The moderating roles of self-efficacy and depression in dual-task walking in multiple sclerosis: A test of self-awareness theory.

OBJECTIVE: Multiple sclerosis (MS) is a debilitating neurological disease associated with a variety of psychological, cognitive, and motoric symptoms. Walking is among the most important functions compromised by MS. Dual-task walking (DTW), an everyday activity in which people walk and engage in a concurrent, discrete task, has been assessed in MS, but little is known about how it relates to other MS symptoms. Self-awareness theory suggests that DTW may be a function of the interactions among psychological, cognitive, and motor processes. METHOD: Cognitive testing, self-report assessments for depression and falls self-efficacy (FSE), and walk evaluations [DTW and single-task walk (STW)] were assessed in seventy-three people with MS in a clinical care setting. Specifically, we assessed whether psychological factors (depression and FSE) that alter subjective evaluations regarding one's abilities would moderate the relationships between physical and cognitive abilities and DTW performance. RESULTS: DTW speed is related to diverse physical and cognitive predictors. In support of self-awareness theory, FSE moderated the relationship between STW and DTW speeds such that lower FSE attenuated the strength of the relationship between them. DTW costs - the change in speed normalized by STW speed - did not relate to cognitive and motor predictors. DTW costs did relate to depressive symptoms, and depressive symptoms moderated the effect of information processing on DTW costs. CONCLUSIONS: Findings indicate that an interplay of physical ability and psychological factors - like depression and FSE - may enhance understanding of walking performance under complex, real-world, DTW contexts.

You get used to it, or do you: symptom length predicts less fibromyalgia physical impairment, but only for those with above-average self-efficacy.

To determine whether the effects of symptom duration on fibromyalgia physical impairment are moderated by symptom self-efficacy, data from 572 female participants, who were members of a large health maintenance organization and had a diagnosis of fibromyalgia syndrome (FMS) were assessed. Age, symptom duration, history of physical, sexual, and emotional abuse, fibromyalgia-specific self-efficacy (Arthritis Self-Efficacy Scale adapted for FMS [ASES]), depression (Centers for Epidemiological Studies Depression Scale [CES-D]), fibromyalgia physical impairment (Fibromyalgia Impact Questionnaire [FIQ]), and pain (McGill Present Pain Index [PPI]) were measured five times across 18 months. Linear regressions were performed to predict baseline FIQ and PPI cross-sectionally. Of primary interest was a hypothesized interaction between ASES and symptom duration, which was significant in relation to FIQ but not PPI. Multilevel mixed models were performed to determine whether the same pattern existed longitudinally controlling for baseline symptom duration as an effect of time and ASES. The interaction was significant in the models for both FIQ and PPI. These results suggest that the effects of age and symptom duration on FMS are unique, and that self-efficacy plays a crucial role in moderating disease course (measured by symptom duration or time) in FMS.

"Experience Keeps a Dear School": the Effects of Ethnicity and Caregiving Experience on Hiring a Healthcare Advocate.

In the present study, ethnic differences in evaluating the severity and associated needs of medical complications experienced by an elderly man and the likelihood of seeking professional assistance (i.e., hire a healthcare advocate [HCA]) to care for him, and for one's own family or parent should they become ill, as a function of previous caregiving experience, were investigated. The 974 participants were White, Black, Hispanic, or Asian/Pacific Islander. They read a hypothetical vignette about a 75-year-old man, Daryl, who was experiencing health problems. Participants were instructed to imagine that they were James, Daryl's son, and asked to indicate how severe his condition(s) were, how much medical assistance he would require, and how likely they would be to hire an HCA to assist him. They were also asked to report whether they previously had assisted a parent with activities of daily living (Assistance) and whether they would be likely to hire an HCA in the future if 1) a family member or 2) a parent, specifically, became ill. Two, 2 (Assistance) × 4 (Ethnicity) multivariate analyses of covariance (MANCOVA) were performed to assess differential responses among individuals of different ethnicities as a function of previous caregiver experience. A priori interaction contrasts were examined to determine whether Black, Hispanic, or Asian/Pacific Islander participants differed on the outcomes from White participants as a function of previous caregiver experience. There were no significant differences between Black or Asian/Pacific Islander and White participants, but Hispanic participants assigned significantly higher severity and need for medical assistance ratings and were significantly more likely to indicate that they would seek assistance from an HCA with respect to the vignette and for their own parents in the future if they had provided caregiving to a parent in the past, whereas White participants were less likely to seek assistance from an HCA if they had provided caregiving in the past to a parent. Although ethnic differences in evaluations of Daryl's condition and in the reported likelihoods of hiring an HCA in various contexts as a function of previous caregiving experience were limited, there are important inter-cultural differences to recognize. It may be important in future research to assess ethnic differences in the expectations and experiences of caregiving.

