The differential relations between the emotion regulation strategies "cognitive reappraisal" and "expressive suppression" and suicidality in a mixed inpatient sample (N = 232, 69.4% female) of a German psychotherapeutic hospital were examined. Patients filled in the Emotion Regulation Questionnaire and items on suicidal ideation and desire. A structural equation model fitted the data (RMSEA = .044; CFI = .96) and revealed that "expressive suppression" significantly predicted increased suicidal ideation. Moderation analysis showed that results were independent from a current depressive episode. Potential implications for psychotherapeutic treatment of suicidality are discussed.
To investigate the congruence and influence of lesion side on staff and patient ratings of activity limitations. Study Design: Retrospective study of activity limitations at admission and discharge using the Rasch model and rating scale analysis. Participants: One-hundred twenty elderly stroke patients. Setting: Outpatient geriatric rehabilitation center. Main Outcome Measure: Barthel Index (BI). Results: High patient-staff agreement was found with the lowest agreement on the bathing item of the BI. Although staff rated the degree of activity limitations significantly higher than patients, the effect size was low at admission and discharge. The discrepancy between patient and staff reports did not change during rehabilitation and was equivalent between patients with right and patients with left hemisphere lesions. Conclusion: Patients with a stroke slightly overestimated their competency compared with rehabilitation staff and remained consistent during rehabilitation.
In medical rehabilitation settings the use of appropriate assessment instruments is essential in many ways. A high quality of psychometric scales has to be ensured in order to allow for an appropriate interpretation of diagnostical data as well as for the evaluation of treatment outcomes and for quality assurance within rehabilitation clinics. Assessment scales developed by means of Rasch analysis possess desirable properties, especially because person parameters reach interval level by definition, and the assumption of only one latent dimension suffices to predict respondents behaviour sufficiently. Accordingly, Rasch scales are strictly one-dimensional and thus allow for unambiguous interpretation of diagnostic results. In this article it is shown which specific properties characterize Rasch scales and how Rasch analysis can be used in order to allow for a more differentiated and clinically meaningful data interpretation and to enhance analysis of clinical data.
This study aimed at confirmatory testing the factorial structure of the established assessment instruments ODI, SF-12 and HADS-D by means of structural equation modeling in a sample of n=184 rehabilitation patients with musculo-skeletal diseases. According to local and global fit indices for each instrument an acceptable to good fit to the underlying theoretical model could be verified. For the ODI as well as for the HADS-D only single weak item-construct associations indicated shortcomings in the assumed model structure. For the SF-12 the constructs "physical health" and "mental health" could be validated after defining the additional first order factors "role - physical", "role - emotional" and "well-being", respectively. In general, the study findings proved the factorial validity of the instruments. Additionally, specific measurement properties on item and structural level could be identified which might enhance the understanding of construct definitions in rehabilitation patients with musculoskeletal diseases.
The Rasch-based, computerized adaptive assessment procedure RehaCAT allows to assess the ICF-oriented dimensions "activities in daily living", "functionality upper extremities" and "functionality lower extremities" as well as "depression" economically and reliably in orthopaedic rehabilitation patients. This validation study aimed at analyzing the multivariate association of the RehaCAT dimensions with the commonly applied ODI, SF-12 and HADS-D assessment scales in a sample of rehabilitation patient suffering from musculoskeletal diseases (spine disease: 58,7%). By means of structural equation modeling high convergent and divergent validity of the RehaCAT dimensions could be proven in a sample of N=184 rehabilitation patients (71,2% inpatient and 28,8% outpatient). In the resulting model between 41% (functionality upper extremities) and 76% (activities in daily living) of the RehaCAT dimensions could be explained mainly by the theoretical assumed predictor constructs. Because of its psychometric foundation, economy and validity, the RehaCAT provides an optimal basis to assess central ICF-oriented constructs in orthopaedic rehabilitation.
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