Associations among quality of life, activities, and participation in elderly residents with joint contractures in long-term care facilities: a cross-sectional study.

BACKGROUND: Joint contractures and degenerative osteoarthritis are the most common joint diseases in the elderly population, can lead to limited mobility in elderly individuals, can exacerbate symptoms such as pain, stiffness, and disability, and can interfere with social participation and quality of life, thus affecting mental health. However, relevant studies on this topic are very limited. This study describes the associations of joint contracture categories and sites in elderly residents in long-term care facilities with their quality of life, activities, and participation. METHODS: Elderly individuals with joint contractures who were residents in long-term care facilities were recruited. The World Health Organization (WHO) Quality of Life and the WHO Disability Assessment Schedule 2.0 were used to survey the participants. Correlations, multiple linear regressions, and multiple analyses of variance, with joint contractures as the response variable, were used in the statistical analysis. RESULTS: The final statistical analysis included 232 participants. The explanatory power of contracture sites on activities and participation had a moderate strength of association (η2 = .113). Compared with elderly residents with joint contractures and osteoarthritis isolated to the upper limbs, those with joint contractures and osteoarthritis in both the upper and lower limbs had significantly worse activity and participation limitations. No significant differences in activity and participation were found between elderly residents with joint contractures affecting only the upper limbs and those with joint contractures affecting only the lower limbs (F1,226 = 2.604 and F1,226 = 0.674, nonsignificant). Osteoarthritis had the greatest impact on activity limitations and participation restrictions among elderly residents with joint contractures affecting both the upper and lower limbs (F1,226 = 6.251, p = .014). CONCLUSIONS: Elderly residents in long-term care facilities belonging to minority groups, with a history of stroke, and with osteoarthritis are at a high risk of developing activity limitations and participation restrictions. Moreover, compared with other contraction sites, regardless of osteoarthritis, joint contractures affecting both the upper and lower limbs were associated with the greatest activity limitations and participation restrictions. TRIAL REGISTRATION: This study has been registered in the Chinese Clinical Trial Registry, registration number and date: ChiCTR2000039889 (13/11/2020).

Predictors of Employment Status for Persons with Bipolar Disorder.

Bipolar disorder is characterized by manic and depressive episodes and can be a lifetime condition. Bipolar disorder has been found to be associated with various types of disabilities, including low employment rate and high dependence on public aid. The purpose of this study is to identify factors related to being employed for persons with bipolar disorder. Nine thousand eight hundred and eighty-six subjects with bipolar disorder were collected between July of 2012 and November of 2013 and retrieved from Taiwan national disability database on May of 2014. The mean age of the sample is 45.41 (SD = 10.5), with 64% as female. Logistic regression was used to examine the log odds of the predictive variables on outcome of employment. A Receiver Operating Characteristics analysis was applied to locate the cutoff score of World Health Organization Disability Assessment Schedule 2.0 for being employed. All demographic variables were found to be significantly correlated with employment status among subjects. The Receiver Operating Characteristics results revealed that those subjects whose scores were below 33.57 had about a four-fold higher probability of being in employment than those whose scores were above 33.57. The result provides insights into future research effort and intervention design aimed at helping persons with bipolar disorder to obtain gainful employment.

Psychometric validation of the Chinese version of the PaArticular Scales among elderly residents in long-term care facilities with joint contractures.

