Identifying Chinese Medicine Patterns of Tension-Type Headache and Understanding Its Subgroups.

Tension-type headache (TTH) is common among adults. Individualized management strategies are limited due to lack of understanding of subtypes of TTH. Chinese medicine (CM) uses the pattern differentiation approach to subtype all health conditions. There is, however, a lack of evidence-based information on CM patterns of TTH. This study aimed to identity common CM patterns of TTH. TTH sufferers were invited for a survey, consisting of a validated Chinese Medicine Headache Questionnaire (CMHQ), Migraine Disability Assessment Test, and Perceived Stress Scale. The CMHQ consisted of information about headache, aggravating and relieving factors, and accompanying symptoms. Principal component analysis was used for factor extraction and TwoStep cluster analyses for identifying clusters. ANOVA was used to compare cluster groups with disability and stress. In total, 170 eligible participants took part in the survey. The commonest headache features were continuous pain (64%); fixed location (74%); aggravated by overwork (74%), stress (74%), or mental strain (70%); and relieved by sleeping (78%). The commonest nonpain symptoms were fatigue (71%) and neck stiffness (70%). Four clusters, differing in their key signs and symptoms, could be assigned to three different CM patterns including ascendant hyperactivity of liver yang (cluster 1), dual qi and blood deficiency (cluster 2), liver depression forming fire (cluster 3), and an unlabelled group (cluster 4). Additionally, over 75% participants in clusters 1 and 2 have episodic TTH, over one-third participants in cluster 3 have chronic TTH, and a majority of participants in cluster 4 have infrequent TTH. The three patterns identified also differed in levels of disability and some elements of coping as measured with PSS. The three CM patterns identified are common clinical presentations of TTH. The new information will contribute to further understanding of the subtypes of TTH and guide the development of targeted intervention combinations for clinical practice and research.

Internet Use by People with Intellectual Disability: Exploring Digital Inequality-A Systematic Review.

Many people with intellectual disability experience digital inequality due to a lack of Internet access; this is known as the digital divide. Digital inequality is also apparent when people with intellectual disability have Internet access, but only use it for a small number of applications (e.g., watching videos and playing games). Recently, it has been suggested that digital inequality also occurs in situations where some Internet users are less likely than others to translate their online activities to offline resources, including educational outcomes and social capital. The extent to which people with intellectual disability are translating their online activities to offline resources has not been examined. We conducted a systematic and critical review using PRISMA guidelines. The search strategy terms "intellectual disability" and "Internet use" were used to search the databases: Scopus; Wiley Online Library; Psychiatry Online; Web of Science; CINAHL; and PubMed. Twenty-four studies were found, which described 53 types of Internet use, 48 risks of Internet use, and 28 benefits of Internet use. The data were identified thematically and categorized to facilitate comparisons. The most frequently reported types of Internet use were in the category of social media/social networking (23%), the most common Internet risks were in the category of emotional distress (24%), and the most often reported benefits were in the category of friendships and social connection (33%). The findings indicate that the benefits of Internet use for people with intellectual disability have received much less attention than the risks.

Modality of exercise influences rate of decrease in depression for cancer survivors with elevated depressive symptomatology.

PURPOSE: This three-arm feasibility controlled trial examined whether different exercise modalities provide reductions in depression symptoms to cancer survivors with elevated depression. METHODS: Thirty-two participants (58.9 ± 9.4 years) were allocated to a 12-week supervised exercise group (EX; n = 10), a self-managed home-based exercise group (SMHB; n = 8), or a usual care control group (CONT; n = 14). EX performed two supervised resistance and aerobic sessions per week. SMHB were provided with printed material about benefits of exercise and encouraged to complete 150 min of exercise weekly. CONT received no exercise or printed material and were encouraged to maintain usual activity. RESULTS: A group × time interaction was found for the primary outcome of depression scores, measured using the Hospital Anxiety and Depression Scale (HADS-D; p = .008). SMHB (6.4 ± 5.3 to 2.2 ± 2.9, p = .006) and EX (6.9 ± 4.2 to 4.0 ± 2.4, p = .021) interventions both effectively reduced HADS-D scores compared to CONT (7.2 ± 2.5 to 7.7 ± 3.6). SMHB decreased depression to a greater extent, and this occurred more rapidly with greatest changes noted at 6 weeks (d = 0.50). Further favourable outcomes for exercise were also noted for several secondary outcome measures. CONCLUSION: The rate of exercise-related reduction in depression is influenced by the modality of exercise. However, increasing the duration of the programme appears to diminish the favourable short-term response to self-managed exercise with subsequent secondary outcomes of mental health favouring supervised exercise.

