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There is a need for a measure to monitor adherence to transmission-reducing behaviours (TRBs) during pandemics. An adherence measure can monitor current TRBs, assess change over time and, potentially, predict later behaviours. The TRB adherence measure (scale consisting of seven items) includes questions based on government behavioural directives in Scotland that were common internationally, i.e., physical distancing, face covering and hand hygiene. Data were collected weekly for 6 weeks at the beginning of the pandemic, including a later follow-up repeated measure of some participants, in 20-minute structured telephone surveys with a nationally representative random sample of adults in Scotland. A total of 2969 people completed the adherence items and were highly adherent. Confirmatory factor analysis supported a unidimensional scale (CFI =.95; TLI =.93; RMSEA =.08; SRMR =.08), although internal consistency was low (Cronbach's alpha =.49). The adherence score significantly predicted adherence to a validity test item (ΔR2 =.114, F(1,2964) = 379.76, p <.001). It also predicted adherence to TRBs later over and above personal habitual styles (Creature of Habit Scale: COHS). The adherence score has been developed for routine monitoring of adherence to TRBs during the COVID-19 pandemic. It can be used to predict future similar behaviours and adherence to other behaviours, although it may be necessary to explore adherence to the specific behaviours occasionally. Adherent behaviour for one TRB is likely to be associated with adherence to government directives to other TRBs. Importantly, these TRBs are likely to be crucial in reducing COVID-19 case numbers, as well as protecting against other infectious diseases including influenza and the common cold. [ABSTRACT FROM AUTHOR]

Objectives: Self‐efficacy is important for adherence to transmission‐reducing behaviours (e.g., physical distancing) as also shown in the CHARIS project. We aimed to show that a theory‐based short message can increase physical distancing self‐efficacy and intentions to keep physical distance. Design: Structured telephone surveys with a randomly selected nationally representative sample of adults in Scotland (N = 497). Methods: Participants were randomly assigned to one of two experimental conditions: message condition (short message to increase self‐efficacy via vicarious experiences, verbal persuasion and emotional arousal) or control condition (no message). Followed by measures for self‐efficacy and intention for physical distancing on 4‐point scales. Adherence to physical distancing was assessed on a 5‐point frequency scale (never – always). Results: Using mediation analyses with bootstrapping procedures, we first confirmed that self‐efficacy was associated indirectly with adherence, via higher intentions in a partial mediation (unstandardized indirect effect.21, 95% CI.18–.25). The message increased self‐efficacy; participants receiving the message reported higher self‐efficacy (M = 4.23, SD =.80) compared to participants in the control condition (M = 4.08, SD =.77; standardized regression coefficient =.19, p <.05) and self‐efficacy affected intention (.48, p <.001). There was a small significant indirect effect of the message on intention via self‐efficacy (unstandardized indirect effect.07, CI.01–.14). Conclusions: Increasing self‐efficacy for physical distancing with a short message can successfully increase intention to physical distance via increased self‐efficacy. As both self‐efficacy and intentions are important predictors of adherence to transmission‐reducing behaviours short messages have potential to limit the spread of COVID‐19. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the efficacy of a behaviour change intervention to reduce patient delay with symptoms of acute coronary syndrome. Design: A 3‐arm web‐based, parallel randomized controlled trial. Methods: The intervention comprised 12 behaviour change techniques (BCTs) embedded in a text‐only or text+visual narrative (the techniques were systematically identified through systematic review and a consensus exercise). Between February and November 2017, n = 145 people who had recently experienced acute coronary syndrome were randomly allocated to intervention ('text+visual' or 'text‐only') or control. Intentions to phone an ambulance immediately for acute coronary syndrome symptoms were assessed before and after the intervention using symptom scenarios, and the change in intention was compared across the three groups. Results: Significant increases in intention to phone an ambulance immediately for ACS symptoms were seen following the 'text+visual' intervention but not following 'text‐only' or control. However, the study was underpowered to detect any significant changes in intention between the 3 groups. There were no unintended effects on intentions for non‐urgent symptoms. Conclusions: A 'text+visual' BCT‐based intervention may significantly increase intention to phone an ambulance with symptoms of ACS. Further testing of the effect of the intervention on actual behaviour is required. [ABSTRACT FROM AUTHOR]

Background: The competence of the person delivering person-to-person behaviour change interventions may influence the effectiveness of the intervention. However, we lack a framework for describing the range of competences involved. The objective of the current work was to develop a competency framework for health behaviour change interventions. Method: A preliminary framework was developed by two judges rating the relevance of items in the competency framework for cognitive behaviour therapies; adding relevant items from reviews and other competency frameworks; and obtaining feedback from potential users on a draft framework. The Health Behaviour Change Competency Framework (HBCCF) was used to analyse the competency content of smoking cessation manuals. Results: Judges identified 194 competency items as relevant, which were organised into two domains: foundation (12 competency topics comprising 56 competencies) and behaviour change (12 topics, 54 competencies); several of the 54 and 56 competencies were composed of sub-competencies (84 subcompetencies in total). Smoking cessation manuals included 14 competency topics from the foundation and behaviour change competency domains. Conclusion: The HBCCF provides a structured method for assessing and reporting competency to deliver behaviour change interventions. It can be applied to assess a practitioner's competency and training needs and to identify the competencies needed for a particular intervention. To date, it has been used in self-assessments and in developing training programmes. We propose the HBCCF as a practical tool for researchers, employers, and those who design and provide training. We envisage the HBCFF maturing and adapting as evidence that identifies the essential elements required for the effective delivery of behaviour change interventions emerges. [ABSTRACT FROM AUTHOR]