BACKGROUND: Joint contractures, which affect activity, participation, and quality of life, are common complications of neurological conditions among elderly residents in long-term care facilities. This study examined the reliability and validity of the Chinese version of the PaArticular Scales in a population with joint contractures. METHODS: A cross-sectional study design was used. The sample included elderly residents older than 64 years with joint contractures in an important joint who had lived at one of 12 long-term care facilities in Taiwan for more than 6 months (N = 243). The Chinese version of the PaArticular Scales for joint contractures was generated from the English version through five stages: translation, review, back-translation, review by a panel of specialists, and a pretest. Test-retest reliability, internal consistency reliability, construct validity, and criterion validity were evaluated, and the results were compared with those for the World Health Organization Quality of Life scale and the World Health Organization Disability Assessment Schedule. RESULTS: The Chinese version of the PaArticular Scales had excellent reliability, with a Cronbach α coefficient of 0.975 (mean score, 28.98; standard deviation, 17.34). An exploratory factor analysis showed three factors and one factor with an eigenvalue > 1 that explained 75.176 and 62.83 % of the total variance in the Activity subscale and Participation subscale, respectively. The subscale-to-total scale correlation analysis showed Pearson correlation coefficients of 0.881 for the Activity subscale and 0.843 for the Participation subscale. Pearson's product-moment correlation revealed that the correlation coefficient (r) between the Chinese version of the PaArticular Scales and the World Health Organization Disability Assessment Schedule was 0.770, whereas that for the World Health Organization Quality of Life scale was - 0.553; these values were interpreted as large coefficients. CONCLUSIONS: The underlying theoretical model of the Chinese version of the PaArticular Scales functions well in Taiwan and has acceptable levels of reliability and validity. However, the Chinese version must be further tested for applicability and generalizability in future studies, preferably with a larger sample and in different clinical domains.

Examining the validity and reliability of the revised developmental work personality scale (RDWPS)-traditional Chinese version.

BACKGROUND: Work personality was found to relate to successful work adjustment, job readiness, work motivation and job maintenance. The revised developmental work personality scale (RDWPS) is a self-reported assessment to evaluate the work personality of the examinee which further psychometric study is required and needs to be applied to different culture. The aim of this study was to examine the theoretical structure, validity, and reliability of the traditional Chinese version of the RDWPS. METHODS: The subjects were 113 university students with no known physical or mental illness who aged between 19 and 22. Cluster analysis was used to examine the theoretical structure. Rasch analysis was applied to examine the psychometric properties. RESULTS: We dropped the unfit three items and found the 11 items of traditional Chinese version of the RDWPS was adequate to fit the theoretical construct. The results of the Rasch analysis showed that the 11 items with a three-point rating scale of the traditional Chinese version of the RDWPS had acceptable internal consistency (α = 0.76), moderate reliability, and met the criteria of unidimensionality. CONCLUSIONS: The results of this study provided initial evidence that the traditional Chinese version of the RDWPS can be readily applied to research related to work behavior for those whose primary language is traditional Chinese, with adequate reliability and validity.

Quality of life outcomes for people with serious mental illness living in supported accommodation: systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis of quality of life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation. METHODS: Studies were identified that described QoL outcomes for people with serious mental illness living in supported accommodation in six electronic databases. We applied a random-effects model to derive the meta-analytic results. RESULTS: 13 studies from 7 countries were included, with 3276 participants receiving high support (457), supported housing (1576) and floating outreach (1243). QoL outcomes related to wellbeing, living conditions and social functioning were compared between different supported accommodation types. Living condition outcomes were better for people living in supported housing ([Formula: see text]= - 0.31; CI = [- 0.47; - 0.16]) and floating outreach ([Formula: see text]= - 0.95; CI = [- 1.30; - 0.61]) compared to high-support accommodation, with a medium effect size for living condition outcomes between supported housing and floating outreach ([Formula: see text]= - 0.40; CI = [- 0.82; 0.03]), indicating that living conditions are better for people living in floating outreach. Social functioning outcomes were significant for people living in supported housing compared to high support ([Formula: see text] = - 0.37; CI = [- 0.65; - 0.09]), with wellbeing outcomes not significant between the three types of supported accommodation. CONCLUSION: There is evidence that satisfaction with living conditions differs across supported accommodation types. The results suggest there is a need to focus on improving social functioning and wellbeing outcomes for people with serious mental illness across supported accommodation types.

The study of the validity and reliability of the Occupational Self-Assessment-traditional Chinese version.