Light sensors for objective light measurement in ambulatory polysomnography.

Ambulatory polysomnography (PSG) does not commonly include an objective measure of light to determine the time of lights off (Loff), and thus cannot be used to calculate important indices such as sleep onset latency and sleep efficiency. This study examined the technical specifications and appropriateness of a prototype light sensor (LS) for use in ambulatory Compumedics Somte PSG.Two studies were conducted. The first examined the light measurement characteristics of the LS when used with a portable PSG device, specifically recording trace range, linearity, sensitivity, and stability. This involved the LS being exposed to varying incandescent and fluorescent light levels in a light controlled room. Secondly, the LS was trialled in 24 home and 12 hospital ambulatory PSGs to investigate whether light levels in home and hospital settings were within the recording range of the LS, and to quantify the typical light intensity reduction at the time of Loff. A preliminary exploration of clinical utility was also conducted. Linearity between LS voltage and lux was demonstrated, and the LS trace was stable over 14 hours of recording. The observed maximum voltage output of the LS/PSG device was 250 mV, corresponding to a maximum recording range of 350 lux and 523 lux for incandescent and fluorescent light respectively. At the time of Loff, light levels were within the recording range of the LS, and on average dropped by 72 lux (9-245) in the home and 76 lux (4-348) in the hospital setting. Results suggest that clinical utility was greatest in hospital settings where patients are less mobile. The LS was a simple and effective objective marker of light level in portable PSG, which can be used to identify Loff in ambulatory PSG. This allows measurement of additional sleep indices and support with clinical decisions.

Exercise Improves Physical Function and Mental Health of Brain Cancer Survivors: Two Exploratory Case Studies.

Background Malignant brain tumors are unpredictable and incurable, with 5-year survival rates less than 30%. The poor prognosis combined with intensive treatment necessitates the inclusion of complementary and supportive therapies that optimize quality of life and reduce treatment-related declines in health. Exercise therapy has been shown to be beneficial in other cancer populations, but no evidence is available for brain cancer survivors. Therefore, we report results from 2 preliminary cases. Methods Two female patients diagnosed with glioblastoma multiforme and oligodendroglioma participated in a structured and supervised 12-week exercise program. The program consisted of two 1-hour resistance and aerobic exercise sessions per week and additional self-managed aerobic sessions. Outcome measures of strength, cardiovascular fitness, and several psychological indicators (depression, anxiety, and quality of life) were recorded at baseline, after 6 weeks and at the conclusion of the intervention. Results Exercise was well tolerated; both participants completed all 24 sessions and the home-based component with no adverse effects. Objective outcome measures displayed positive responses relating to reduced morbidity. Similar positive responses were found for psychological outcomes. Scores on the Hospital Anxiety and Depression Scale showed clinically meaningful improvements in depression and total distress. Conclusion These findings provide initial evidence that, despite the difficulties associated with brain cancer treatment and survivorship, exercise may be safe and beneficial and should be considered in the overall management of patients with brain cancer.

A Preliminary Investigation into Worry about Mental Health: Development of the Mental Health Anxiety Inventory.