Usefulness of the Montreal Cognitive Assessment (MoCA) in Huntington's disease.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is a brief screening instrument for dementia that is sensitive to executive dysfunction. This study examined its usefulness for assessing cognitive performance in mild, moderate, and severe Huntington's disease (HD), compared with the use of the Mini-Mental State Examination (MMSE). METHODS: We compared MoCA and MMSE total scores and the number of correct answers in 5 cognitive-specific domains in 104 manifest HD patients and 100 matched controls. RESULTS: For the total HD sample, and for the moderate and severe patients, significant differences between both MoCA and MMSE total scores and almost all cognitive-specific domains emerged. Even mild HD subjects showed significant differences with regard to total score and several cognitive domains on both instruments. CONCLUSIONS: We conclude that the MoCA, although not necessarily superior to the MMSE, is a useful instrument for assessing cognitive performance over a broad level of functioning in HD.

Evaluating the contribution of reactive balance to prediction of fall rates cross-sectionally and longitudinally in persons with multiple sclerosis.

BACKGROUND: Falls are common in persons with multiple sclerosis (PwMS). Reactive postural control-one's response to a balance perturbation-is likely an aspect of fall risk; however, the relationship between reactive posture and falls is poorly understood in PwMS. OBJECTIVE: We evaluated tibialis anterior muscle onset latency (TA latency) after balance perturbations as a predictor of fall rates in PwMS, controlling for clinical, functional, sensory, psychological, and cognitive factors. METHOD: At baseline of the 18-month cohort study, 122 participants with MS (EDSS = 2.23) were included. Assessments were conducted every 6 months. RESULTS: Of the original 122 participants at the baseline collection, data were available from 41, 39, and 34 people at the 6, 12, and 18 month follow-ups, respectively. Percent fallers at the four time points were 35.3%, 12.2%, 15.4%, and 20.5%. Cross-sectionally (i.e., at baseline), the Timed Up-and-Go, Falls Efficacy Scale - International (FES-I), and TA latency after perturbations were significant predictors of retrospective falls rates using negative binomial regression. Longitudinally, random-effects negative binomial regression found that trait-level FES-I, Stroop Color-Word, and TA latency were significant predictors for falls rates. CONCLUSION: Delays in automatic postural responses seem to account uniquely for fall rates in PwMS-beyond clinical, balance, or mobility measures. These delays may contribute to the increased fall rate in PwMS. In addition to brief self-report instruments (FES-I) and cognitive assessments, muscle onset after balance perturbations may be a valuable tool for predicting falls in those with MS.

Change in 'first-trial' performance after protective step practice in people with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a debilitating, neurodegenerative disorder causing considerable gait and balance dysfunction. Reactive balance (i.e., quick movements in response to a loss of balance) is particularly important for fall risk and is impaired in people with MS compared to neurotypical peers. Therefore, improving reactive balance among those with MS is critical. However, for maximum ecological validity, improvements in reactive balance through training would be demonstrable upon first loss-of-balance, rather than an average of several trials as is typically reported. This study evaluated changes in performance on the first stepping trial in people with MS after one day of practice. METHODS: Fourteen people with MS underwent two, consecutive days of support-surface perturbations from stance. On day 1, participants underwent a single backward-stepping trial, followed by 35 practice trails (forward and backward). Approximately 24 h later, participants were again exposed to a single backward stepping perturbation. Protective stepping outcomes were step length, step latency, and margin of stability at first foot contact. The backward step performance on the first trial of days one and two were compared, and difference scores were evaluated for relationships with correlates based on theoretical considerations. FINDINGS: First-trial margin of stability increased (improved) from day 1 to day 2 (P = .016). Steps were also faster on average by approximately 5 ms on day 2, although this improvement was not significant (P = .062). INTERPRETATIONS: Although preliminary, these findings provide evidence that individuals with MS may be able to experience first-trial improvements after a low dose of perturbation training.

Perturbation practice in multiple sclerosis: Assessing generalization from support surface translations to tether-release tasks.