Aims: To estimate the strengths of associations between use of behaviour change techniques (BCTs) and clusters of BCTs in behavioural smoking cessation interventions and comparators with smoking cessation rates. Method: Systematic review and meta‐regression of biochemically verified smoking cessation rates on BCTs in interventions and comparators in randomized controlled trials, adjusting for a priori‐defined potential confounding variables, together with moderation analyses. Studies were drawn from the Cochrane Tobacco Addiction Group Specialised Register. Data were extracted from published and unpublished (i.e. obtained from study authors) study materials by two independent coders. Adequately described intervention (k = 143) and comparator (k = 92) groups were included in the analyses (n = 43 992 participants). Using bivariate mixed‐effects meta‐regressions, while controlling for key a priori confounders, we regressed smoking cessation on (a) three BCT groupings consistent with dual‐process theory (i.e. associative, reflective motivational and self‐regulatory), (b) 17 expert‐derived BCT groupings (i.e. BCT taxonomy version 1 clusters) and (c) individual BCTs from the BCT taxonomy version 1. Results: Among person‐delivered interventions, higher smoking cessation rates were predicted by BCTs targeting associative and self‐regulatory processes (B = 0.034, 0.041, P < 0.05), and by three individual BCTs (prompting commitment, social reward, identity associated with changed behaviour). Among written interventions, BCTs targeting taxonomy cluster 10a (rewards) predicted higher smoking cessation (B = 0.394, P < 0.05). Moderation effects were observed for nicotine dependence, mental health status and mode of delivery. Conclusions: Among person‐delivered behavioural smoking cessation interventions, specific behaviour change techniques and clusters of techniques are associated with higher success rates. [ABSTRACT FROM AUTHOR]

Objective: Over 90 behaviour change techniques (BCTs) have been specified but there is limited guidance to assist non-specialist practitioners in the choice of which BCTs to select for use with clients. This paper describes the development of MAP, a theory-based mnemonic designed to aid practitioners in their use of BCTs. Each BCT is MAPed to one or more of three recognized routes to behaviour change, namely Motivation development, Action control, and Prompted or cued route.Design: A cross-sectional online discriminant content validity (DCV) questionnaire.Methods: Fourteen judges participated, decided whether each BCT affects behaviour via each of the three routes, and provided a confidence rating for each judgement. Wilcoxon one-sample tests classified each BCT to a route or combination of routes. Intraclass correlation coefficients (ICC) assessed agreement between judges.Results: Fifty-eight BCTs were judged to affect behaviour via a single route; 28, 21, and nine BCTs were judged to act via the Motivation, Action, or Prompted routes, respectively. Judges did not agree on a route for 35 BCTs. Overall ICC (0.89) value was high and did not differ between routes.Conclusions: There was good agreement on candidate BCTs for interventions designed to operate through Motivation, Action, or Prompted/Cued psychological processes. MAP is a mnemonic that can be used by non-specialist practitioners who implement behaviour change with their clients. MAP is not a replacement for sophisticated theory-based organization of BCTs required for theory testing. While providing practical guidance, further work is necessary to establish effectiveness of BCTs tailored to each route. [ABSTRACT FROM AUTHOR]

Background : Governments have relied on their citizens to adhere to a variety of transmission-reducing behaviours (TRBs) to suppress the Covid-19 pandemic. Understanding the psychological and sociodemographic predictors of adherence to TRBs will be heavily influenced by the particular theories used by researchers. This review aims to identify the theories and theoretical constructs used to understand adherence to TRBs during the pandemic within the UK social and legislative context. Methods: A systematic review identified studies to understand TRBs of adults in the UK during the pandemic. Identified theoretical constructs were coded to the Theoretical Domains Framework. Data are presented as a narrative summary. Results: Thirty-five studies (n = 211,209) investigated 123 TRBs, applied 13 theoretical frameworks and reported 50 sociodemographic characteristics and 129 psychological constructs. Most studies used social cognition theories to understand TRBs and employed cross-sectional designs. Risk of sampling bias was high. Relationships between constructs and TRBs varied, but in general, beliefs about the disease (e.g. severity and risk perception) and about TRBs (e.g. behavioural norms) influenced behavioural intentions and self-reported adherence. More studies than not found that older people and females were more adherent. Conclusions: Behavioural scientists in the UK generated a significant and varied body of work to understand TRBs during the pandemic. However, more use of theories that do not rely on deliberative processes to effect behaviour change and study designs better able to support causal inferences should be used in future to inform public health policy and practice. Prospero Registration: CRD42021282699. [ABSTRACT FROM AUTHOR]

In the United States earthworms of two Asian species (Amynthas tokioensis and A. agrestis) are leading a northward invasion into temperate forests and horticultural landscapes. Some studies have shown temperature sensitivity in earthworms, but none has explicitly tested the range of heat tolerance for A. tokioensis and A. agrestis cocoons. This study tested the hypothesis A. tokioensis and A. agrestis cocoons would become nonviable when exposed to 55 C in a laboratory setting. Clitellate earthworms of A. tokioensis and A. agrestis were established in replicate incubation cultures to quantify cocoon production rate and to obtain cocoons of known source. Cocoons were then exposed to heat treatments (3 or 15 d at 20, 30, 40, 45, 50, 55, or 60 C) to determine viability after heat exposure. Twelve A. tokioensis and A. agrestis earthworms produced as many as 74 and 82 cocoons in 20 d, respectively (overall mean = 0.14 ± 0.10 cocoons earthworm–1 d–1). All heat treatments ≥40 C resulted in zero viability (P < 0.001), but the 30 C treatment was no different than the control at 20 C (P = 1.000). These findings were consistent regardless of species, treatment length, or period of incubation during which the cocoons were collected. The threshold of tolerance was between 27.1 C (maximum of the 30 C treatment) and 38.1 C (minimum of the 40 C treatment) for A. tokioensis and A. agrestis cocoons. These data may guide management decisions concerning the spread of A. tokioensis and A. agrestis to new locations. [ABSTRACT FROM AUTHOR]