BACKGROUND: Worry about physical health is broadly referred to as health anxiety and can range from mild concern to severe or persistent anxiety such as that found in DSM-IV hypochondriasis. While much is known about anxiety regarding physical health, little is known about anxiety regarding mental health. However, recent conceptualizations of health anxiety propose that individuals can experience severe and problematic worry about mental health in similar ways to how people experience extreme worry about physical health. AIMS: Given the paucity of research in this area, the aim of the current study was to explore anxiety regarding mental health through validation of the Mental Health Anxiety Inventory (MHAI), a modified version of the Short Health Anxiety Inventory. METHOD: The MHAI, and measures of state anxiety (Depression, Anxiety and Stress Scales-21), trait worry (Penn State Worry Questionnaire), and health anxiety (Short Health Anxiety Inventory) were administered to 104 adult volunteers from the general community. RESULTS: The MHAI demonstrated high internal consistency, acceptable test-retest reliability, and good construct validity when correlated with other measures of anxiety. Results also indicated that participants worried about their mental health and physical health equally, and that almost 9% of participants reported levels of mental health anxiety that were potentially problematic. CONCLUSION: Preliminary results suggest that a small proportion of adults in the community may experience high levels of mental health anxiety requiring treatment, and that the MHAI, if validated further, could be a useful tool for assessing this form of anxiety.

Chinese students studying at Australian universities with specific reference to nursing students: a narrative literature review.

OBJECTIVE: To report the current knowledge on the Chinese nursing students' learning at Australian universities. The intent is to provide educators and researchers with a background to the contexts, the methodologies, the emphases of various relevant studies, and to provide recommendations for future research. BACKGROUND: Attracting international students has become an important part of Australian universities' business and contributes to their cultural diversity. Teaching international students has received considerable attention in the educational research literature. Experiences of international students can vary greatly depending on their country of origin. This paper critically reviews current literature relating to issues for Chinese students and in particular, Chinese nursing students, the biggest single group of international nursing students at Australian universities DESIGN: Narrative literature review. METHOD: A comprehensive search of seven electronic databases for literature between 2003 and 2014 helped to identify qualitative and quantitative studies that addressed issues of Asian international students with English as a second language (ESL) (included nursing students) studying in Australia, New Zealand, the UK, the United States and China. Pertinent websites were also searched. The reference lists and bibliographies of retrieved articles were hand- searched to identify other relevant studies. RESULTS: Fifteen studies met the inclusion criteria for the review. The majority of existing literature claimed that there is a range of challenges confronting international students including Chinese nursing students, in assimilation into their host country. These include issues with English language proficiency, cultural barriers, social problems, different learning styles, academic demands, perceived racism, homesickness, lack of assertiveness and financial problems. CONCLUSION: There is limited research about the Chinese students' study in Australia. In particular, the learning experience of Chinese nursing students has not been fully explored nor understood. This paper highlights the need for further research into the lived learning experience of Chinese nursing students studying at Australian universities.

Perspectives on the impact on vocal function of heavy vocal load among working professional music theater performers.

Music theater singers (MTS) typically have a heavy vocal load, but the impact on their voices has not been previously evaluated. A group of 49 MTS from two professional productions were administered the Singing Voice Handicap Index (SVHI). Responses for the SVHI demonstrated that, although the SVHI supported the performers' self-report of healthy vocal status, it lacked the sensitivity to detect potential subtle fluctuations or changes in physical functioning of the voice for working singers. Secondarily, descriptive data regarding professional working singers' perspectives were collected regarding how their singing voices typically responded to performing in a music theater production after a show, across a working week, and across a production season. Seventy-nine currently performing MTS were involved in a series of focus group interviews (n=43) or a written survey (n=36) to detail their perception of the impact of performing in an eight-show per week professional production on their vocal function and vocal health. Thematic analysis revealed the MTS commonly perceived transient and variable changes in their singing voice status in both positive and negative directions after heavy vocal load. Based on these data, a list of 97 descriptors of these perceptual changes was generated using the singers' own terminology and experiences. These included symptoms of vocal impairment and vocal fatigue but also some novel descriptors of positive vocal changes to the physical functioning of the singing voice as a perceived consequence of heavy vocal load. This study offers new and valuable insights into performers' perceptions of the impact of performing in a musical theater production on physical aspects of vocal function.

Evaluating the psychometric properties of the attitudes towards depression and its treatments scale in an Australian sample.

