUCTION: This study examined burnout risk and job satisfaction reported by care coordinators in three programs integrating physical and behavioral health care; it also assessed the relationship between job support and burnout and the organizational supports helpful to care coordinators. METHODS: As part of an evaluation of the Centers for Medicare & Medicaid Services' Health Care Innovation Awards, the research team performed secondary data analysis of interviews conducted with staff (including care coordinators) in three integrated behavioral health models in 2014 and 2015 (n=88, n=69); focus groups with care coordinators in 2015 (n=3); and a survey of care coordinators in 2015 (n=231) that included the Maslach Burnout Inventory. RESULTS: Analysis of survey data completed in 2017 indicated that although care coordinators felt stressed, they also experienced high levels of job satisfaction, perceived job support, and personal accomplishment, and low levels of disconnection from participants; as a result, risk of burnout was low. Analyses of interview and focus group data identified factors that may have contributed to lowered risk, including (1) appropriate training, particularly on coordinator roles and participants' complex conditions and diverse needs; (2) supportive supervisors and managers; and (3) support from care team members and other coordinators. CONCLUSIONS: Results have implications regarding how organizations can support care coordinators to prevent burnout among these vital members of the integrated care workforce. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The SCI Exercise Self-Efficacy Scale (ESES): development and psychometric properties.

BACKGROUND: Rising prevalence of secondary conditions among persons with spinal cord injury (SCI) has focused recent attention to potential health promotion programs designed to reduce such adverse health conditions. A healthy lifestyle for people with SCI, including and specifically, the adoption of a vigorous exercise routine, has been shown to produce an array of health benefits, prompting many providers to recommend the implementation of such activity to those with SCI. Successfully adopting such an exercise regimen however, requires confidence in one's ability to engage in exercise or exercise self-efficacy. Exercise self-efficacy has not been assessed adequately for people with SCI due to a lack of validated and reliable scales, despite self efficacy's status as one of the most widely researched concepts and despite its broad application in health promotion studies. Exercise self efficacy supporting interventions for people with SCI are only meaningful if appropriate measurement tools exist. The objective of our study was to develop a psychometrically sound exercise self-efficacy self-report measure for people with SCI. METHODS: Based on literature reviews, expert comments and cognitive testing, 10 items were included and made up the 4-point Likert SCI Exercise Self-Efficacy Scale (ESES) in its current form. The ESES was administered as part of the first wave of a nationwide survey (n = 368) on exercise behavior and was also tested separately for validity in four groups of individuals with SCI. Reliability and validity testing was performed using SPSS 12.0. RESULTS: Cronbach's alpha was .9269 for the ESES. High internal consistency was confirmed in split-half (EQ Length Spearman Brown = .8836). Construct validity was determined using principal component factor analysis by correlating the aggregated ESES items with the Generalised Self Efficacy Scale (GSE). We found that all items loaded on one factor only and that there was a statistically significant correlation between Exercise Self-Efficacy Scale (ESES) and Generalised Self Efficacy Scale (GSE) (Spearman RHO = .316; p < .05; n = 53, 2-sided). CONCLUSION: Preliminary findings indicate that the ESES is a reliable instrument with high internal consistency and scale integrity. Content validity both in terms of face and construct validity is satisfactory.

Health and housing among low-income adults with physical disabilities.

The purpose of this study was to understand the impact of living environment on the health and access to health care of low-income working-age adults with physical disabilities. We conducted focus groups of participants with physical disabilities in the District of Columbia living in each of three housing situations (a homeless shelter, a nursing home, and an inaccessible house or apartment). Twenty-eight people participated in the focus groups. Most were male (79%) and African American (93%). Participants from a homeless shelter expressed concerns about accessibility and sanitation at the shelter. Nursing home participants expressed a need for privacy and autonomy that would foster consumer-directed care. Participants living in inaccessible apartments or houses worried about their ability to maintain daily living and social activities. Participants perceived barrier-free housing conditions to be a prerequisite for independent living and for ensuring their basic health and well-being.

State strategies for coordinating Medicaid and housing services.

OBJECTIVE: This article reports findings from case studies of 4 states (Illinois, Louisiana, Massachusetts, and Tennessee) that used different approaches to coordinate Medicaid services with temporary or permanent housing supports for individuals with psychiatric disabilities. METHOD: Data were collected through document review, telephone interviews with state officials and managed care organizations, and site visits to behavioral health and housing providers, and consumer organizations. Qualitative analyses focused on identifying key features of each state's approach, including the strengths and limitations from multiple perspectives. RESULTS: All 4 states facilitated partnerships between behavioral health and housing providers. Each state used managed care strategies to some degree and identified opportunities to use Medicaid to finance the coordination of services with housing providers. These financing strategies included using flexible case rates to fund community support workers; using a 1915(i) state plan amendment to fund intensive Medicaid behavioral health services for those in permanent supportive housing; funding new local entities to support local partnerships between health and housing organizations; and creating a Medicaid supportive housing benefit. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These 4 states took advantage of the flexibility that Medicaid offers to implement different service models in an effort to improve the coordination of behavioral health services and housing. The strategies used in these states may be useful to other states and communities seeking to strengthen coordination of care for individuals who require housing support. (PsycINFO Database Record

Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry.