Non-native earthworms have been increasing in density within cities in the USA and around the world, but how earthworms respond to variation in plant cover within these systems remains unclear. We collected earthworms and standing plant biomass from five residences in Madison, Wisconsin, USA, each possessing two plant cover types—a turfgrass lawn and a prairie garden containing flora native to the Midwestern USA—on two occasions (once each in 2007 and 2008). Soil moisture and temperature were also quantified. On average, volumetric soil moisture was 2.8% lower and standing plant biomass 384 g m −2 greater in the prairie gardens than in the turfgrass lawns. Earthworm densities increased by 0.1 and 2.7 individuals m −2 on average with each increase of 1 g m −2 in standing plant biomass and of 1% in soil moisture, respectively. Further, when the effects of plant biomass and soil moisture were factored out, earthworm densities were estimated to be 55 individuals m −2 lower in prairie gardens than in adjacent lawns. These findings suggest native-flora prairie gardens may provide less favorable habitat for non-native earthworms, all else being equal. [ABSTRACT FROM AUTHOR]

Objective: Communication of the content of a behaviour change intervention (BCI) involves clear description followed by appropriate recognition and interpretation. We investigated accuracy of recognition of BCI descriptions and the effects of training in the behaviour change taxonomy BCTTv1. Methods: Materials were 166 written descriptions of two BCIs previously written by 166 separate writers after viewing a video of the BCI. Each of the current participants (12 naïve and 12 trained in BCTTv1) was presented with a random sample of the written descriptions and asked to form groups of descriptions they judged to be describing the same intervention. For each participant, we assessed the number of groupings of BCI descriptions, their purity (containing only one BCI) and their differentiation (having a dominant BCI). Results: All except one participant classified the descriptions into more than two groupings. Naïve participants created significantly more groupings, fewer ‘pure’ groupings and less differentiated groupings (all Mann-Whitney p < .05). Conclusions: Written communications of BCI contents may not be recognised and interpreted adequately to support implementation. BCT taxonomy training may lead to some progress in interpreting the active content of interventions but, based on this limited study, further progress is needed if BCIs for accurate implementation. [ABSTRACT FROM AUTHOR]

Implementing research findings into healthcare practice and policy is a complex process occurring in diverse contexts; it invariably depends on changing human behaviour in many parts of an intricate implementation system. Questions asked with the aim of improving implementation are multifarious variants of 'What works, compared with what, how well, with what exposure, with what behaviours (for how long), for whom, in what setting and why?'. Relevant evidence is being published at a high rate, but its quantity, complexity and lack of shared terminologies present challenges. The achievement of efficient, effective and timely synthesis of evidence is facilitated by using 'ontologies' to systematically structure and organise the evidence about constructs and their relationships, using a controlled, well-defined vocabulary. [ABSTRACT FROM AUTHOR]

Aims To evaluate the efficacy of a behaviour change technique-based intervention and compare two possible modes of delivery (text + visual and text-only) with usual care. Background Patient delay prevents many people from achieving optimal benefit of time-dependent treatments for acute coronary syndrome. Reducing delay would reduce mortality and morbidity, but interventions to change behaviour have had mixed results. Systematic inclusion of behaviour change techniques or a visual mode of delivery might improve the efficacy of interventions. Design A three-arm web-based, parallel randomized controlled trial of a theory-based intervention. Methods The intervention comprises 12 behaviour change techniques systematically identified following systematic review and a consensus exercise undertaken with behaviour change experts. We aim to recruit n = 177 participants who have experienced acute coronary syndrome in the previous 6 months from a National Health Service Hospital. Consenting participants will be randomly allocated in equal numbers to one of three study groups: i) usual care, ii) usual care plus text-only behaviour change technique-based intervention or iii) usual care plus text + visual behaviour change technique-based intervention. The primary outcome will be the change in intention to phone an ambulance immediately with symptoms of acute coronary syndrome ≥15-minute duration, assessed using two randomized series of eight scenarios representing varied symptoms before and after delivery of the interventions or control condition (usual care). Funding granted January 2014. Discussion Positive results changing intentions would lead to a randomized controlled trial of the behaviour change intervention in clinical practice, assessing patient delay in the event of actual symptoms. Trial registration Registered at ClinicalTrials.gov: NCT02820103. [ABSTRACT FROM AUTHOR]

Purpose: Dekker et al. (2016) propose an updated definition of behavioural medicine. Method: In this commentary, we discuss how the field and the disciplines involved have changed over time before suggesting small amendments to the proposed definition. Results: We suggest that the range of medicine which might be considered 'behavioural' is increasing to encompass virtually all medical practice. In addition, the role of behaviour and the potential for behaviour change as a means of improving health have become increasingly important. A defining characteristic of behavioural medicine is the involvement of multiple disciplines, working together or in parallel and, as the extent of the field expands, more disciplines are likely to be involved. Conclusion: We therefore propose that the definition should represent the full width of the research, practice and disciplines involved in behavioural medicine. [ABSTRACT FROM AUTHOR]

The article presents the opinion of the author on variation in the behaviour of people as described by Professor J. Ogden. The author favors the role of variability in theories, methods and practices to create the link between health and behaviour of both patients and healthcare professionals. The author also supports Behaviour Change Technique Taxonomy, but also suggests that not all variability is effective.

Background: Clinicians' behaviours require deliberate decision-making in complex contexts and may involve both impulsive (automatic) and reflective (motivational and volitional) processes. Purpose: The purpose of this study was to test a dual process model applied to clinician behaviours in their management of type 2 diabetes. Methods: The design used six nested prospective correlational studies. Questionnaires were sent to general practitioners and nurses in 99 UK primary care practices, measuring reflective (intention, action planning and coping planning) and impulsive (automaticity) predictors for six guideline-recommended behaviours: blood pressure prescribing ( N = 335), prescribing for glycemic control ( N = 288), providing diabetes-related education ( N = 346), providing weight advice ( N = 417), providing self-management advice ( N = 332) and examining the feet ( N = 218). Results: Respondent retention was high. A dual process model was supported for prescribing behaviours, weight advice, and examining the feet. A sequential reflective process was supported for blood pressure prescribing, self-management and weight advice, and diabetes-related education. Conclusions: Reflective and impulsive processes predict behaviour. Quality improvement interventions should consider both reflective and impulsive approaches to behaviour change. [ABSTRACT FROM AUTHOR]