BACKGROUND: Individuals' attitudes towards depression and its treatments may influence their likelihood of seeking professional help and adherence to treatment when depressed. Objective measures, such as the Attitudes Towards Depression and its Treatments scale (ATDT), have been developed to assess such attitudes. The aims of this research were to test the reliability and validity of ATDT on an Australian sample who were not depressed during the study or who had previously been depressed, to explore the attitudes of the Australian public towards depression, and to compare these attitudes to those of a Canadian sample of people with depression. METHODS: A sample of 63 males and 140 females (mean age = 32.2 years, SD = 12.9 years) from Melbourne, Australia took part in this study. Fourteen of the males and 52 of the female participants (mean age = 35.4 years, SD = 13.2 years) stated that they had been previously diagnosed with depression. RESULTS: THE ATTITUDES OF THE AUSTRALIAN SAMPLE AND THE SUBSET OF THAT SAMPLE WHO HAD PREVIOUSLY EXPERIENCED DEPRESSION DIFFERED FROM THOSE OF THE CANADIAN OUTPATIENT SAMPLE: they were less ashamed of depression, more likely to take antidepressants and consider psychotherapy, and more likely to seek help from professionals or significant others in their lives. However, those in the Australian sample were more likely to report that antidepressants made them lose control, and they were less willing to consider electric shock as a treatment option for their depression. The internal reliability as measured by Cronbach's alpha was lower in the current study (0.63 and 0.57 for both the general public and the depressed Australian sample) than in the Canadian study. Confirmatory factor analysis failed to replicate the factor structure reported previously. LIMITATIONS: The Australian sample of this study may be underrepresentative due to the sampling methods used, and the high proportion of females should not be overlooked. CONCLUSION: Researchers should be vigilant when utilizing measures constructed in different countries. In comparison to the Canadians, the selected Australian sample had more positive attitudes towards depression and its available treatments. The ATDT scale was not a reliable and valid measure in this sample.

The relationship between insomnia and depressive symptoms: genuine or artifact?

BACKGROUND: Somatic symptom overlap between depression and insomnia has emerged as a major concern. Self-report measures such as the Beck Depression Inventory Second Edition (BDI-II) include somatic symptoms related to depression that are also present in the research diagnostic criteria for insomnia. This study aimed firstly to examine the relationship between the cognitive and somatic factors of the BDI-II and global scores on the Pittsburgh Sleep Quality Index (PSQI) in individuals presenting for insomnia treatment and secondly to examine whether treating insomnia in depressed individuals with insomnia will lead to a reduction in their depressive symptoms and whether this reduction is related to a decrease in the somatic or cognitive factors of depressive symptoms. METHODS: A total of 379 individuals (133 males and 246 females), with a mean (M) age of 49.95 (standard deviation [SD] = 14.15) years, were used to address the first aim. To address the second aim, a total of 64 participants (27 males and 37 females) with both insomnia and depressive symptoms were treated for their insomnia. Their ages ranged between 22 and 87 (M = 50.97, SD = 15.13) years. RESULTS: A significant relationship was found between both the cognitive and somatic factors of the BDI-II and global scores on the PSQI. Furthermore, although results in this study are only suggestive, they lend support to the idea that the relationship between insomnia and depression is not due to somatic symptom overlap. Results may also support the hypothesis that insomnia is primary to the presentation of depressive symptoms. CONCLUSION: Clinicians and health care providers could initially treat insomnia in individuals suffering from insomnia who also experience depressive symptoms, as this will not only remit insomnia but also abate the accompanying depressive symptoms.

Medically unexplained dyspnea: partly moderated by dysfunctional (thoracic dominant) breathing pattern.