OBJECTIVE: To determine whether improvements in protective stepping experienced after repeated support surface translations generalize to a different balance challenge in people with multiple sclerosis (PwMS) BACKGROUND: MS affects almost 1 million people in the United States and impairs balance and mobility. Perturbation practice can improve aspects of protective stepping in PwMS, but whether these improvements generalize is unknown. METHODS: Fourteen PwMS completed two visits, 24hrs apart. The balance tasks included tether-release trials and support surface translations on a treadmill eliciting backward protective stepping. Margin of stability, step length, and step latency were calculated. Generalization was assessed via multilevel mediation models (MLMM) with bootstrapping to produce percentile and bias corrected confidence intervals RESULTS: There were no mediated effects for margin of stability or step latency; however, mediation was observed for step length, indicating that participants increased step length throughout the treadmill trials, and this generalized to tether-release trials DISCUSSION: MLMM may be useful for evaluating generalization of motor training to novel balance situations, particularly in small sample sizes. Using these analyses, we observed PwMS generalized improvements in step length, suggesting that aspects of protective step training may translate to improvements in other reactive balance tasks in PwMS.

Vignette responses and future intentions in a health decision-making context: How well do they correlate?

INTRODUCTION: Vignettes are commonly used to assess health care decision making when it is impractical or unethical to use experimental methods. We sought to determine whether decisions made in response to hypothetical vignettes requiring medical decisions for self or parents related to reported future likelihoods of engaging in similar behaviors. METHOD: Respondents (n = 1,862) were adults recruited in person in general community settings. Individuals were assigned randomly to read 1 of a variety of vignettes that presented various medical problems being experienced either by oneself or a parent in a hypothetical context. Individuals reported their likelihoods of hiring a health care advocate to perform a variety of tasks in the context of the vignette and their likelihoods of hiring a health care advocate for themselves or their own parents in the future. Multigroup analysis was performed to estimate a latent variable path model for the vignette hiring questions and real-world future intention to hire by condition. RESULTS: The configural model was retained. Tests of invariance for the correlation between future intentions to hire and the latent variable from the vignette decision making indicated a significant difference between self and parent conditions. However, moderate relationships existed between vignette responses and future intentions in both conditions, with approximately 25% of the variance in personal, future intentions being accounted for by vignette responses. DISCUSSION: Our findings support the continued study of vignettes as a possible tool to measure behavioral intentions in the context of positive and negative health care decisions impacting self and others. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relating Parkinson freezing and balance domains: A structural equation modeling approach.

BACKGROUND: People with PD who exhibit freezing of gait (FOG) also exhibit poor balance compared to those who do not freeze. However, balance is a broad construct that can be subdivided into subdomains that include dynamic balance (gait), anticipatory postural adjustments (APAs) & gait initiation, postural sway in stance, and automatic postural responses (e.g., reactive stepping). Few studies have provided a robust investigation on how each of these domains is impacted by FOG, and no studies have compared balance across groups while rigorously controlling for disease severity. METHODS: Structural equation modeling was used to evaluate the relationships between FOG and balance domains constructed as latent variables and controlling for disease severity. Domains included: dynamic balance (gait), APAs, postural sway, and reactive stepping. Models were run relating domains to both the presence and severity of FOG. RESULTS: Latent variables reflecting domains of Gait and APAs, but not postural sway or reactive stepping, were significantly related to the severity of FOG. Models for presence of FOG showed the same results, as Gait and APAs, but not postural sway or reactive stepping, were related to presence of FOG. CONCLUSION: These results are consistent with hypotheses that balance deficits in people with PD who freeze are most pronounced in gait and anticipatory postural adjustments. Reactive stepping and postural sway domains are less effected in PD patients who freeze compared to those who do not. These findings suggest that rehabilitative strategies focused on gait and APAs may be most effective for people with PD who freeze.

The Effects of Racial/Ethnic Minority Status on Sleep, Mood Disturbance, and Depression in People with Fibromyalgia.

