Physical impairments related to kinetic energy during sit-to-stand and curb-climbing following stroke.

OBJECTIVE: Compare kinetic energy and duration of task during sit-to-stand and curb-climbing of two groups: hemiparetic stroke patients and matched controls. For patients, describe relationships between selected physical impairments and sit-to-stand and curb-climbing performance. DESIGN: Descriptive and correlational.Background. Measures and treatments are best selected after specific limitations in functional activities (e.g., sit-to-stand) and related impairments are identified. METHOD. Fifteen patients, 29-77 (mean=53.7) years with recent stroke and 15 demographically matched healthy controls participated. Physical performance variables measured were standing balance, maximum paretic extremity weight-bearing, and knee extension strength. Sit-to-stand and curb-climbing performance were characterized using kinetic energy and task duration. Differences in physical and functional performance between groups were determined. Spearman correlations were calculated between patients' physical impairments and sit-to-stand and curb-climbing performance. RESULTS: Compared to controls, patients demonstrated reduced kinetic energy (P< or =0.003) and prolonged duration (P< or = 0.001) for sit-to-stand and curb-climbing. Significant relationships (r(s)=0.49-0.50) were demonstrated between sit-to-stand kinetic energy and knee extension strength, standing balance, and maximum weight-bearing. For curb climbing, significant relationships (r(s)=0.45) were found between kinetic energy and standing balance and maximum weight-bearing. CONCLUSION: Impaired balance and maximum weight-bearing are relevant to sit-to-stand and curb-climbing limitations after stroke. RELEVANCE: Clinicians treating sit-to-stand or curb-climbing limitations have reason to measure and treat impairments in maximum weight-bearing, knee extension strength, and standing balance.

Measuring attitudes toward persons with AIDS: the AAS-G as an alternate form of the AAS.

For most of the score of years that the Acquired Immune Deficiency Syndrome (AIDS) has been with us, we have been concerned with the care of and attitudes toward AIDS patients. As the treatment and face of AIDS changes, not all of those suffering with the disease are considered patients. Many are active community members, young and old, male and female. The AIDS Attitude Scale (AAS) is a widely used measure of health professionals' attitudes toward persons with AIDS who are patients. That scale was developed with the intended audience of respondents being nurses or others dealing directly with AIDS patients. This research details the development and validation of an alternate form of the AAS, the AAS-G, intended for use with the general public. The AAS-G may be completed by lay members of the community and is not limited to assessing attitudes toward patients alone. Reliability and validity information, Classical Test Theory estimates and Generalizability Theory estimates for psychometrics on the AAS-G are reported. These estimates are compared to the same estimates available for the AAS in order to make informed decisions about the utility of the new AAS-G. The AAS-G appears to be a promising, efficient instrument for measuring the attitudes of lay individuals toward persons with AIDS.

Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults.

BACKGROUND: Muscle size and strength decrease with aging, and the resultant muscle weakness has been implicated in increased risk of falls in older adults. These falls have large economic and functional costs. METHODS: The purpose of this randomized, controlled study was to determine if an 8-week, 3-day per week intense (77.8 +/- 3.4% of 1-repetition maximum [1RM]) strength training program could improve functional ability related to the risk of falling in subjects aged 61--87 years (mean 72, SD 6.3). Twelve strength-training-naive subjects performed two sets of 10 repetitions for six lower body exercises while 12 subjects served as nonintervention controls. Subjects were tested pre-, mid-, and postintervention for strength gain and on three tests of functional ability. RESULTS: Postintervention strength was significantly better (p <.017) in all training subjects across all exercises, and no injuries were reported as a result of either training or 1RM testing. After controlling for preintervention differences, repeated measure analysis of covariance (ANCOVA) found a significant difference between experimental and nonintervention control subjects for postintervention maximal walking speed [F(1,19) = 5.03, p <.05]. There were no significant between-group differences for 1-leg blind balance time or 5-repetition sit-to-stand performance [F(1,19) =.082; F(1,19) =.068, respectively, p >.05]. CONCLUSIONS: These findings suggest that strength training alone does not appear to enhance standing balance or sit-to-stand performance in active, community-dwelling older adults but that it may improve maximal walking speed. The relationship between strength gain and risk of falls remains unclear. The data do reinforce the notion that intense strength training is a safe and effective way to increase muscle strength in this population.

