Development and validation of a military fear avoidance questionnaire.

Chronic pain due to musculoskeletal injury is one of the leading causes of disability and reduced combat readiness in the U.S. Army. Unidimensional pain management systems are not effective in addressing the complex phenomenon of pain-related disability. Growing evidence has supported use of the Fear Avoidance Model (FAM) as a suitable model to address pain-related disability and chronicity from a multidimensional pain neuroscience approach. While several fear avoidance measurement tools exist, one that addresses the complexity of the Army environment encouraged the authors to develop and test the reliability and validity of a military specific questionnaire. This study developed and validated an Army specific fear avoidance screening, the Return to Duty Readiness Questionnaire (RDRQ), which subsequently demonstrated good psychometric properties. Reliability coefficients demonstrate high internal consistency values both during pilot study (α = 0.96) and validation study (α = 0.94, ωt = 0.94). A Correlation Coefficient of 0.74 when compared with the Fear Avoidance Components Scale (FACS) suggests good concurrent validity. Future study should include replication in a new army population, investigation of responsiveness, test-retest reliability, structural validity and establishing severity scores with minimal clinically important differences to enhance utility.

Examining the psychometric properties of the Integrative Hope Scale's English translation in a mixed-diagnostic community health sample.

OBJECTIVE: Our objective is to provide preliminary evidence of the English translation of the Integrative Hope Scale (IHS). Hope is a critical concept for recovery. Synthesizing from other hope models, Schrank and colleagues developed the IHS. Although translated into five languages, no known studies assess the IHS's English translation within a clinical sample. Additionally, no known studies investigate the IHS's relationships with mental health measures in a mixed-diagnostic clinical sample. METHOD: To address these gaps in the literature, we used confirmatory factor analyses, alpha, and omega reliability coefficients, and correlational analyses to assess the IHS within a suburban, mixed-diagnostic intensive outpatient community mental health sample (n = 125) in the midwestern United States. RESULTS: While poorest fit was found within the one-factor model, the four-factor oblique, higher-order, and bifactor models showed improved fit. Reliability for the total score was good, with subscales ranging from acceptable to good. Significant relationships were found for the IHS in expected directions with measures of hope and depression at a large effect size and anxiety and stress at a moderate effect size. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study provides preliminary evidence that the IHS may have the potential to serve as a central measure of hope. Given hope's role within recovery and given its relationships with mental health measures shown in this mixed-diagnostic clinical sample, the IHS should continue to be investigated by researchers, clinicians, and clients, especially in recovery-focused programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Confirmatory Factor Analysis of the 'Return to Duty Readiness Questionnaire'.

The Readiness to Return to Duty Questionnaire (RDRQ) is a recently developed screening instrument for detecting fear-avoidance behavior in a military musculoskeletal pain population. The RDRQ was developed based on the Fear-Avoidance Model which postulates four factors resulting in overall fear-avoidance behavior. While research investigating the factor structure of the RDRQ does not exist, research investigating the factor structure of other measures of fear avoidance have found evidence of one and two factor solutions. In the present paper we assess the adequacy of the proposed factor structure of the RDRQ using confirmatory factor analysis. The results favor a three-factor model. Theoretical implications for research using the RDRQ are discussed.

The Spirituality Index of Well-Being: a new instrument for health-related quality-of-life research.

PURPOSE: Despite considerable interest in examining spirituality in health-related quality-of-life studies, there is a paucity of instruments that measure this construct. The objective of this study was to test a valid and reliable measure of spirituality that would be useful in patient populations. METHODS: We conducted a multisite, cross-sectional survey using systematic sampling of adult outpatients at primary care clinic sites in the Kansas City metropolitan area (N = 523). We determined the instrument reliability (Cronbach's alpha, test-retest) and validity (confirmatory factor analysis, convergent and discriminant validation) of the Spirituality Index of Well-Being (SIWB). RESULTS: The SIWB contains 12 items: 6 from a self-efficacy domain and 6 from a life scheme domain. Confirmatory factor analysis found the following fit indices: chi2 (54, n = 508) = 508.35, P < .001; Comparative Fit Index = .98; Tucker-Lewis Index = .97; root mean square error of approximation = .13. The index had the following reliability results: for the self-efficacy subscale, alpha = .86 and test-retest r = 0.77; for the life scheme subscale, alpha = .89 and test-retest r = 0.86; and for the total scale alpha = .91 and test-retest r = 0.79, showing very good reliability. The SIWB had significant and expected correlations with other quality-of-life instruments that measure well-being or spirituality: Zung Depression Scale (r = 0-.42, P < .001), General Well-Being Scale (r = 0.64, P < .001), and Spiritual Well-Being Scale (SWB) (r = 0.62, P < .001). There was a modest correlation between the religious well-being subscale of the SWB and the SIWB (r = 0.35, P < .001). CONCLUSIONS: The Spirituality Index of Well-Being is a valid and reliable instrument that can be used in health-related quality-of-life studies.

Nicardipine to control neonatal hypertension during extracorporeal membrane oxygen support.

OBJECTIVE: To describe the clinical course of a newborn (gestational age 38 wk, 6 d) administered intravenous nicardipine to control hypertension while on extracorporeal membrane oxygen (ECMO) support. SETTING: Urban, university teaching hospital. CASE SUMMARY: A 1-day-old male neonate presenting with a left congenital diaphragmatic hernia developed a sustained elevation in blood pressure following a change of ECMO tubing. After several unsuccessful treatment regimens, nicardipine was started at a rate of 0.5 micro g/kg/min and aggressively titrated to 1.5 micro g/kg/min. Nicardipine produced a sustained antihypertensive effect that was noticed 8 hours after the start of the infusion. The infusion was continued through postoperative day 2. Following a second circuit change, nicardipine was discontinued and sodium nitroprusside therapy was started. Treatment with nitroprusside failed to lower the blood pressure. DISCUSSION: Nicardipine is an effective antihypertensive agent for neonates receiving ECMO therapy. However, the expanded volume of distribution caused by the ECMO circuit may result in a reduced serum concentration and a reduced antihypertensive effect. CONCLUSIONS: We recommend a conservative initial dose of nicardipine of 0.5 micro g/kg/min that is aggressively titrated to reduce blood pressure effectively in neonates receiving ECMO therapy.

Spirituality Index of Well-Being Scale: development and testing of a new measure.

OBJECTIVE: To evaluate the reliability and validity of the Spirituality Index of Well-Being (SIWB) Scale in a patient population. STUDY DESIGN: Cross-sectional survey. POPULATION: Community-dwelling elderly individuals (n = 277) recruited from primary care clinic sites in the Kansas City metropolitan area. OUTCOMES MEASURED: Internal consistency, concurrent construct validity, discriminant validity, and factor analysis with Varivax rotation. RESULTS: The initial version of the SIWB contained 40 items: 20 from a self-efficacy domain and 20 from a life scheme domain. Factor analysis yielded 6 items loaded most strongly on factor 1 (intrapersonal self-efficacy) and 6 other items loaded strongly on factor 2 (life scheme). The Self-efficacy subscale had an alpha of.83 and the Life Scheme subscale had an alpha of.80; the total 12-item SIWB Scale had an alpha of.87. The SIWB had significant and expected correlations with other quality-of-life measures related to subjective well-being: EuroQol (r =.18), Geriatric Depression Scale (r = -35), the Physical Functioning Index from the Short Form 36 (r =.28), and the Years of Healthy Life Scale (r = -.35). Religiosity did not correlated significantly with the SIWB (r =.12, P =.056). CONCLUSIONS: The 12-item SIWB Scale is a valid and reliable measure of subjective well-being in an older patient population.