PURPOSE: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder that is characterized by persistent and widespread pain. FMS has been associated with sleep disturbance, mood disorders and depression. Racial/ethnic minorities are less likely to receive a diagnosis of FMS than White individuals. Although mood disorders and depression are prevalent among racial/ethnic minority groups, researchers have not examined whether there are differences between racial/ethnic minorities and White individuals with FMS. PARTICIPANTS AND METHODS: The participants were 600 people who were 18 years of age or older and who had a physician's diagnosis of FMS, which was confirmed using the 1990 American College of Rheumatology criteria. Most participants were female (95.5%) and White (85.0%). Sleep disturbance was assessed using the Pittsburgh Sleep Quality Index (PSQI), mood disturbance was assessed using the Profile of Mood States (POMS), and depression was assessed via the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: Racial/ethnic minorities reported significantly greater levels of sleep disturbance, significantly greater levels of mood disturbance, and had significantly greater levels of depression than White participants. However, racial/ethnic minorities had significantly greater reductions in mood disturbance over the one-year period than White participants. CONCLUSION: Overall, the findings from the present study indicated that racial/ethnic minorities had "worse" physical and psychological outcomes than White participants.

A longitudinal analysis of pain experience and recall in fibromyalgia.

AIM: To evaluate pain experiences and memories in fibromyalgia (FM) patients over time. METHOD: Participants included 572 females who were members of a large health maintenance organization who had a diagnosis of FM syndrome (FMS) and met inclusion criteria for the study. Recruitment was for an intervention study that tested the effects of social support and education treatment arms, but there were no treatment effects. Reports of experiential pain (EP), historical peak pain (HPP), and historical valley pain (HVP) for FM were collected. Differences between HPP and EP and EP and HVP (bias) were calculated to determine whether HPP and HVP were distributed evenly around EP over time across participants. Models were performed to assess personal history and psychosocial factors that affect EP, HPP, HVP, and bias. RESULTS: There was systematic tendency for HPP to be significantly larger than EP relative to EP vs HVP. EP and HPP decreased significantly over time, but not HVP. There were significant predictors of EP, HPP, HVP, and bias, including depression, self-efficacy, and sleep quality, among others. CONCLUSION: The experiences and recollections of pain in FM appear to provide a unique means of understanding the maintenance of chronic pain-including factors that affect this process.

Protective stepping in multiple sclerosis: Impacts of a single session of in-place perturbation practice.

OBJECTIVES: To evaluate the impact of a single day of protective stepping practice in individuals with Multiple Sclerosis (MS). BACKGROUND: Multiple Sclerosis is a leading cause of disability among young adults in the United States. Gait and balance dysfunction are both widespread in MS and strong predictors of falls, disability, and quality of life among those with MS. METHOD: Fourteen participants with MS and 11 neurotypical, age-matched control participants were exposed to repeated support surface perturbations over the course of 2 days: one "training" day and one "retention" day. Perturbations were elicited on an instrumented treadmill and marker data were collected to evaluate five outcomes (Margin of Stability, Step Length, Step Latency, Leg Angle, and Trunk Angle). ANALYTIC METHOD: Repeated measures data were analyzed using linear growth models and mixed effects models to evaluate the effects of group (MS or Control), trial, and the interaction of group by trial. RESULTS: Significant improvements in Step Length and Leg Angle and a trend for improvement in Margin of Stability among those with MS were observed. Step Latency and Trunk Angle did not show significant changes. Retention analyses revealed significant retention of improvements in Step Length and Leg Angle among MS participants. DISCUSSION: Protective step characteristics have been shown to be important predictors of fall risk in populations affected by neurological disorders. The present study indicates that these characteristics may be amenable to intervention through exposure to repeated, perturbations requiring protective stepping. Further research is needed to establish the predictive utility of these biomechanical markers for falls in MS specifically; however, the present findings suggest that perturbation training may be a valuable means of decreasing fall risk among those affected by MS.

Investing in the Early Childhood Mental Health Workforce Development: Enhancing Professionals' Competencies to Support Emotion and Behavior Regulation in Young Children.

This paper delineates a preventive approach to early childhood mental health by preparing the workforce to provide relational, sensitive care to young children ages 0-5. One of the most prevalent issues in early childhood is behavioral challenges and the inability of young children to regulate themselves. This leads to an expulsion rate in early childhood (3-4 times higher than K-12 expulsion rate) and future mental health issues. The Early Childhood Social-Emotional and Behavior Regulation Intervention Specialist (EC-SEBRIS) graduate level certificate program was created to strengthen early care and education providers with the knowledge and practice of how to support emotion and behavior regulation in young children in their groups. Evaluation data provide evidence that early care and education professionals increased in their perception of self-efficacy and in their sensitivity of care and skills to support behavioral health in young children. Results indicated that the children in their care showed less challenging behaviors and increased social competencies. This manuscript highlights the importance of prevention and the dire need to provide young children with high-quality, appropriate care to support their mental health.