An intervention to increase quality of life and self-care self-efficacy and decrease symptoms in breast cancer patients.

This study tested effects of a nurse-administered self-efficacy intervention given on five monthly occasions and designed to enhance patients' self-care self-efficacy. The hypotheses were that at four months and eight months after beginning chemotherapy the efficacy-enhancing experimental group would have significantly higher scores on quality of life and self-care self-efficacy than the control group and significantly less symptom distress. Fifty-six women receiving chemotherapy for breast cancer were randomized to the experimental and control groups. Outcome variables were quality of life, measured by the Functional Assessment of Cancer Treatment-Breast (FACT-B), symptom distress, measured by the Symptom Distress Scale (SDS), and factors of self-care self-efficacy, measured by Strategies Used by Patients to Promote Health (SUPPH). The interaction effects for the FACT-B ranged from small for functional concerns (eta square = .03) to large for social concerns (eta square = .110); effects for the SDS were large (eta square = .140), and for factors on the SUPPH effect sizes ranged from small (eta square = .01) for Enjoying Life and Stress Reduction to medium (eta square = .089) for Coping, and large (eta square = .141) for Making Decisions. Interventions to promote self-efficacy may increase quality of life and decrease symptom distress for women diagnosed with breast cancer.

Bladder scanner accuracy during everyday use on an acute rehabilitation unit.

The use of portable ultrasound scanners is becoming more common in the rehabilitation setting as a noninvasive method of estimating bladder volume. Bladder scanners are used to screen patients for post-void residual volumes and to determine the need for intermittent catheterization based on volume rather than time. Benefits include a decreased number of invasive catheterizations, thus decreasing the potential for urinary tract infections and urethral trauma, and increasing patient satisfaction. Testing at this facility revealed a high potential for inaccuracy, although bladder scanners have been described in the literature as highly accurate, with the equipment easy to use and requiring little staff training. This article reports the authors' findings of staff competency testing and examines patient characteristics that may affect scanner accuracy.

Relationship of cardiac inpatients' outcomes to mood state.

This descriptive study used a computerized charge capture system (CCCS) to explore the differences of cost and length of stay (LOS) between cardiac inpatients with a diagnosis of depression (n = 144) and cardiac inpatients without depression (n = 9,099). Level of severity, gender, and mood state (depression vs. nondepression) were also compared. A matched sample of 352 nondepressed patients was compared with a sample of 94 depressed patients. There were no significant differences between the depressed and nondepressed groups. However, the study did indicate interesting findings regarding mood state, gender, and cardiac outcomes. Depression was significantly overrepresented among females (chi 2 = 24.0, df = 1, P < 0.05). When gender and mood state were considered together, women with cardiac disease who were depressed had significantly longer lengths of stay (LOSs) and increased costs than men with depression (F = 6.6, df = 1, P = 0.01). A major unanticipated finding was the extremely low incidence of depression detected in these patients (1.6%) when compared with patients in other studies. One possible reason for the low incidence of depression was related to the use of a financial, rather than a clinical, data set.

Cross-cultural explanations of body image disturbance in Western cultural samples.

OBJECTIVE: We replicated and extended the findings of S. M. Stormer and J. K. Thompson (1996), by comparing the relationships among body image disturbance (BID) and teasing history, age of pubertal onset, societal pressures to be thin, and appearance comparison, across three Western cultures. METHODS: College females from the United States, Italy, and England completed several BID measures, as well as measures of the four predictors. Body mass levels and self-esteem, two known correlates of BID, were also examined. Data were analyzed using first standard, then hierarchical regression procedures. RESULTS: This investigation essentially found no cultural differences in the relationships among BID and its correlates for six of the seven criteria (BID) measures. Only one of the measures, the Figure Rating Scale (FRS), distinguished across groups. DISCUSSION: A lack of true cultural differences, or general similarities among university students, might explain these results. Nevertheless, these findings support the use of a Western cross-cultural research model.