The International Classification of Functioning Disability and Health (ICF) offers an agreed language on which a scientific model of functional outcomes can be built. The ICF defines functional outcomes as activity and activity limitations (AL) and defines both in behavioural terms. The ICF, therefore, appears to invite explanations of AL as behaviours. Studies of AL find that psychological variables, especially perceptions of control, add to biomedical variables in predicting AL. Therefore, two improved models are proposed, which integrate the ICF with two psychological theories, the theory of planned behaviour (TPB) and social cognitive theory (SCT). These models have a sound evidence base as good predictors of behaviour, include perceived control constructs and are compatible with existing evidence about AL. When directly tested in studies of community and clinic-based populations, both integrated models (ICF/TPB and ICF/SCT) outperform each of the three basic models (ICF, TPB and SCT). However, when predicting activity rather than AL, the biomedical model of the ICF does not improve prediction of activity by TPB and SCT on their own. It is concluded that these models offer a better explanation of functional outcomes than the ICF alone and could form the basis for the development of improved models. [ABSTRACT FROM PUBLISHER]

Behavioral theory is often tested on one behavior in isolation from other behaviors and theories. We aimed to test the predictive validity of constructs from motivation and action theories of behavior across six diabetes-related clinician behaviors, within the same sample of primary care clinicians. Physicians and nurses ( n = 427 from 99 practices in the United Kingdom) completed questionnaires at baseline and 12 months. Primary outcomes: six self-reported clinician behaviors related to advising, prescribing and examining measured at 12 months; secondary outcomes: baseline intention and patient-scenario-based simulated behavior. Across six behaviors, each theory accounted for a medium amount of variance for 12-month behavior (median R = 0.15), large and medium amount of variance for two intention measures (median R = 0.66; 0.34), and small amount of variance for simulated behavior (median R = 0.05). Intention/proximal goals, self-efficacy, and habit predicted all behaviors. Constructs from social cognitive theory (self-efficacy), learning theory (habit) and action and coping planning consistently predicted multiple clinician behaviors and should be targeted by quality improvement interventions. [ABSTRACT FROM AUTHOR]

Background: To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes. Methods: Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane 'Risk of Bias Tool' 2.0 and the GRADE assessment to evaluate the overall quality of evidence. Results: Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI −0.12–0.87) and the effect on weight loss was uncertain (BMI mean difference −0.17, 95% CI −1.1–0.83) at the end-treatment follow-up. Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17–0.42) and physical function (SMD 0.42, 95% CI 0.12–0.73), and moderate improvements were seen for depression symptoms (SMD −0.70, 95% CI −0.97–0.42). Studies using the BCTs 'action planning' and 'social support (practical)' reported greater physical activity and weight loss. Conclusions: Behavioural interventions targeting lifestyle behaviours may improve health-related quality of life and physical function, and reduce depression, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time. [ABSTRACT FROM AUTHOR]

Objectives Karasek's job demand-control model postulates that demand, control, and distress are environmental rather than individual features although these levels are often confounded. The objective was to investigate whether job demand, control, and demand × control predict environmental and individual distress in primary care clinicians, and the mediating role of distress in the relationships between demand and control with intention to leave and absenteeism. Design Predictive national survey. Methods We invited 2,079 staff from 99 general practices in the United Kingdom (843 GPs and nurses, 1,236 administrators) to complete postal questionnaires assessing distress, intention to leave, absenteeism, job demand, and control. Random intercept multilevel models and bootstrapped mediation models were run to test the study hypotheses. Results One thousand five hundred and ninety staff completed questionnaires (77% staff-level response rate; complete responses by ≥80% of all workers in 68 work environments). There was evidence of environmental variation between practices in intention to leave, absenteeism, job demand, and control, but not distress. Job demand and control both significantly predicted distress, and control moderated the relationship between demand and distress with the effects of demand being reduced at low levels by high control. A small indirect effect via distress was observed for the relationship between job demand and absenteeism, and between job control and intention to leave. No support was found for environmental effects of work settings on distress, but there was evidence of individual-level effects. Conclusions There is a need for considering environmental and individual levels and a danger of generalizing conclusions from one level to the other. Statement of contribution What is already known on this subject? Karasek's job demand-control model shows consistent prediction of distress in health professionals., Environmental and individual features of distress, demand, and control are often confounded., What does this study add? Nationally representative UK survey of doctors, nurses, and admin primary care staff., Test individual and environment effect of demand and control on distress, absenteeism, leaving intention., Indirect effect of demand on absenteeism via distress and of control on intention to leave via distress. [ABSTRACT FROM AUTHOR]

Objectives In studies involving theoretical constructs, it is important that measures have good content validity and that there is not contamination of measures by content from other constructs. While reliability and construct validity are routinely reported, to date, there has not been a satisfactory, transparent, and systematic method of assessing and reporting content validity. In this paper, we describe a methodology of discriminant content validity ( DCV) and illustrate its application in three studies. Methods Discriminant content validity involves six steps: construct definition, item selection, judge identification, judgement format, single-sample test of content validity, and assessment of discriminant items. In three studies, these steps were applied to a measure of illness perceptions ( IPQ- R) and control cognitions. Results The IPQ- R performed well with most items being purely related to their target construct, although timeline and consequences had small problems. By contrast, the study of control cognitions identified problems in measuring constructs independently. In the final study, direct estimation response formats for theory of planned behaviour constructs were found to have as good DCV as Likert format. Conclusions The DCV method allowed quantitative assessment of each item and can therefore inform the content validity of the measures assessed. The methods can be applied to assess content validity before or after collecting data to select the appropriate items to measure theoretical constructs. Further, the data reported for each item in Appendix S1 can be used in item or measure selection. [ABSTRACT FROM AUTHOR]