BACKGROUND: Dysfunctional breathing (DB) may contribute to disproportionate dyspnea and other medically unexplained symptoms. The extent of dysfunctional breathing is often evaluated using the Nijmegen Questionnaire (NQ) or by the presence of abnormal breathing patterns. The NQ was originally devised to evaluate one form of dysfunctional breathing - hyperventilation syndrome. However, the symptoms identified by the NQ are not primarily due to hypocapnia and may be due to other causes including breathing pattern dysfunction. OBJECTIVES: The relationships between breathing pattern abnormalities and the various categories of NQ symptoms including respiratory or dyspnea symptoms have not been investigated. This study investigates these relationships. METHOD: 62 patients with medically unexplained complaints, that seemed to be associated with tension and breathing dysfunction, were referred, or self-referred, for breathing and relaxation therapy. Dysfunctional breathing symptoms and breathing patterns were assessed at the beginning and end of treatments using the NQ for assessment of DB symptoms, and the Manual Assessment of Respiratory Motion (MARM) to quantify the extent of thoracic dominant breathing. Subscales for the NQ were created in 4 categories, tension, central neurovascular, peripheral neurovascular and dyspnea. Relationships between the NQ (sum scores and subscales) and the MARM were explored. RESULTS: Mean NQ scores were elevated and mean MARM values for thoracic breathing were also elevated. There was a small correlation pre-treatment between MARM and NQ (r=0.26, p<0.05), but classification of subjects as normal/abnormal on both measurements agreed in 74% (p < 0.001) of patients. From the sub scores of NQ only the respiratory or 'dyspnea' items correlated with the MARM values. Dyspnea was only elevated for subjects with abnormal MARM. After treatment, both MARM and NQ returned to normal values (p< 0.0001). Changes in NQ were largest for subjects with abnormal MARM pre-treatment. There was a large interaction between the change in the NQ sub score dyspnea and initial MARM values. (p<0.001).

Relationships between measures of dysfunctional breathing in a population with concerns about their breathing.

BACKGROUND: Dysfunctional breathing (DB) is implicated in physical and psychological health, however evaluation is hampered by lack of rigorous definition and clearly defined measures. Screening tools for DB include biochemical measures such as end-tidal CO(2), biomechanical measures such assessments of breathing pattern, breathing symptom questionnaires and tests of breathing function such as breath holding time. AIM: This study investigates whether screening tools for dysfunctional breathing measure distinct or associated aspects of breathing functionality. METHOD: 84 self-referred or practitioner-referred individuals with concerns about their breathing were assessed using screening tools proposed to identify DB. Correlations between these measures were determined. RESULTS: Significant correlations where found within categories of measures however correlations between variables in different categories were generally not significant. No measures were found to correlate with carbon dioxide levels. CONCLUSION: DB cannot be simply defined. For practical purposes DB is probably best characterised as a multi-dimensional construct with at least 3 dimensions, biochemical, biomechanical and breathing related symptoms. Comprehensive evaluation of breathing dysfunction should include measures of breathing symptoms, breathing pattern, resting CO(2) and also include functional measures such a breath holding time and response of breathing to physical and psychological challenges including stress testing with CO(2) monitoring.

Traditional chinese medicine: an update on clinical evidence.

BACKGROUND: As an alternative medical system, Traditional Chinese Medicine (TCM) has been increasingly used over the last several decades. Such a consumer-driven development has resulted in introduction of education programs for practitioner training, development of product and practitioner regulation systems, and generation of an increasing interest in research. Significant efforts have been made in validating the quality, effectiveness, and safety of TCM interventions evidenced by a growing number of published trials and systematic reviews. Commonly, the results of these studies were inconclusive due to the lack of quality and quantity of the trials to answer specific and answerable clinical questions. OBJECTIVES: The methodology of a randomized clinical trial (RCT) is not free from bias, and the unique features of TCM (such as individualization and holism) further complicate effective execution of RCTs in TCM therapies. Thus, data from limited RCTs and systematic reviews need to be interpreted with great caution. Nevertheless, until new and specific methodology is developed that can adequately address these methodology challenges for RCTs in TCM, evidence from quality RCTs and systematic reviews still holds the credibility of TCM in the scientific community. CONCLUSIONS: This article summarizes studies on TCM utilization, and regulatory and educational development with a focus on updating the TCM clinical evidence from RCTs and systematic reviews over the last decade. The key issues and challenges associated with evidence-based TCM developments are also explored.