Counseling women with breast cancer using principles developed by Albert Bandura.

PROBLEM: Although researchers suggest treatments that provide patients with an active coping strategy may increase patients' sense of self-efficacy, previous studies have not measured patients' self-efficacy. METHODS: Eighteen women receiving chemotherapy for breast cancer were randomized to efficacy-enhancing experimental (n = 10) and usual-care control (n = 8) groups. The experimental group received five interventions delivered monthly. Variables--quality of life, symptom distress, and self-care self-efficacy--were measured at baseline and at 4 and 8 months later. FINDINGS: At 4 and 8 months the interaction effects for the Functional Assessment of Cancer Treatment-Breast, used to measure quality of life, ranged from small for functional concerns to large for social concerns. Interaction effects for symptom distress, measured by the Symptom Distress Scale, were large. Interaction effects for self-care self-efficacy ranged from small for Enjoying Life and Stress Reduction, medium for Stress Reduction, and large for Making Decisions. CONCLUSIONS: Interventions to promote self-efficacy may increase quality of life and decrease distress for women diagnosed with breast cancer.

American and Korean adolescents' physical and mental health self-efficacy.

Self-efficacy beliefs are thought to have causal influence on behavior, helping to explain what tasks people approach, persevere at, or abandon. Few cross-cultural studies of adolescents' self-efficacy beliefs have been conducted or reported. We compared physical and mental health self-efficacy beliefs of Korean and American high school students. A Korean translation of the English language School Health Efficacy Questionnaire (SHEQ) was used in data collection. The translated version of the SHEQ showed psychometric estimates similar to the original English language version. Sizable age and culturally related differences were found on both physical and emotional health self-efficacy perceptions between the two groups of adolescents.

Age, self-efficacy, and change in patients' adjustment to cancer.

OBJECTIVES: The purpose of this secondary analysis was to investigate cancer patients' self-care self-efficacy and measures of adjustment over time, as well as the role of self-care self-efficacy with measures of adjustment. The primary study was a longitudinal study of cancer patients and family members' adjustments. MATERIALS AND METHODS: Three hundred seven cancer patients at all stages of cancer completed study instruments on one occasion; 181 completed the instruments 4 months later; and 124, 8 months later. Instruments included the Strategies Used by Patients to Promote Health (SUPPH) to measure self-care self-efficacy, the Functional Assessment of Cancer Treatment (FACT) to measure quality of life, the Profile of Mood States (POMS) to measure patients' mood disturbances, and the Symptom Distress Scale (SDS) to measure patients' concerns. RESULTS: Using analysis of variance, a series of one-way repeated measures used to investigate changes in cancer patients' self-care self-efficacy and measures of adjustment revealed significant decreases in patients' self-care self-efficacy (P = .01) and quality of life (P = .001) over time. Patients' symptoms and mood disturbances did not significantly change over time. The role of self-care self-efficacy with measures of adjustment was investigated using canonical correlations. For the predictor variables, subscores for coping and enjoying life on the SUPPH showed the strongest loadings, 0.83 and 0.94, respectively. On the dependent variables, the FACT was by far the most important variable, with a loading of 0.92. CONCLUSIONS: Results demonstrate that without intervention, cancer patients' measures of self-efficacy and adjustment decrease over time, and patients' self-efficacy influences their adjustment. Psychosocial interventions have been designed to increase self-efficacy and to enhance adjustment. Longitudinal study of efficacy-enhancing interventions is needed.

Uses and abuses of the analysis of covariance.

The analysis of covariance (ANCOVA) is a powerful analytic tool, but there continue to be abuses of the method. We review assumptions and illustrate legitimate uses of ANCOVA, and summarize statistical packages' approach to the method. Finally, we consider how ANCOVA is used in contemporary nursing research.

Isopropyl pad use in neonatal intensive care units.