Background: Previous research has supported an integrated biomedical and behavioural model explaining activity limitations. However, further tests of this model are required at the within-person level, because while it proposes that the constructs are related within individuals, it has primarily been tested between individuals in large group studies. We aimed to test the integrated model at the within-person level. Method: Six correlational N-of-1 studies in participants with arthritis, chronic pain and walking limitations were carried out. Daily measures of theoretical constructs were collected using a hand-held computer (PDA), the activity was assessed by self-report and accelerometer and the data were analysed using time-series analysis. Results: The biomedical model was not supported as pain impairment did not predict activity, so the integrated model was supported partially. Impairment predicted intention to move around, while perceived behavioural control (PBC) and intention predicted activity. PBC did not predict activity limitation in the expected direction. Conclusions: The integrated model of disability was partially supported within individuals, especially the behavioural elements. However, results suggest that different elements of the model may drive activity (limitations) for different individuals. The integrated model provides a useful framework for understanding disability and suggests interventions, and the utility of N-of-1 methodology for testing theory is illustrated. [ABSTRACT FROM AUTHOR]

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]

Background The SF-36 is a very commonly used generic measure of health outcome in osteoarthritis (OA). An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items work in the same way across subgroup of a population. That is, if respondents have the same 'true' level of outcome, does the item give the same score in different subgroups or is it biased towards one subgroup or another. Differential item functioning (DIF) can identify items that may be biased for one group or another and has been applied to measuring patient reported outcomes. Items may show DIF for different conditions and between cultures, however the SF-36 has not been specifically examined in an osteoarthritis population nor in a UK population. Hence, the aim of the study was to apply the DIF method to the SF-36 for a UK OA population. Methods The sample comprised a community sample of 763 people with OA who participated in the Somerset and Avon Survey of Health. The SF-36 was explored for DIF with respect to demographic, social, clinical and psychological factors. Well developed ordinal regression models were used to identify DIF items. Results DIF items were found by age (6 items), employment status (6 items), social class (2 items), mood (2 items), hip v knee (2 items), social deprivation (1 item) and body mass index (1 item). Although the impact of the DIF items rarely had a significant effect on the conclusions of group comparisons, in most cases there was a significant change in effect size. Conclusions Overall, the SF-36 performed well with only a small number of DIF items identified, a reassuring finding in view of the frequent use of the SF-36 in OA. Nevertheless, where DIF items were identified it would be advisable to analyse data taking account of DIF items, especially when age effects are the focus of interest. [ABSTRACT FROM AUTHOR]

Purpose: The predictive utility of an integrated model of disability is tested. The integrated model incorporates an impairment based model (International Classification of Functioning, Disability and Health (ICF)) and the behavioural models. Methods: Community dwelling adults (n = 628) completed a postal questionnaire measuring the integrated model. The ability of the model to predict disability in the form of activity limitations (ALs) and walking, in the full community sample and in respondents reporting chronic pain was tested. Results: In both the community and chronic pain samples each version of the integrated model explained a majority (55%-67%) of the variance in ALs but only 11%-29% of the variance in walking behaviour (WB). Impairment directly predicted ALs but did not directly predict WB. Control related cognitions were direct predictors, and mediators, of the relationship between bodily impairment and both ALs and WB. In addition, intentions and outcome expectancies predicted WB. Self-efficacy (SE) was the most consistent predictor of both ALs and WB. Conclusions: An integrated model which combines psychological constructs and impairment is required for an adequate understanding of ALs. By contrast, behavioural models, but not degree of impairment, are necessary to explain activity levels. [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]

Background: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a widely used patient reported outcome in osteoarthritis. An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items exhibit differential item functioning (DIF). That is, if respondents have the same underlying level of an attribute, does the item give the same score in different subgroups or is it biased towards one subgroup or another. The aim of the study was to explore DIF in the Likert format WOMAC for the first time in a UK osteoarthritis population with respect to demographic, social, clinical and psychological factors. Methods: The sample comprised a community sample of 763 people with osteoarthritis who participated in the Somerset and Avon Survey of Health. The WOMAC was explored for DIF by gender, age, social deprivation, social class, employment status, distress, body mass index and clinical factors. Ordinal regression models were used to identify DIF items. Results: After adjusting for age, two items were identified for the physical functioning subscale as having DIF with age identified as the DIF factor for 2 items, gender for 1 item and body mass index for 1 item. For the WOMAC pain subscale, for people with hip osteoarthritis one item was identified with age-related DIF. The impact of the DIF items rarely had a significant effect on the conclusions of group comparisons. Conclusions: Overall, the WOMAC performed well with only a small number of DIF items identified. However, as DIF items were identified in for the WOMAC physical functioning subscale it would be advisable to analyse data taking into account the possible impact of the DIF items when weight, gender or especially age effects, are the focus of interest in UK-based osteoarthritis studies. Similarly for the WOMAC pain subscale in people with hip osteoarthritis it would be worthwhile to analyse data taking into account the possible impact of the DIF item when age comparisons are of primary interest. [ABSTRACT FROM AUTHOR]

Information on this issue of the journal "Health Psychology Review" is presented, including a discussion on the conceptual and methodological advances in behavior change, standards for identifying and evaluating behavior change intervention and an overview of articles that used behavior change therapy (BCT).

Failing to achieve healthy intentions can have a direct impact on subsequent health. The extent of this impact is partially determined by the size of the discrepancy between intentions and behaviour, that is, on whether an unachieved behavioural target is missed by an inch or a mile. Over two studies, measures of 'executive control' ability were used to predict the size of the intention-behaviour gap for two dietary behaviours - eating fruits and vegetables and snacking. In Study 1, participants (n = 50) reported intended dietary intake, completed objective and self-report measures of executive control ability and recorded actual dietary intake over 3 days with computerised diaries. Using multiple regression, general executive control ability was found to account for 16-23% of the variance in the size of intention-behaviour gap for both the dietary behaviours. In Study 2 (n = 52), deviation from intentions about snacking was significantly related to individual differences in prepotent response inhibition. Overall, individuals with weak executive control ate less fruits and vegetables and more snacks than intended. Intention-behaviour 'failures' are not homogenous, but instead vary predictably with the availability of executive control resources. This suggests that individuals with large intention-behaviour shortfalls may benefit from interventions designed to reduce the demands on executive control. [ABSTRACT FROM AUTHOR]