Four-item fall risk screening tool for subacute and residential aged care: The first step in fall prevention.

AIM: To report the reliability, accuracy and compliance of a brief fall risk screening tool in subacute and residential aged care. METHOD: A 9-item tool, developed by expert and literature review, was administered to 291 persons admitted to subacute and residential aged care at Peninsula Health (PH) Victoria, Australia. Items were analysed for their ability to predict falls and the four strongest incorporated into a screening tool. Reliability was assessed on six nurses. RESULTS: Most predictive items were recent falls (0.82), psychological status (0.55), medications (0.46) and cognition (0.41) chi(2) (4, n= 291) = 89.89, P < 0.0001. The final 4-item tool (PH-FRAT) provides 80% accuracy (sensitivity(ER) 70.2%, specificity(ER) 68.8%) and high reliability (ICC = 0.79). The PH-FRAT is now used in 50 local subacute and residential facilities. CONCLUSION: The 4-item PH-FRAT is a popular, moderately predictive, reliable and brief method of screening fall risk in subacute and residential aged care.

Self-reported sleep in systemic lupus erythematosus.

The objectives of the study were to assess sleep disturbances in systemic lupus erythematosus (SLE) and to compare these with a working sample and a treatment-seeking sample reporting insomnia. The primary sample was 172 people with SLE. This sample represented 32% of all members of two lupus support association. Two comparison samples were used: 223 adults who expressed interest in taking part in a psychological treatment for sleep problems and 456 Australian adults who were working at a large organization. All individuals completed the Pittsburgh Sleep Quality Index (PSQI; 6). Data derived from the PSQI included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, as well as the global and seven component scores. The SLE sample reported significantly worse sleep on all parameters than the working sample, but significantly better sleep than the sample of those seeking treatment for sleep disorders, except for sleep onset latency. The percentages scoring >5 on the PSQI global score was 80.5% for SLE, 91.5% for those seeking treatment for sleep disorders, and 28.5% for the working sample. PSQI component scores for the SLE group more closely resembled those of the treatment-seeking group. Self-reported sleep in this sample of people with SLE was significantly better on most parameters than that of a group seeking treatment for sleep disorders. However, the values obtained tended to be worse than previous reports and indicated less than optimal sleep. However, the low response rate of the sample was of concern and may indicate that the sample was biased. The present results suggest that sleep disturbance is common in those with SLE and deserves more attention in a more representative sample.

Desired Chinese medicine practitioner capabilities and professional development needs: a survey of registered practitioners in Victoria, Australia.

BACKGROUND: The State of Victoria in Australia introduced Chinese medicine practitioner registration in 2000 and issued its education guidelines in late 2002 for introduction in 2005. This study obtained practitioners' views on desired capabilities for competent Chinese medicine practice and to identify professional development needs. METHODS: A questionnaire, consisting of 28 predefined capabilities in four categories with a rating scale of importance from one to five, was developed and sent to all registered Chinese medicine practitioners in the State of Victoria, Australia in October, 2005. RESULTS: Two hundreds and twenty eight completed questionnaires were returned which represented a response rate of 32.5%. Of the four categories of capabilities, technical capabilities were considered to be the most important for clinical practice. Specifically, the ability to perform acupuncture treatment and/or dispense an herbal prescription was ranked the highest. In contrast, research and information management capabilities were considered the least important. The educational background of practitioners appeared to be an important factor influencing their rating of capabilities. Significantly, nearly double the number of practitioners with Australian qualifications than practitioners trained overseas valued communication as an important capability. For continuing professional education, clinical skills courses were considered as a priority while research degree studies were not. CONCLUSION: Registered Chinese medicine practitioners viewed skills training as important but did not support the need for research and information management training. This represents a significant hurdle to developing Chinese medicine as a form of evidence-based healthcare.

Depression and pain in night time and daytime functioning of individuals with lupus.