INTRODUCTION: Health professionals who work in mental healthcare settings need to use standardised, objective instruments; however, it is also extremely important that they maintain a client-focused perspective. The purpose of this study was to investigate the validity and reliability of the 'Traditional Chinese version of the Occupational Self-Assessment' (TC-OSA). METHODS: A total of 593 participants with mental illnesses participated in the study. The data were analysed using confirmatory factor analysis as well as the Rasch measurement model. RESULTS: The results of our analysis revealed that the TC-OSA encompasses four domains: self-performance (11 items), self-habituation (5 items), self-volition (5 items) and environment (8 items). Most of the items within each domain were found to have a good fit with the Rasch measurement model, whereas the CFA index was found to have a good fit for only three of the domains, the one exception being the environment domain. CONCLUSIONS: We suggest applying the scale in clinical practice to identify the priority of intervention and as a measure for changes in outcomes. Further development and refinement of the environmental domain is guaranteed.

Determinants of Employment Outcome for the People with Schizophrenia Using the WHODAS 2.0.

Purpose Since the vocational outcomes of people with schizophrenia should be viewed in a holistic way, the second edition of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) might provide an evaluation regarding employment potential. To determine whether the WHODAS 2.0 scores can be used to predict employment status, we examined the probabilistic cut-off values of the scores and analyzed the relationship between work status and demographic characteristics. Methods We selected 31,793 people aged between 18 and 65 with schizophrenia or schizoaffective disorder from the disability evaluation database in Taiwan and separated them into two groups based on employment status (employed and unemployed). We used logistic regression to explore the association between employment and demographic characteristics. Moreover, we conducted a receiver operating characteristic (ROC) analysis to determine the cut-off point to assist in determining employment potential based on the WHODAS 2.0 score. Results Among the 31,793 participants, 3367 were employed and 18,801 were unemployed. The unemployed participants accounted for a higher percentage of disability in each domain of the WHODAS. The ROC analysis revealed that the optimal cut-off point of the WHODAS score to distinguish the people who were employed and unemployed was 25.78 (area under curve = 0.80). Conclusions The present study indicated that work status can be determined by the total score across the six domains of the WHODAS score. Furthermore, the probability of employment may be determined initially by the cut-off point of the WHODAS score in order to economize evaluation time and prepare prevocational training for those with scores above 25.78.

Reliability and validity of the self-reported Activities of Daily Living Scale for people with mental illness.

BACKGROUND/OBJECTIVES: Patient-reported outcome measures have been found to be an effective method of reflecting client perspectives on their personal health condition. The primary aim of this study was to determine the reliability and validity of the self-reported Activities of Daily Living Scale (sf-ADLS) using Rasch analysis in Taiwan. METHODS: A total of 455 people were included in this study; 224 were persons with mental illness and 231 were healthy adults. We applied Rasch analysis as the means of testing the psychometrics of the scale. RESULTS: The final version of the sf-ADLS used in this study included 14 items, with no differential item functioning being discernible on the gender variable. The scale was found to be of use in classifying the subjects into four levels of independence. CONCLUSIONS: The revised sf-ADLS conforms to the Rasch measurement model in the formulation of a unidimensional scale. The scale can be used to measure the level of independence with acceptable reliability (internal consistency as 0.9) and validity.

Life Adaptation Skills Training (LAST) for persons with depression: A randomized controlled study.

BAKGROUND: To investigate the efficacy of the "Life Adaptation Skills Training (LAST)" program for persons with depression. METHODS: Sixty-eight subjects with depressive disorder were recruited from psychiatric outpatient clinics in Taipei city and were randomly assigned to either an intervention group (N=33), or a control group (N=35). The intervention group received 24-sessions of the LAST program, as well as phone contact mainly related to support for a total of 24 times. The control group only received phone contact 24 times. The primary outcome measure utilized was the World Health Organization Quality of Life-BREF-Taiwan version. Secondary outcome measures included the Occupational self-assessment, the Mastery scale, the Social support questionnaire, the Beck anxiety inventory, the Beck depression inventory-II, and the Beck scale for suicide ideation. The mixed-effects linear model was applied to analyze the incremental efficacy of the LAST program, and the partial eta squared (ηp(2)) was used to examine the within- and between- group effect size. RESULTS: The subjects who participated in the LAST program showed significant incremental improvements with moderate to large between-group effect sizes on their level of anxiety (-5.45±2.34, p<0.05; ηp(2)=0.083) and level of suicidal ideation (-3.09±1.11, p<0.01; ηp(2)=0.157) when compared to the control group. The reduction of suicidal ideations had a maintenance effect for three months after the end of intervention (-3.44±1.09, p<0.01), with moderate between-group effect sizes (ηp(2)=0.101). Both groups showed significant improvement on overall QOL, overall health, physical QOL, psychological QOL, level of anxiety, and level of depression. The within-group effect sizes achieved large effects in the intervention group (ηp(2)=0.328-0.544), and were larger than that of the control group. LIMITATIONS: A small sample size in the study, a high dropout rate, lower compliance rates for the intervention group, and lacking of true control group. CONCLUSIONS: The occupation-based LAST program, which focuses on lifestyle rearrangement and coping skills enhancement, could significantly improve the level of anxiety and suicidal ideations for persons with depression.