This randomized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness. There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements. Imagining hand movements could stimulate restitution and redistribution of brain activity, which accompanies recovery of hand function, thus resulting in a reduced motor deficit. Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to methodological limitations. This randomized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke (on average <3 months post-stroke). Randomization was performed using an automated statistical minimizing procedure. The primary outcome measure was a blinded rating on the Action Research Arm test. The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week, compared to 31 patients who performed equally intensive non-motor mental rehearsal, and 32 patients receiving normal care without additional training. No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test (ANCOVA statistical P = 0.77, and effect size partial η2 = 0.005) or any of the secondary outcome measures. Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke. In light of the evidence, it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right. [ABSTRACT FROM AUTHOR]

Background: The International Classification of Functioning, Disability and Health (ICF) proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P). The ICF model allows for all paths between the constructs to be explored, with significant paths likely to vary for different conditions. The relationships between I, A and P have been explored in some conditions but not previously in people with osteoarthritis prior to joint replacement. The aim of this paper is to examine these relationships using separate measures of each construct and structural equation modelling. Methods: A geographical cohort of 413 patients with osteoarthritis about to undergo hip and knee joint replacement completed the Aberdeen measures of Impairment, Activity Limitation and Participation Restriction (Ab-IAP). Confirmatory factor analysis was used to test the three factor (I, A, P) measurement model. Structural equation modelling was used to explore the I, A and P pathways in the ICF model. Results: There was support from confirmatory factor analysis for the three factor I, A, P measurement model. The structural equation model had good fit [S-B Chi-square = 439.45, df = 149, CFI robust = 0.91, RMSEA robust = 0.07] and indicated significant pathways between I and A (standardised coefficient = 0.76 p < 0.0001) and between A and P (standardised coefficient = 0.75 p < 0.0001). However, the path between I and P was not significant (standardised coefficient = 0.01). Conclusion: The significant pathways suggest that treatments and interventions aimed at reducing impairment, such as joint replacement, may only affect P indirectly, through A, however, longitudinal data would be needed to establish this. [ABSTRACT FROM AUTHOR]

In interview studies, sample size is often justified by interviewing participants until reaching 'data saturation'. However, there is no agreed method of establishing this. We propose principles for deciding saturation in theory-based interview studies (where conceptual categories are pre-established by existing theory). First, specify a minimum sample size for initial analysis (initial analysis sample). Second, specify how many more interviews will be conducted without new ideas emerging (stopping criterion). We demonstrate these principles in two studies, based on the theory of planned behaviour, designed to identify three belief categories (Behavioural, Normative and Control), using an initial analysis sample of 10 and stopping criterion of 3. Study 1 (retrospective analysis of existing data) identified 84 shared beliefs of 14 general medical practitioners about managing patients with sore throat without prescribing antibiotics. The criterion for saturation was achieved for Normative beliefs but not for other beliefs or studywise saturation. In Study 2 (prospective analysis), 17 relatives of people with Paget's disease of the bone reported 44 shared beliefs about taking genetic testing. Studywise data saturation was achieved at interview 17. We propose specification of these principles for reporting data saturation in theory-based interview studies. The principles may be adaptable for other types of studies. [ABSTRACT FROM AUTHOR]

Abstract: Overeating can be automatically triggered by the presence of palatable food. When presented with an opportunity to consume unlimited chocolate under the guise of a consumer study, chocolate consumption in individuals (n =62) with healthy dietary intentions could be predicted from a psychological measure of cognitive inhibition. Individuals who were less able to suppress goal-incongruent responses in an established inhibitory task: (a) ate more chocolate and (b) had a higher body mass index than others suggesting that these individuals were less able to exert dietary control in the presence of palatable but intention-incongruent foods. [Copyright &y& Elsevier]

Background: Psychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour -- the placing of fissure sealants.Methods: Measures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs) in Scotland. Outcomes were behavioural simulation (scenario decision-making), and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model, and knowledge (a non-theoretical construct). Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive value.Results: Behavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT), timeline acute (CS-SRM), and outcome expectancy (SCT) entered the equation, together explaining 38% of the variance. Behavioural intention - theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT) and attitude (TPB) entered the equation, together explaining 68% of the variance in intention.Summary: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that may predict clinical behaviour and so provide possible targets for knowledge translation interventions. Results suggest that more evidence-based behaviour may be achieved by influencing beliefs about the positive outcomes of placing fissure sealants and building a habit of placing them as part of patient management. However a number of conceptual and methodological challenges remain. [ABSTRACT FROM AUTHOR]

Theory provides a helpful basis for designing interventions to change behaviour but offers little guidance on how to do this. This paper aims to illustrate methods for developing an extensive list of behaviour change techniques (with definitions) and for linking techniques to theoretical constructs. A list of techniques and definitions was generated from techniques published in two systematic reviews, supplemented by “brainstorming” and a systematic search of nine textbooks used in training applied psychologists. Inter-rater reliability of extracting the techniques and definitions from the textbooks was assessed. Four experts judged which techniques would be effective in changing 11 theoretical constructs associated with behaviour change. Thirty-five techniques identified in the reviews were extended to 53 by brainstorming and to 137 by consulting textbooks. Agreement for the 53 definitions was 74.7 per cent (15.4% cells completed and 59.3% cells empty for both raters). Agreement about the link between the 35 techniques and theoretical constructs was 71.7 per cent of 385 judgments (12.2% agreement that effective and 59.5% agreement that not effective). This preliminary work demonstrates the possibility of developing a comprehensive, reliable taxonomy of techniques linked to theory. Further refinement is needed to eliminate redundancies, resolve uncertainties, and complete technique definitions. [ABSTRACT FROM AUTHOR]

This editorial addresses two key aspects of the investigation of behaviour: the science and the application. On the one hand, researchers and policy makers recognise a need for good scientific evidence about behaviour and behaviour change, but are slow to turn to psychology for such evidence. On the other hand, there is a gap in scientific thinking about behaviour and behaviour change. [ABSTRACT FROM AUTHOR]