Assessing the Structure of the Ways of Coping Questionnaire in Fibromyalgia Patients Using Common Factor Analytic Approaches.

The Ways of Coping Questionnaire (WCQ) is a widely used measure of coping processes. Despite its use in a variety of populations, there has been concern about the stability and structure of the WCQ across different populations. This study examines the factor structure of the WCQ in a large sample of individuals diagnosed with fibromyalgia. The participants were 501 adults (478 women) who were part of a larger intervention study. Participants completed the WCQ at their 6-month assessment. Foundational factoring approaches were performed on the data (i.e., maximum likelihood factoring [MLF], iterative principal factoring [IPF], principal axis factoring (PAF), and principal components factoring [PCF]) with oblique oblimin rotation. Various criteria were evaluated to determine the number of factors to be extracted, including Kaiser's rule, Scree plot visual analysis, 5 and 10% unique variance explained, 70 and 80% communal variance explained, and Horn's parallel analysis (PA). It was concluded that the 4-factor PAF solution was the preferable solution, based on PA extraction and the fact that this solution minimizes nonvocality and multivocality. The present study highlights the need for more research focused on defining the limits of the WCQ and the degree to which population-specific and context-specific subscale adjustments are needed.

Evaluating Recall and Recognition Memory Using the Montreal Cognitive Assessment: Applicability for Alzheimer's and Huntington's Diseases.

We sought to investigate whether the Montreal Cognitive Assessment (MoCA) could provide a brief assessment of recall and recognition using Huntington disease (HD) and Alzheimer disease (AD) as disorders characterized by different memory deficits. This study included 80 participants with HD, 64 participants with AD, and 183 community-dwelling control participants. Random-effects hierarchical logistic regressions were performed to assess the relative performance of the normal control (NC), participants with HD, and participants with AD on verbal free recall, cued recall, and multiple-choice recognition on the MoCA. The NC participants performed significantly better than participants with AD at all the 3 levels of assessment. No difference existed between participants with HD and NC for cued recall, but NC participants performed significantly better than participants with HD on free recall and recognition. The participants with HD performed significantly better than participants with AD at all the 3 levels of assessment. The MoCA appears to be a valuable, brief cognitive assessment capable of identifying specific memory deficits consistent with known differences in memory profiles.

Honor Thy Parents: An Ethnic Multigroup Analysis of Filial Responsibility, Health Perceptions, and Caregiving Decisions.

The present study explores patterns of parity and disparity in the effect of filial responsibility on health-related evaluations and caregiving decisions. Participants who identified as White, Black, Hispanic, or Asian/Pacific Islander read a vignette about an older man needing medical care. They were asked to imagine that they were the man's son and answer questions regarding their likelihood of hiring a health care advocate (HCA) for services related to the father's care. A multigroup (ethnicity) path analysis was performed, and an intercept invariant multigroup model fits the data best. Direct and indirect effect estimation showed that filial responsibility mediated the relationship between both the perceived severity of the father's medical condition and the perceived need for medical assistance and the likelihood of hiring an HCA only for White and Hispanic participants, albeit differently. The findings demonstrate that culture and ethnicity affect health evaluations and caregiving decision making.

Physical function and quality of well-being in fibromyalgia: the applicability of the goodness-of-fit hypothesis.

Objective: The goodness-of-fit hypothesis suggests that the effectiveness of a coping strategy depends on the match between type of strategy (problem-focused, emotion-focused) and the level of perceived control. This hypothesis was examined as a predictor of physical functioning and quality of well-being (QWB) in a large sample of women with fibromyalgia. Methods: Participants were 478 women with diagnosed fibromyalgia (Mage = 54.31, SD = 11.2), who were part of a larger intervention in which no intervention effects were found. Hierarchical, mixed selection regressions were performed to determine whether the relationship between coping and control-predicted physical functioning and QWB. Results: Participants who reported having lower levels of perceived control over their fibromyalgia syndrome and who engaged in more self-controlling coping (emotion-focused strategy) experienced greater QWB and physical functioning than those who used less self-controlling coping. Various main effects for coping and perceived control were also found. Level of physical functioning was also related to escape-avoidance, distancing, and perceived control. The level of QWB was related to social-support seeking, accepting responsibility, distancing, problem-solving, and perceived control. Conclusions: This study provides a greater understanding of the relationships among coping, perceived control, physical functioning, and well-being for women with fibromyalgia. Implications and directions for future research are discussed.