Examining the validity and reliability of the Taita symptom checklist using Rasch analysis.

BACKGROUND/PURPOSE: The Taita symptom checklist (TSCL) is a standardized self-rating psychiatric symptom scale for outpatients with mental illness in Taiwan. This study aimed to examine the validity and reliability of the TSCL using Rasch analysis. METHODS: The TSCL was given to 583 healthy people and 479 people with mental illness. Rasch analysis was used to examine the appropriateness of the rating scale, the unidimensionality of the scale, the differential item functioning across sex and diagnosis, and the Rasch cut-off score of the scale. RESULTS: Rasch analysis confirmed that the revised 37 items with a three-point rating scale of the TSCL demonstrated good internal consistency and met criteria for unidimensionality. The person and item reliability indices were high. The TSCL could reliably measure healthy participants and patients with mental illness. Differential item functioning due to sex or psychiatric diagnosis was evident for three items. A Rasch cut-off score for TSCL was produced for detecting participants' psychiatric symptoms based on an eight-level classification. CONCLUSION: The TSCL is a reliable and valid assessment to evaluate the participants' perceived disturbance of psychiatric symptoms based on Rasch analysis.

Psychometric properties of the Mastery Scale-Chinese version: applying classical test theory and Rasch analysis.

AIMS: This study examines the reliability and validity of the Mastery Scale-Chinese version (MS-C) when applied to three groups diagnosed with major depression, schizophrenia, or HIV/AIDS. METHODS: The individuals participating in the study were recruited from outpatient units of a medical center and a municipal hospital in northern Taiwan. The study sample (n = 2009) included 237 patients with depressive disorders, 160 with schizophrenia, and 1612 with HIV/AIDS. The reliability and construct validity of the MS-C was evaluated by confirmatory factor analysis (CFA) and Rasch analysis. RESULTS: The results of the CFA showed that the MS-C has adequate construct validity with all indices meeting the criteria, except for chi-square values. The Rasch analysis supported the four-point rating scale structure and a unidimensional construct of the MS-C. The DIF analysis showed that all items demonstrated stable measurement properties among the different diagnosis groups (major depression, schizophrenia, HIV/AIDS). CONCLUSION: This study found that MS-C has acceptable psychometric qualities in terms of reliability, construct validity, rating scale performance, and item characteristics when applied to patients with depression, schizophrenia, and HIV/AIDS in Taiwan.

Reliability and validity of the Paediatric Volitional Questionnaire - Chinese version.

OBJECTIVE: The purpose of this study is to examine the psychometric properties of the Chinese version of the Paediatric Volitional Questionnaire (PVQ-C) for use amongst preschoolers in Taiwan. METHODS: Forty preschoolers with developmental delays were randomly selected from northern Taiwan, along with another 40 typically developing preschoolers. The data was analysed using Rasch measurement model for construct validity and classical test theory for item reliability, intra- and inter-rater reliability, and convergent validity. RESULTS: The results indicated the PVQ items of PVQ-C fit into a unidimensional continuum of volition (logit -6.63~3.05) with 2 items representing differential item functioning for diagnostic group. The person-fit statistics showed that 83% participants' response could be appropriately estimated and stratified (separation index = 1.86). Using a modified 3-point rating scale resulted in acceptable item reliability (0.97), intra-rater reliability (0.412-1.0), 86% PVQ items in test-retest reliability > 0.4, and convergent validity (r = 0.562-0.656). CONCLUSIONS: The PVQ-C is regarded as a reliable and valid instrument for assessing the volitional status of children, as a reference for subsequent clinical judgement, and for client-centred intervention programmes and treatment effects.