This study investigated whether Negative Affectivity (NA) causes bias in self-report measures of activity limitations or whether NA has a real, non-artifactual association with activity limitations. The Symptom Perception Hypothesis (NA negatively biases self-reporting), Disability Hypothesis (activity limitations cause NA) and Psychosomatic Hypothesis (NA causes activity limitations) were examined longitudinally using both self-report and objective activity limitations measures. Participants were 101 stroke patients and their caregivers interviewed within two weeks of discharge, six weeks later and six months post-discharge. NA and self-report, proxy-report and observed performance activity (walking) limitations were assessed at each interview. NA was associated with activity limitations across measures. Both the Disability and Psychosomatic Hypotheses were supported: initial NA predicted objective activity limitations at six weeks but, additionally, activity limitations at six weeks predicted NA at six months. These results suggest that NA both affects and is affected by activity limitations and does not simply influence reporting. [ABSTRACT FROM AUTHOR]

Background: Paget's disease of bone (PDB) disrupts normal bone architecture and causes pain, deformity, deafness, osteoarthritis, and fractures. Genetic factors play a role in PDB and genetic tests are now conducted for research purposes. It is thus timely to investigate the potential for a clinical programme of genetic testing and preventative treatment for people who have a family history of PDB. This study examines the beliefs of relatives of people with PDB. It focuses particularly on illness and treatment representations as predictors of the acceptability and uptake of potential clinical programmes. Illness representations are examined using Leventhal's Common Sense Self-Regulation Model while cognitions about treatment behaviours (acceptance of testing and treatment uptake) are conceptualised within the Theory of Planned Behaviour. Methods/Design: A postal questionnaire of non-affected relatives of people with Paget's disease. The sample will include relatives of Paget's patients with a family history of Paget's disease and relatives of Paget's patients without a family history of Paget's disease. The questionnaire will explore whether a range of factors relate to acceptability of a programme of genetic testing and preventive treatment in relatives of Paget's disease sufferers. The questionnaire will include several measures: illness representations (as measured by the Brief Illness Perceptions Questionnaire); treatment representations (as measured by Theory of Planned Behaviour-based question items, informed by a prior interview elicitation study); descriptive and demographic details; and questions exploring family environment and beliefs of other important people. Data will also be collected from family members who have been diagnosed with Paget's disease to describe the disease presentation and its distribution within a family. Discussion: The answers to these measures will inform the feasibility of a programme of genetic testing and preventive treatment for individuals who are at a high risk of developing Paget's disease because they carry an appropriate genetic mutation. They will also contribute to theoretical and empirical approaches to predicting diagnostic and treatment behaviours from the combined theoretical models. [ABSTRACT FROM AUTHOR]

Background: The International Classification of Functioning, Disability and Health (ICF) model of the consequences of disease identifies three health outcomes, impairment, activity limitations and participation restrictions. However, few orthopaedic health outcome measures were developed with reference to the ICF. This study examined the ability of a valid and frequently used measure of upper limb function, namely the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), to operationalise the ICF. Methods: Twenty-four judges used the method of Discriminant Content Validation to allocate the 38 items of the DASH to the theoretical definition of one or more ICF outcome. One-sample ttests classified each item as measuring, impairment, activity limitations, participation restrictions, or a combination thereof. Results: The DASH contains items able to measure each of the three ICF outcomes with discriminant validity. The DASH contains five pure impairment items, 19 pure activity limitations items and three participation restriction items. In addition, seven items measured both activity limitations and participation restrictions. Conclusion: The DASH can measure the three health outcomes identified by the ICF. Consequently the DASH could be used to examine the impact of trauma and subsequent interventions on each health outcome in the absence of measurement confound. [ABSTRACT FROM AUTHOR]

Background: Despite the significant health benefits associated with eating healthily, diet is extremely difficult to change, with the majority of people who intend to eat more healthily failing to do so. Recent evidence has suggested that the ability to turn intentions into actions may be related to individual differences in one facet of executive control - cognitive inhibition (i.e. the ability to inhibit irrelevant information and suppress prepotent responses). The present study investigates the role of this and other executive processes (inhibition, task switching, planning and cognitive flexibility) in the translation of dietary intentions into action. In addition, as the literature suggests that weak executive control may be associated with hyper-responsivity to cues to action, the role of executive processes in susceptibility to environmental food cues and responses to If-Then plans designed to cue intended behaviour are investigated. Methods: Future intentions about consumption of fruits and vegetables and snack foods will be measured in a sample of young adults. Actual consumption of the target foods will be recorded with computerised diaries over a subsequent 3-day period. Performance on a battery of established executive control tasks (Go-NoGo, Tower task, Verbal Fluency task and Trail-Making) will be used to predict the discrepancy between intended and actual dietary behaviour. In addition, executive control scores will be used to predict reported susceptibility to environmental food cues and benefit derived from the use of 'If-Then plans' designed to cue intended behaviour. Discussion: Our findings will add to understanding about the role of executive control in translating intentions into actions and may demonstrate potential for future public health interventions. If participants with weak executive control are found to be less likely to eat as they intend than those with strong executive control, then interventions that reduce the load on these executive processes may increase chances of successful intention-behaviour translation. If those with weak executive control are found to be more responsive to cues to action they may also benefit more from the use of If-Then plans designed to cue intended behaviour. [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]

Background: Biomedical research constantly produces new findings, but these are not routinely incorporated into health care practice. Currently, a range of interventions to promote the uptake of emerging evidence are available. While their effectiveness has been tested in pragmatic trials, these do not form a basis from which to generalise to routine care settings. Implementation research is the scientific study of methods to promote the uptake of research findings, and hence to reduce inappropriate care. As clinical practice is a form of human behaviour, theories of human behaviour that have proved to be useful in other settings offer a basis for developing a scientific rationale for the choice of interventions. Aims: The aims of this protocol are 1) to develop interventions to change beliefs that have already been identified as antecedents to antibiotic prescribing for sore throats, and 2) to experimentally evaluate these interventions to identify those that have the largest impact on behavioural intention and behavioural simulation. Design: The clinical focus for this work will be the management of uncomplicated sore throat in general practice. Symptoms of upper respiratory tract infections are common presenting features in primary care. They are frequently treated with antibiotics, and research evidence is clear that antibiotic treatment offers little or no benefit to otherwise healthy adult patients. Reducing antibiotic prescribing in the community by the "prudent" use of antibiotics is seen as one way to slow the rise in antibiotic resistance, and appears safe, at least in children. However, our understanding of how to do this is limited. Participants will be general medical practitioners. Two theory-based interventions will be designed to address the discriminant beliefs in the prescribing of antibiotics for sore throat, using empirically derived resources. The interventions will be evaluated in a 2 × 2 factorial randomised controlled trial delivered in a postal questionnaire survey. Two outcome measures will be assessed: behavioural intention and behavioural simulation. [ABSTRACT FROM AUTHOR]