The purpose of this study was to investigate the role of pain and depression in night time and daytime functioning of individuals with lupus. A cross-sectional research design was used. Participants were recruited via a mail-out to members of the Lupus Australia Foundation and the Lupus Association of New South Wales. One hundred and fifty-four participants completed a questionnaire package consisting of a Lupus Medical and Symptoms Questionnaire designed by the researchers, the Cardiac Depression Scale and the Pittsburgh Sleep Quality Index. Hierarchical regression analyses revealed that pain principally predicted levels of sleep disturbance, whilst depression and pain (to a lesser extent) together predicted daytime dysfunction. The present results suggested the need for more adequate pain management, particularly at night and psychological interventions to decrease levels of depression that interfere with daily functioning in individuals with lupus.

Coping with hallucinated voices in schizophrenia: a review of self-initiated strategies and therapeutic interventions.

This article reviews the state of knowledge about strategies used by people with a diagnosis of schizophrenia to cope with hallucinated voices, and considers the role of coping in psychological treatments for persisting symptoms. The use of self-initiated ('natural') coping strategies appears almost universal amongst voice-hearers. These strategies are similar across cultures, and include diverse behaviours, only a minority of which is specific to hallucinations. Most strategies are reported by at least some users to be effective, but more sophisticated outcome studies are lacking. Some evidence for the efficacy of certain behavioural techniques of coping, for the manipulation of auditory input, and for strategies involving subvocalisation, is available from experimental studies. Therapeutic enhancement of natural coping strategies for persisting symptoms has demonstrated some efficacy, but its benefit for voices is unknown. Despite this, it has become an established part of some CBT interventions for psychosis. Further advances in knowledge and practice may come from utilisation of coping models in research, longitudinal and ideographic methods of study and a movement away from descriptive coping lists to investigations of coping styles, mechanisms of action, and the process of coping.

High-Level Mobility Assessment Tool (HiMAT): interrater reliability, retest reliability, and internal consistency.

BACKGROUND AND PURPOSE: The High-Level Mobility Assessment Tool (HiMAT) assesses high-level mobility in people who have sustained a traumatic brain injury (TBI). The purpose of this study was to investigate the interrater reliability, retest reliability, and internal consistency of data obtained with the HiMAT. SUBJECTS: Three physical therapists and 103 people with TBI were recruited from a rehabilitation hospital. METHODS: Three physical therapists concurrently assessed a subset of 17 subjects with TBI to investigate interrater reliability. One physical therapist assessed a different subset of 20 subjects with TBI on 2 occasions, 2 days apart, to investigate retest reliability. Data from the entire sample of 103 subjects were used to investigate the internal consistency of this new scale. RESULTS: Both the interrater reliability (intraclass correlation coefficient [ICC]=.99) and the retest reliability (ICC=.99) of the HiMAT data were very high. For retest reliability, a small systematic change was detected (t=3.82, df=19), indicating a marginal improvement of 1 point at retest. Internal consistency also was very high (Cronbach alpha=.97). DISCUSSION AND CONCLUSION: The HiMAT is a new tool specifically designed to measure high-level mobility, which currently is not a component of existing scales used in TBI. This study demonstrated that the HiMAT is a reliable tool for measuring high-level mobility.

Can transtheoretical model measures predict relapse from the action stage of change among ex-smokers who quit after calling a quitline?

This study explored whether transtheoretical model (TTM) measures could predict relapse from the action stage, i.e., during the first 6 months of smoking cessation. Predictors of relapse were examined between time 2 (3-month) and time 3 (6-month) assessments (n = 247), and also between time 3 (6-month) and time 4 (12-month) assessments (n = 204). Consistent predictors of relapse included lower self-efficacy and determination to quit and higher temptations to smoke. Some predictors of relapse changed according to how long a person had already been quit for. Contrary to the TTM, greater behavioral change process use predicted relapse among people who had already quit for less than a month, and did not prevent relapse among those who had already quit for a month or more between time 2 and time 3. Cross-sectional analyses showed significant decreases in temptations to smoke and in the use of some of the change processes, which stabilised at about 1 month post-cessation. The findings suggest that there may be a stage boundary at around 1 month post-cessation, and question the homogeneity, and hence validity, of the TTM-defined action stage of change.