A longitudinal study of the predictors of quality of life in patients with major depressive disorder utilizing a linear mixed effect model.

We set out in this study to examine a longitudinal dataset using a linear mixed effects model. Our ultimate aim is to identify predictors of the quality of life (QOL) domains and items amongst patients suffering from major depressive disorders. Four categories of variables are included in our analysis, composed of 'personal predisposition', 'psychosocial', 'illness-related' and 'time', while the outcome variables for this study are the 'physical', 'psychological', 'social' and 'environmental' domains of QOL, in conjunction with all of the items within the scale. A total of 104 subjects from an outpatient clinic of a university-affiliated hospital participated in this longitudinal study, with a one-time follow up being carried out on 70 of these subjects (67.3%) who agreed to participate in the follow-up study. The 'severity of depression', 'sense of competence' and 'sense of mastery', 'use of anti-depressant medication' and 'environmental resources' are found to be significant predictors of the detailed aspects of QOL. Of these, 'symptom severity', 'sense of competence' and 'sense of mastery' were found to occur most often. Finally, the results of the present study demonstrate that 'illness-related' and 'psychosocial' categories are capable of predicting the various QOL domains for patients suffering from depression.

Mastery and stigma in predicting the subjective quality of life of patients with schizophrenia in Taiwan.

A total of 199 outpatients with schizophrenia are assessed in this study for their sense of mastery, stigma, social support, symptom severity, and quality of life (QOL), with path models being used to test the direct and indirect effects of these factors on the physical, psychological, social, and environmental QOL domains. Symptoms, stigma, mastery, and social support are found to be key direct predictors for all 4 QOL domains, with mastery having the greatest direct effect on QOL, whereas stigma has the greatest indirect effect, although mediated by mastery and social support. Such results imply that in nonwestern cultures, mastery and stigma are still crucial factors affecting the QOL of patients with schizophrenia. Our results highlight the importance of enhancing the mastery of such patients and reducing the associated stigma when designing treatment programs. To enhance the QOL of patients with schizophrenia, interventions which can optimize the meaningful use of time may well enhance the mastery of these patients, whereas strategies aimed at improving their ability to cope with perceived stigma, at both individual and community levels, may help to reduce the detrimental effects.

Quality of life for patients with major depression in Taiwan:A model-based study of predictive factors.

The 'quality of life' (QOL) for patients suffering from depression is affected by four factors: stigma, social support, mastery and depressive symptoms. The purpose of this study was to develop and empirically validate an appropriate path model for the QOL of patients suffering from major depression. We recruited a total of 237 patients suffering from depression from the outpatient psychiatry department of a university-affiliated hospital in northern Taiwan. The sample was predominantly female (74.3%), had at least a high school level of education (79.7%), had a mean age of 46.95 years, and were living with their families (87.3%). Path analysis was used to identify the 'best fit' model for the QOL of the patients in four domains: physical, psychological, social and environmental. The key determinant for all QOL domains is found to be the intensity of the depressive symptoms, with social support also affecting QOL both directly and indirectly, whilst stigma is found to have an indirect effect on QOL mediated by the intensity of the depressive symptoms, mastery and social support. We conclude that more effective improvements in all aspects of QOL for patients suffering from depression could be achieved by the provision of comprehensive intervention programs aimed at reducing stigma, as well as placing greater emphasis on a reduction in the patients' depressive symptoms, and enhancements to their social support and mastery.

International efforts to disseminate and develop the model of human occupation.

This paper documents efforts in Canada, France, Finland, Germany, Hispanoamerica, Israel, Japan, The Netherlands, and Taiwan to disseminate the Model of Human Occupation (MOHO). We aim to characterize the challenges involved, the strategies used, and the impact of these efforts in diverse cultural and social conditions.

A psychometric study of the chinese version of the assessment of communication and interaction skills.