Subjective measures involving clinician ratings or patient self-assessments have become recognised as an important tool for the assessment of health outcome. The value of a health outcome measure is usually assessed by a psychometric evaluation of its reliability, validity and responsiveness. However, psychometric testing involves an accumulation of evidence and has recognised limitations. It has been suggested that an evaluation of how well a measure has been developed would be a useful additional criteria in assessing the value of a measure. This paper explored the theoretical background and methodological development of subjective health status measures commonly used in osteoarthritis research. Fourteen subjective health outcome measures commonly used in osteoarthritis research were examined. Each measure was explored on the basis of their i) theoretical framework (was there a definition of what was being assessed and was it part of a theoretical model?) and ii) methodological development (what was the scaling strategy, how were the items generated and reduced, what was the response format and what was the scoring method?). Only the AIMS, SF-36 and WHOQOL defined what they were assessing (i.e. the construct of interest) and no measure assessed was part of a theoretical model. None of the clinician report measures appeared to have implemented a scaling procedure or described the rationale for the items selected or scoring system. Of the patient self-report measures, the AIMS, MPQ, OXFORD, SF-36, WHOQOL and WOMAC appeared to follow a standard psychometric scaling method. The DRP and EuroQol used alternative scaling methods. The review highlighted the general lack of theoretical framework for both clinician report and patient self-report measures. This review also drew attention to the wide variation in the methodological development of commonly used measures in OA. While, in general the patient self-report measures had good methodological development, the clinician report measures appeared less well developed. It would be of value if new measures defined the construct of interest and, that the construct, be part of theoretical model. By ensuring measures are both theoretically and empirically valid then improvements in subjective health outcome measures should be possible. [ABSTRACT FROM AUTHOR]

Background: The study aims to assess the therapeutic benefits of motor imagery training in stroke patients with persistent motor weakness. There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements. Imagining hand movements could stimulate the redistribution of brain activity, which accompanies recovery of hand function, thus resulting in a reduced motor deficit. Methods/Design: A multi-centre randomised controlled trial recruiting individuals between one and six months post-stroke (n = 135). Patients are assessed before and after a four-week evaluation period. In this trial, 45 patients daily mentally rehearse movements with their affected arm under close supervision. Their recovery is compared to 45 patients who perform closely supervised nonmotor mental rehearsal, and 45 patients who are not engaged in a training program. Motor imagery training effectiveness is evaluated using outcome measures of motor function, psychological processes, and level of disability. Discussion: The idea of enhancing motor recovery through the use of motor imagery rehabilitation techniques is important with potential implications for clinical practice. The techniques evaluated as part of this randomised controlled trial are informed by the current understanding in cognitive neuroscience and the trial is both of scientific and applied interest. [ABSTRACT FROM AUTHOR]

Background: Paget's disease of bone (PDB) is characterised by focal increases in bone turnover, affecting one or more bones throughout the skeleton. This disrupts normal bone architecture and causes pain, deformity, deafness, osteoarthritis, and fractures. Genetic factors are recognised to play a role in PDB and it is now possible to carry out genetic tests for research. In view of this, it is timely to investigate the clinical potential for a programme of genetic testing and preventative treatment for people who have a family history of PDB, to prevent or delay the development of PDB. Evidence from non-genetic conditions, that have effective treatments, demonstrates that patients' beliefs may affect the acceptability and uptake of treatment. Two groups of beliefs (illness and treatment representations) are likely to be influential. Illness representations describe how people see their illness, as outlined in Leventhal's Self-Regulation Model. Treatment representations describe how people perceive potential treatment for their disease. People offered a programme of genetic testing and treatment will develop their own treatment representations based on what is offered, but the beliefs rather than the objective programme of treatment are likely to determine their willingness to participate. The Theory of Planned Behaviour is a theoretical model that predicts behaviours from people's beliefs about the consequences, social pressures and perceived control over the behaviour, including uptake of treatment. Methods/design: This study aims to examine the acceptability of genetic testing, followed by preventative treatment, to relatives of people with PDB. We aim to interview people with Paget's disease, and their families, from the UK. Our research questions are: 1. What do individuals with Paget's disease think would influence the involvement of their relatives in a programme of genetic testing and preventative treatment? 2. What do relatives of Paget's disease sufferers think would influence them in accepting an offer of a programme of genetic testing and preventative treatment? Discussion: Our research will be informed by relevant psychological theory: primarily the Self-Regulation Model and the Theory of Planned Behaviour. The results of these interviews will inform the development of a separate questionnaire-based study to explore these research questions in greater detail. [ABSTRACT FROM AUTHOR]

Previous studies predicting functional outcomes of stroke have mainly used clinical and demographic measures. This study examines the additional predictive value of psychological predictors. A cohort of patients were assessed on 6 occasions between admission to hospital and 3 years post-stroke, with 40 of the original sample of 101 being available at the final assessment. Demographic variables, clinical indexes, and psychological measures were used to predict survival to 3 years and 3-year functional recovery was assessed using measures derived from the Barthel Index which took account of initial levels of performance. For functional recovery, multiple regression analyses showed that fixed clinical and demographic indexes explained 16% to 40% of the variance in recovery. Perceptions of control 6 months after discharge added significantly to the predictive equations. Because these cognitions are modifiable, they offer opportunities for intervention to improve patient outcomes. Multiple regression showed that no psychological variables predicted survival. [ABSTRACT FROM AUTHOR]