OBJECTIVES: Isopropyl pads (IPs) are commonly used to cleanse skin. This traditional practice is benign when applied to adults, however, its efficacy and safety when used for health-compromised neonates is questionable. This research explores the extent of IP use in 114 infants in neonatal intensive care units and identifies characteristics associated with IP use. STUDY DESIGN: A descriptive design, with data collected at two different sites over multiple observation periods, was used. RESULTS: Generally low IP to skin use was found, with most babies being exposed to one to two pads per 8 hours. Some babies, most frequently the lowest weight, most premature, and health compromised babies, had exposure to as many as eight pads per 8 hours. CONCLUSIONS: Because the smallest, most vulnerable neonates are those most exposed to the highest levels of isopropyl alcohol on the skin, conscious attention needs be paid to IP use to avoid or eliminate unnecessary exposure to the potentially toxic substance.

A prospective study of adjustment to hemodialysis.

OBJECTIVE: To examine (a) changes in subjects' self-care self-efficacy over time and (b) the relationship of subjects' self-care self-efficacy with adjustment to hemodialysis. DESIGN: A longitudinal design was used to study changes in self-care self-efficacy and associations between self-care self-efficacy and measures of adjustment: health status, mood distress, symptom distress, dialysis stress, and perceived adherence to fluid restriction. SAMPLE/SETTING: Subjects were recruited from 8 settings in the Northeast where outpatient hemodialysis treatment was administered. Sixty-four subjects were recruited to the study. Twenty-eight subjects completed 3 occasions of data collection. METHODS: Data were collected on three occasions: (a) baseline-within 100 days of beginning treatment; (b) 4 months after beginning treatment; and (c) 8 months after beginning treatment. Eta-squared, a measure of practical significance, is reported for four factors of the self-care self-efficacy measure on each of the three occasions. Associations between self-care self-efficacy and measures of adjustment were examined by means of Pearson correlations. RESULTS: Eta-squared estimates showed generally positive changes occurring over time in subjects' self-care self-efficacy, health status, mood distress, symptom distress, dialysis stress, and perceived adherence to fluid restriction. Changes were more positive at 4-months than at 8-months after enrollment. Significant correlations (p < .05) occurred between self-care self-efficacy and mood states, health status, symptom distress, and perceived adherence to fluid restrictions. Correlations occurred more frequently between self-care self-efficacy and mood states than between self-care self-efficacy and other measures of adjustment. CONCLUSIONS: The study provided pilot data suggesting that hemodialysis patients' self-care self-efficacy and measures of adjustment change over time. Patients who had increased confidence in self-care strategies (self-efficacy) were associated with having more positive mood states, health status, and perceived adherence to fluid restrictions and less symptom distress. Interventions designed to increase patients' self-care self-efficacy may yield positive results. Nurses are in an excellent position to give efficacy enhancing feedback that may promote patients' adjustment.

Further validation of the AIDS Attitude Scale.

The AIDS Attitude Scale (AAS) is a self-report measure of attitude toward persons with AIDS. Since its introduction in 1992, the AAS has been used in over 30 research studies. Initial psychometric estimates of reliability and validity for the scale were supportive. This report summarizes emerging psychometric data from a broad range of samples. These data offer additional support for the internal consistency and stability of the two dimensions underlying the scale, as well as documenting the factorial and construct validity of the AAS.

A measure of self-care self-efficacy.

Strategies Used by People to Promote Health (SUPPH), a 29-item self-report, is a measure of self-care self-efficacy. Items for the SUPPH were empirically generated, validated by an expert panel, and tested (N = 275) for psychometric properties, factor composition, and convergent and discriminant evidence with existing scales. Good initial psychometric properties were found for the SUPPH and four factors emerged: coping, stress reduction, making decisions, and enjoying life. These factors are consistent with the underlying self-efficacy theory upon which the scale is based.

Asian-American men's acculturation and gender-role conflict.