This study examined the dependability of the Assessment of Communication and Interaction Skills-Chinese version (ACIS-C) with psychiatric participants in Taiwan. A convenience sample of 101 participants diagnosed with psychiatric illness were recruited from four day-care wards in northern and eastern Taiwan. The results of the Rasch analysis showed that the ACIS-C items coalesced to form a measure of communication/interaction and the 4-point rating scale functioned as intended. The ACIS-C differentiated participants into six levels of communication and interaction skills. The findings support the conclusion that the ACIS-C is a valid and sensitive tool when used with Chinese clients. Moreover the study supports the generalizability of the Model of Human Occupation concept of communication and interaction skills to an Eastern context.

Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization.

As stigmatization has a large impact on patients, therapists need a measure of this impact to provide patients with adequate services. This study, therefore, examined the reliability and validity of the Social Impact Scale (SIS) when applied to three groups of individuals diagnosed with major depression, schizophrenia, or HIV/AIDS. The study sample (N=580) included 237 patients with depressive disorder, 119 with schizophrenia, and 224 with HIV/AIDS. Of these, 56% were men, 45.5% had an elementary school education or less, 48% were employed, and 56% were single. The Rasch measurement model, an item-response theory, was used to analyze the SIS structure and quality. The Rasch model solves several statistical problems of traditional measurement theory, such as misuse of ordinal data as interval data and sample dependence. Rasch analysis indicated that the 24 items of the SIS fit the measurement model. The match between item difficulties and person abilities was adequate. All items showed acceptable rating scale structure. The separation reliability of the scale reached 0.99. The SIS had acceptable psychometric qualities in terms of internal consistency, item validity, person validity, sensitivity, and concurrent validity when applied to patients with depression, schizophrenia, and HIV/AIDS in Taiwan.

The predictive factors for length of stay for stroke patients in Taiwan using the path model.

The aim of this study was to examine the predictive factors, and their relative strengths, for predicting length of rehabilitation stay using the path model. One hundred and seventeen stroke patients were recruited from two rehabilitation units in university-affiliated hospitals in northern Taiwan. The Taiwanese Rehabilitation Database System was used to collect the patient's relevant information. Path analysis was used to explore the relative strengths of each predictive factor. The results showed that the ability to engage in self-care activities was the only direct predictor, whereas subjective well-being and cognitive social skills had an indirect effect on the length of rehabilitation stay, mediating through cognitive-social skills and ability to engage in activities of daily living, respectively. The effect of subjective well-being, mediating through cognitive-social skills, on the length of stay was about 1.5 times that of the effects of ability to engage in self-care activities on length of stay. The results of the study confirmed that the ability of stroke patients to engage in self-care activities consistently had a major impact on the length of stay. The effect of subjective well-being of the patients on the rehabilitation outcome raised the issue of psychosocial rehabilitation as an important part of successful rehabilitation services.

Reliability and validity of the Canadian Occupational Performance Measure for clients with psychiatric disorders in Taiwan.

The purpose of the study was to examine the reliability and validity of the Canadian Occupational Performance Measure (COPM) in Taiwanese clients with psychiatric disorders. The COPM was translated into Mandarin and tested on 141 Taiwanese clients. The average age of the clients was 35.6 years; 94% were diagnosed with schizophrenia. The results of the study showed that the test retest reliability of the COPM was r = 0.842. The COPM identified occupational performance problems that included self-care (37%), productivity (25%), and leisure occupations (20%). Fifty percent of the therapists were receptive in adapting the client-centred approach and applying the COPM in their clinical practice. It was concluded that the COPM can be applied reliably to Taiwanese clients. Furthermore, the COPM was valuable in identifying information related to occupational performance that could not be identified elsewhere. Since 50% of the therapists felt reluctant about the appropriateness of the client-centred approach in their culture, it was important to examine the gap between clients' judgements and actual performance, as well as to evaluate the feasibility of the client-centred concept in clinical practice. Finally, the concept of the client-centred approach needs to be disseminated and communicated to the occupational therapy profession in order that the COPM can be adequately applied in mental health practice.