Predictors of pain and functioning over time in fibromyalgia syndrome: an autoregressive path analysis.

OBJECTIVE: Fibromyalgia is a disabling, chronic pain condition of unknown etiology. Although many factors have been recognized as important contributors to the pain experiences and functional abilities of fibromyalgia patients, the factors that are most impactful (and therefore represent optimal targets for intervention) are still unclear. The aim of the present study was to examine the pathways among depression, self-efficacy, pain, and physical functioning in a large sample of fibromyalgia patients over a 1-year timeframe. METHODS: Data from 462 participants (441 women) were analyzed using an autoregressive path analytical model with first- and second-order cross-lagged effects. RESULTS: Self-efficacy was the only significant predictor of depression, physical functioning, and pain intensity ratings across time. Physical functioning at 6 months predicted self-efficacy at 1 year; no other factors related significantly to self-efficacy in the model. CONCLUSION: Our model suggests that self-efficacy is a salient factor in fibromyalgia symptomatology. Our findings support designing interventions that use a multimodal approach, with an explicit focus on combining exercise (or other means) to improve physical functioning and psychotherapy (e.g., cognitive-behavioral therapy) with the intention of reprocessing the functional improvements and the implications of these improvements for the patients' ability to manage their fibromyalgia symptoms. By doing so, self-efficacy should be enhanced, and this would produce the greatest and broadest benefits for fibromyalgia patients.

The functional implications of motor, cognitive, psychiatric, and social problem-solving states in Huntington's disease.

OBJECTIVE: Huntington's disease (HD) is a genetic, neurodegenerative disorder characterized by motor, cognitive, and psychiatric dysfunction. In HD, the inability to solve problems successfully affects not only disease coping, but also interpersonal relationships, judgment, and independent living. The aim of the present study was to examine social problem-solving (SPS) in well-characterized HD and at-risk (AR) individuals and to examine its unique and conjoint effects with motor, cognitive, and psychiatric states on functional ratings. METHOD: Sixty-three participants, 31 HD and 32 gene-positive AR, were included in the study. Participants completed the Social Problem-Solving Inventory-Revised: Long (SPSI-R:L), a 52-item, reliable, standardized measure of SPS. Items are aggregated under five scales (Positive, Negative, and Rational Problem-Solving; Impulsivity/Carelessness and Avoidance Styles). Participants also completed the Unified Huntington's Disease Rating Scale functional, behavioral, and cognitive assessments, as well as additional neuropsychological examinations and the Symptom Checklist-90-Revised (SCL-90R). A structural equation model was used to examine the effects of motor, cognitive, psychiatric, and SPS states on functionality. RESULTS: The multifactor structural model fit well descriptively. Cognitive and motor states uniquely and significantly predicted function in HD; however, neither psychiatric nor SPS states did. SPS was, however, significantly related to motor, cognitive, and psychiatric states, suggesting that it may bridge the correlative gap between psychiatric and cognitive states in HD. CONCLUSION: SPS may be worth assessing in conjunction with the standard gamut of clinical assessments in HD. Suggestions for future research and implications for patients, families, caregivers, and clinicians are discussed.

The good life: assessing the relative importance of physical, psychological, and self-efficacy statuses on quality of well-being in osteoarthritis patients.

Background and Purpose. The purpose of the present study was to examine the interrelationships among physical dysfunction, self-efficacy, psychological distress, exercise, and quality of well-being for people with osteoarthritis. It was predicted that exercise would mediate the relationships between physical dysfunction, self-efficacy, psychological distress, and quality of well-being. Methods. Participants were 363 individuals with osteoarthritis who were 60 years of age or older. Data were collected from the baseline assessment period prior to participating in a social support and education intervention. A series of structural equation models was used to test the predicted relationships among the variables. Results. Exercise did not predict quality of well-being and was not related to self-efficacy or psychological distress; it was significantly related to physical dysfunction. When exercise was removed from the model, quality of life was significantly related to self-efficacy, physical dysfunction, and psychological distress. Conclusions. Engagement in exercise was directly related to physical functioning, but none of the other latent variables. Alternatively, treatment focused on self-efficacy and psychological distress might be the most effective way to improve quality of well-being.