Individuals with physical disabilities are less likely to utilise primary preventive healthcare services than the general population. At the same time they are at greater risk for secondary conditions and as likely as the general population to engage in health risk behaviours. This qualitative exploratory study had two principal objectives: (1) to investigate access barriers to obtaining preventive healthcare services for adults with physical disabilities and (2) to identify strategies to increase access to these services. We conducted five focus group interviews with adults (median age: 46) with various physically disabling conditions. Most participants were male Caucasians residing in Virginia, USA. Study participants reported a variety of barriers that prevented them from receiving the primary preventive services commonly recommended by the US Preventive Services Task Force. We used a health services framework to distinguish structural-environmental (to include inaccessible facilities and examination equipment) or process barriers (to include a lack of disability-related provider knowledge, respect, and skilled assistance during office visits). Participants suggested a range of strategies to address these barriers including disability-specific continuing education for providers, the development of accessible prevention-focused information portals for people with physical disabilities, and consumer self-education, and assertiveness in requesting recommended services. Study findings point to the need for a more responsive healthcare system to effectively meet the primary prevention needs of people with physical disabilities. The authors propose the development of a consumer- and provider-focused resource and information kit that reflects the strategies that were suggested by study participants.

Matching study designs to disability-related comparative effectiveness research questions.

Comparative effectiveness research can help patients with disabilities; their caregivers and providers determine which healthcare choices are beneficial and will most reduce limitations and barriers, and improve quality of life. Well-designed comparative effectiveness research will be critical as the number of working-age adults affected by disability grows in the future, along with disability-related health expenditures. To better address the need for high-quality and informative research on the effectiveness of interventions for people with disabilities, the authors conducted a comprehensive review of existing standards for assessing evidence quality, collecting input from a wide range of experts and policy makers to determine the type of evidence needed for informing disability-related decision-making and the applicability of existing standards to disability research. This review article presents methodological and design issues for researchers to consider when addressing disability-related comparative effectiveness research questions.

Perceived exercise self-efficacy as a predictor of exercise behavior in individuals aging with spinal cord injury.

OBJECTIVE: The purpose of this study was to test the hypothesized association between exercise self-efficacy and exercise behavior, controlling for demographic variables and clinical characteristics, in a sample of individuals with spinal cord injuries. DESIGN: A cross-sectional national survey of 612 community-dwelling adults with spinal cord injury in the United States ranging from 18 to 89 yrs of age was conducted. Sample consisted of 63.1% men with a mean (SD) duration of 15.8 (12.79) yrs postinjury; 86.3% reported using a wheelchair. RESULTS: Self-efficacy was the only independent variable that consistently predicted all four exercise outcomes. Self-efficacy beliefs were significantly related to frequency and intensity of resistance training (R(2) change = 0.08 and 0.03, respectively; P < 0.01 for all) and aerobic training (R(2) change = 0.07 and 0.05, respectively; P < 0.01 for all), thus explaining between 3% and 8% of the variance. Hierarchical linear regression analysis revealed that controlling for other demographic and physical capability variables, the age-related variables made statistically significant contributions and explained between 1% and 3% of the variance in aerobic exercise frequency and intensity (R(2) change = 0.01 and 0.03, respectively; P < 0.01 for all). Clinical functional characteristics but not demographic variables explained participation in resistance exercise. CONCLUSIONS: Self-efficacy beliefs play an important role as predictors of exercise. Variations in exercise intensity along the age continuum have implications for exercise prescription and composition. Future research should replicate findings with objective activity measures.

Reporting trends of spinal cord injury research representation: a media content analysis.

BACKGROUND: Over the past few decades, medical and technological advances in rehabilitation have improved the lives of people with spinal cord injury (SCI). More recently, promises of embryonic stem cell research has made finding a cure for SCI a real possibility, and the media and public have seemingly focused accordingly. Examining media reporting trends of SCI research can help interested researchers, clinicians, and policy makers understand how such research is framed for the public. OBJECTIVE: We sought to identify potential differences in reporting trends between rehabilitation-focused and cure-focused SCI research and to juxtapose those trends with a timeline of other news events. METHODS: LexisNexis search was performed on 5 U.S. newspapers to identify articles on SCI research between 1998 and 2007. Eligible articles were reviewed and data extracted including type and context of research, referenced institutions, quoted individuals, and other cited news events. RESULTS: The search identified 356 articles on SCI research; 80% were cure focused and mostly referenced in the context of funding or promotion, and 11% were rehabilitation focused and were mostly referenced in the context of ongoing conduction or application of findings. Commonly cited news events included President Bush's 2001 federal funding restriction on embryonic stem cell research and the injury and death of Christopher Reeve. CONCLUSION: Research focused on curing SCI has received more attention by some print media than research aimed at rehabilitating SCI. The context in which each is referenced differs significantly. Cure-focused research may have benefited from a stronger and more prominent coalition of advocates, its political and controversial nature, and the existence of reporting "triggers."