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Purpose/Objective: Activity limitations following surgery are common, and patients may have an extended period of pain and rehabilitation. Inguinal hernia surgery is a common elective procedure. This study incorporated fear-avoidance models in investigating cognitive and emotional variables as potential risk factors for activity limitations 4 months after inguinal hernia surgery. Method: This was a prospective cohort study, predicting activity limitations 4 months postoperatively (Time 3 [T3]) from measures taken before surgery (Time 1, [T1]) and 1 week after surgery (Time 2 [T2]). The sample size at T1 was 135; response rates were 89% and 84% at T2 and T3 respectively. Questionnaires included measures of catastrophizing, fear of movement, depression, anxiety, optimism, perceived control over pain, pain, and activity limitations. Biomedical and surgical variables were recorded. Predictors of T3 activity limitations from T1 and T2 were examined in hierarchical multiple regression equations. Results: Over half of participants (57.7%) reported activity limitations due to their hernia at 4 months post- surgery. Higher activity limitation levels were significantly predicted by older age, higher preoperative activity limitations, higher preoperative anxiety, and more severe postoperative pain and depression scores. Conclusions/Implications: Interventions to reduce preoperative anxiety and postoperative depression may lead to reduced 4-month activity limitations. However, the additional variance explained by psychological variables was low (ΔR2 = 0.05). Our models, which included biomedical and surgical variables, accounted for less than 50% of the variance in activity limitations overall. Therefore, further investigation of psychological variables, particularly cognitions related specifically to activity behavior, would be merited. [ABSTRACT FROM AUTHOR]

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 examine the extent to which proxy-report measures adequately assess walking limitations and are interchangeable with self-report measures in stroke survivors. Design and Participants: Self-report, proxy-report, and observed performance measures of walking limitations were compared cross-sectionally on 3 occasions following the discharge from hospital of 101 stroke survivors. Correlations between measures, differences between mean scores, and agreement of self- and proxy reports were analyzed. Results and Conclusions: Self- and proxy-report measures correlated significantly with each other and with observed performance measures; differences between mean scores were not found. Agreement between individual self- and proxy-report pairs was poor, however, indicating that freely substituting proxy-report data for self-report data when self-report data are unavailable is inappropriate. [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]

Objective: Between-participant research has shown that high negative affectivity predicts greater activity limitations and vice versa. This study examined both between- and within-participant associations of negative and positive affectivity with activity levels using ecological momentary assessment. Method: Participants were 25 people who had undergone joint replacement surgery 12 months previously. Participants made multiple reports of their activity and positive and negative affectivity over a single day using a computerized diary. Activity was also objectively recorded using an activity monitor. The following day, participants made a self-report of their activity over the measurement day and general positive and negative affectivity levels were recorded. Results: Higher self-reported walking time over the whole measurement day was associated with higher general positive affectivity but not negative affectivity. However, using ecological momentary assessment, higher diary reports of negative affectivity predicted increased activity levels while positive affectivity neither predicted nor was predicted by activity. Conclusion: These findings demonstrate the importance of within-participant methodology in detecting subtle and immediate effects of individuals' mood on behavior that may differ from findings investigating between-participant effects over longer time periods. [ABSTRACT FROM AUTHOR]