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Objective: Disability from chronic illness is a major problem for society, yet the study of its determinants lacks an overall theoretical paradigm. Johnston (1996) has proposed conceptualizing disability as behavior and integrating biomedical and behavioral predictors. Dixon, Johnston, Rowley, and Pollard (2008) tested a model including constructs from the International Classification of Functioning, Disability and Health (ICF) and the theory of planned behavior (TPB) using structural equation modeling; it fitted better and explained more variance than the ICF or TPB alone. We replicated their study with a new sample from the same population (orthopedic patients awaiting joint replacement) and also tested the model after the patients had surgery. Methods: Two weeks before surgery, 342 orthopedic patients who had joint pain (most with arthritis) completed a questionnaire, with 228 completing it again 1 year after surgery. The authors tested Dixon et al.'s best-fit models cross-sectionally (before and after surgery) and assessed the goodness of fit of these imposed models to our data using structural equation modeling. Results: Findings strongly supported those of Dixon et al. Before surgery, results were very similar to Dixon et al. with all models accounting for significant variance and fitting well, but the integrated model fitted better and accounted for more variance. One year after surgery, Dixon et al.'s models showed even stronger fit to the data. Conclusions: Although behavioral and biomedical (ICF) models were supported, the integrated model provided a better explanation of disability in this population than either of these models alone and suggests biopsychosocial interventions to reduce disability. [ABSTRACT FROM AUTHOR]

Objective: To test the ability of a model that integrates the theory of planned behavior (TPB) into the International Classification of Functioning, Disability and Health (ICF), to predict walking limitations in adults awaiting hip or knee replacement surgery. Study Design and Participants: Cross-sectional structural equation modeling study of activity limitations in 190 adults. Method: A postal questionnaire measuring TPB, ICF, and walking limitations. Results: The integrated model accounted for more variance in activity limitations (57%) than did either TPB or ICF alone. Control beliefs (TPB) significantly mediated the relationship between impairment (ICF) and activity limitations. Conclusions: The integrated model provides an interdisciplinary, theoretical framework that identifies intervention targets to effect reductions in disability without the need for concomitant reductions in impairment. [ABSTRACT FROM AUTHOR]

Objectives: To gain a better understanding of the influence of the health condition on emotions and control cognitions by using the International Classification of Functioning, Disability and Health (ICF) framework. The relations between health condition, impairment, activity limitations, and emotions or control cognitions were investigated in people with 1 of 2 different disabling conditions, chronic idiopathic axonal polyneuropathy (CIAP) or stroke. Method: Two existing databases were used: cross-sectional data from 56 participants with CIAP; longitudinal data of 100 participants with stroke. Participants were assessed on measures of the health condition, impairment, activity limitations, emotions, and control cognitions. Results: In participants with CIAP, impairment explained variance in concurrent control cognitions (9%-25%), activity limitation in concurrent depression (8%), and control cognitions (26%-36%). In stepwise regression activity, limitation was more powerful in explaining variance in emotions and control cognitions than impairment. In people with stroke, only activity limitations explained variance in emotions (4%-9%) and control cognitions (4%-7%). Conclusions: These results suggest that targeting activity limitations in rehabilitation efforts is likely to relate to control cognitions, which in themselves have been shown to benefit recovery of physical consequences in chronic illness. [ABSTRACT FROM AUTHOR]