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Context—No tools exist to measure patients' self-efficacy for and adherence to the complex home-care regimen after having a left ventricular device (LVAD) implanted. Objective—To develop 2 new instruments, the LVAD Patient Self-Efficacy Scale (LPSES) and the LVAD Patient Home Management Adherence Scale (LPHMAS), and evaluate their psychometric properties. Methods—This multistage instrumentation study recruited 102 patients (77.5% men and 22.5% women) aged 20 to 82 years, predominantly from the Midwest (34.3%) and the Northeast (26.5%) regions of the United States. Main indications for LVAD were bridge-to-transplant (69.6%) and destination therapy (21.6%), with mean implant duration of 19.9 (SD, 15.5) months. Study participants completed the following instruments: LPSES, LPHMAS, General Self-Efficacy Scale (GSES), Medical Outcomes Study General Adherence (MOSGA), and Self-Care Heart Failure Index (SCHFI) confidence and maintenance subscales. Item analyses, psychometric properties including factorial and convergent validities, and internal consistency reliability were tested. Results—Factor analyses showed that the variances for the 20-item LPSES and 9-item LPHMAS were 60.2% and 53.6%, respectively. Convergent validity of the newly developed instruments was supported by the following correlations: LPSES and GSES (r = 0.34); LPSES and SCHFI-confidence (r = 0.60); LPHMAS and MOSGA (r = 0.33); LPHMAS and SCHFI-maintenance (r = 0.40). Internal consistency reliability coefficients were 0.94 (LPSES) and 0.84 (LPHMAS). Based on these data, the LPSES and LPHMAS are valid and reliable measures of self-efficacy and adherence specific for LVAD patients. Confirmatory testing is needed to further support the validity of these instruments for use in research and clinical practice. [ABSTRACT FROM AUTHOR]

Context—No published instrument has been designed to measure caregivers' self-efficacy for and adherence to the complex home-care regimen of patients with a left ventricular assist device (LVAD). Objective—To evaluate the psychometric properties of 2 newly developed instruments: the LVAD Caregiver Self-Efficacy Scale (LCSS) and the LVAD Caregiver Home Management Adherence Scale (LCAS). Methods—A multistage design was employed for this instrumentation study. Of the 125 LVAD caregivers recruited from online support groups, 98 (78.4%) provided complete data. Participants were predominantly female (80%), aged 18 to 79 years, from 4 regions of the United States. They completed the following instruments: LCSS, LCAS, General Self-Efficacy Scale (GSE), and the confidence and maintenance subscales of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI). Item analyses, factorial construct validity, convergent validity, and internal consistency reliability of the scales were evaluated. Results—The analysis of the LCSS (21 items) revealed a 2-factor solution, which consisted of a 17-item routine factor and a 4-item anticipatory factor. Convergent validity of the LCSS was supported by moderate correlations among LCSS, GSE, and CC-SCHFI-confidence. The analysis of LCAS (17 items) revealed a 1-factor solution. Its convergent validity was supported by moderate correlation between LCAS and CC-SCHFI-maintenance. Internal consistency reliability coefficients of the LCSS and LCAS were α = 0.93 and α = 0.96, respectively. These data suggest that the 2 instruments are adequately valid and reliable measures of self-efficacy and adherence in the context of LVAD patient care managed by home caregivers. Further research is needed to support the applicability of these instruments in other research and practice settings. [ABSTRACT FROM AUTHOR]

Background: Unexplained prolonged fatigue (UPF) is one of the most common complaints in primary care. UPF is difficult to manage because of its nonspecific nature and unknown mechanism. UPF frequently frustrates health care professionals and has negative impacts on the physician-patient relationship. Although it is nonfatal, fatigue- associated functional impairments and economic consequences are substantial, negatively impacting patients' quality of life. Objectives: To evaluate current knowledge development of UPF and to help focus the direction of future investigations. Methods: A literature review was undertaken with the MEDLINE databases chosen as the primary electronic resources to retrieve the literature. Results: Current understanding of UPF is limited. Lack of consistent scientific language is a major problem. There is no consensus about the case definition of UPF even for the most widely studied chronic fatigue syndrome (CFS). Various sets of classification have been developed, each with similar but not identical criteria. Clinicians are dubious about perceiving fatigue as a clinical entity and ignore the diagnosis criteria. Many more patients are excluded than included from the current classifications and lack appropriate evaluation and treatment. The predisposing factors are not well established with the exception of being female and relatively young. Laboratory testing and immune and endocrine abnormalities are inconsistent in determining the causes. Psychological and social factors play an important but inconclusive role in mediating fatigue status. Conclusions: The high prevalence, persistence, and disability-associated consequences of UPF warrant more attention. Further investigations of the symptoms, psychosocial-based symptom experiences, and a search for effective management are needed. [ABSTRACT FROM PUBLISHER]