There is limited research on Asian-Americans' acculturation and conflicts with contemporary gender roles. This research assessed three samples of Asian-American men's acculturation and gender-role conflict. Differences between Chinese-American, Japanese-American, and Korean-American men's acculturation and the four patterns of gender-role conflict were analyzed. The relationship of demographic and acculturation variables to gender-role conflict was also calculated. Subjects (N = 125) were administered a demographic questionnaire, the Suinn-Lew Asian Self-identity Acculturation Scale, and the Gender-role Conflict Scale. Multivariate analysis of variance showed no differences between the Asian-American groups on acculturation and the four patterns of gender-role conflict. A canonical correlation analysis indicated one significant variate connecting acculturation with two patterns of issues of gender-role conflict: success, power, and competition and restrictive emotionality. Methodological limitations and research are mentioned.

Contextual strategy instruction: socially/emotionally maladjusted adolescents with language impairments.

Ten socially/emotionally maladjusted adolescents with language impairments (SEM/LI) and ten non-impaired adolescents received four treatment sessions in the use of a "context clues strategy" for facilitating comprehension of unfamiliar words in four sentence types. Both groups improved their ability to use a context clues strategy following direct instruction. The SEM/LI subjects exhibited greater difficulty with the appositive sentence type than did the non-impaired subjects. The results indicated that SEM/LI adolescents probably would benefit from receiving direct instruction involving any of the three other sentence types (i.e., cause/effect, example, grouping), prior to instruction involving the appositive sentence type

Would it make a difference? A discussion group in a behaviorally oriented inpatient eating disorder program.

1. The formation of a group solely for patients with eating disorders was viewed as being very therapeutic by patients and staff. 2. Due to fluctuation of group size and variability of needs, the group had to be flexible in its focus and format. 3. The need and/or desire for an outpatient transitional group for patients with eating disorders was an unexpected outcome of this study.

Influence of hip position on measurements of the straight leg raise test.

Variations of the straight leg raise (SLR) test are described clinically; however, no studies have examined how these variations may affect the outcome of this test. This study examined whether measurements of SLR are influenced by position of contralateral hip (flexed vs. extended), nature of the trial (active vs. passive), or trial repetitions (1 vs. 2). Twenty-two healthy, young subjects participated in this study. A 35-mm camera recorded the position of the pelvis and lower limb during the performance of a right SLR. Passive SLR (opposite hip extended vs. opposite hip flexed) and active SLR (opposite hip extended vs. opposite hip flexed) were performed twice, in random order. Three different measures of SLR were obtained while subjects performed SLR under the aforementioned conditions--SLR relative to horizontal, SLR relative to pelvis, and pelvis relative to horizontal. Differences in SLR between opposite hip flexed vs. extended, passive vs. active, and trials were analyzed using a multifactorial analysis of variance for repeated measures. Hip position affected SLR relative to horizontal (p < .000) and pelvis relative to horizontal (p < .000), with an increase in measurement occurring with the opposite hip flexed. Nature of the trial (active vs. passive) affected SLR to pelvis (p < .003) and pelvis to horizontal (p < .000) with an increase in measurement for passive SLR. A difference in measurements existed between trials 1 and 2 for SLR to horizontal (p < .005) and for SLR to pelvis (p < .005). Although conducted on healthy subjects, the study points out the necessity of consistency of method when performing and interpreting the SLR test.

Instrument development: cardiac diet and exercise self-efficacy.

Self-efficacy has been documented as a strong predictor of health behaviors. Unfortunately, availability of reliable and valid measures of self-efficacy for a range of health behaviors is still limited. This study validated two measures of cardiac risk factor self-efficacy: the Cardiac Diet Self-Efficacy Instrument (CDSEI) and the Cardiac Exercise Self-Efficacy Instrument (CESEI). A sample of 370 cardiac rehabilitation participants provided data for principal factor analyses showing the unidimensionality of each instrument. Known groups construct validity was supported by a comparison of CDSEI and CESEI scores for cardiac rehabilitation participants and marathon runners. The value of CDSEI and CESEI scores in predicting subsequent exercise and diet performance was demonstrated with a third group of cardiac rehabilitation participants. Stability and internal consistency estimates in the .80s and .90s, respectively, support the scales' reliabilities.