Rehabilitation psychology: 2020 state of the field survey.

PURPOSE/OBJECTIVE: To date, there are no published formal surveys of the "state of the field" of Rehabilitation Psychology in terms of education, training, practice patterns, professional identity, and relative salary and income structures for those who identify as Rehabilitation Psychologists. RESEARCH METHOD/DESIGN: In an effort to gather this information, the Practice Committee of APA Division 22 (Rehabilitation Psychology) conducted a convenience-sample survey of its listserv subscribers to obtain a representation of Rehabilitation Psychologists across the United States, and a depiction of the fields in which they work. RESULTS: There were 282 respondents to the survey. Most respondents were female (69%) and worked in hospital/medical facilities (70%). Most worked in urban/suburban areas (96%), with adults (57%), and had a straight salary income structure (78%). Salary was found to be associated with age (p < .001), gender (p < .001), degree (p = .001), board certification status (p < .001), years licensed (p < .001), and Manager/Director position status (p < .001). Salary was not significantly different by region. CONCLUSIONS: Implications regarding the need for advocacy for the roles of Rehabilitation Psychology in health care, promotion of the specialty with consumers, and the development of future professionals are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Medication Management Intervention for Patients and Families with SCI and ABI.

The purpose of this study was to develop and test the efficacy of a pre-discharge, medication management intervention to improve perceived knowledge and perceived confidence for post-discharge medication management for rehabilitation patients with spinal cord injuries (SCIs) and families of patients with SCIs or acquired brain injuries (ABIs). We used a quasi-experimental, matched-pair design. Treatment participants (n = 112) completed the intervention with pre- and post-tests assessing perceived knowledge and perceived confidence for post-discharge medication management. Control participants (n = 95) enrolled at 60-days post-discharge. All participants (N = 207) completed measures on perceived knowledge, perceived confidence, and medication management by phone at 60-days post-discharge. The intervention significantly increased treatment participants' perceived knowledge and perceived confidence from pre- to post-test. Sex, injury severity, and income were associated with primary outcomes. Treatment participants used more tools for medication management post-discharge. Our findings suggest that patients and family members may benefit from pre-discharge medication management interventions.

Outcomes After Functional Electrical Stimulation Cycle Training in Individuals with Multiple Sclerosis Who Are Nonambulatory.

BACKGROUND: Exercise is safe and beneficial for people with multiple sclerosis (MS). Functional electrical stimulation (FES) cycling offers people with significant weakness and mobility challenges an option for exercise. We sought to evaluate the safety of FES cycling and its potential to improve fatigue, pain, spasticity, and quality of life in people with moderate-to-severe MS. METHODS: Sixteen participants with MS who were nonambulatory cycled for 30 minutes two to three times a week for 1 month. Outcomes assessed included MS Quality of Life Inventory (MSQLI) subscales, Modified Ashworth Scale (MAS), and manual muscle test (MMT). RESULTS: Fourteen participants (six women and eight men) with MS completed the training. All were able to maintain or increase their cycle time; half increased the resistance while cycling. Participants demonstrated a significant decrease in the Physical (P = .02) and Psychosocial (P < .01) subscales of the Modified Fatigue Impact Scale. There was no significant change in the other MSQLI subscale scores. There was no change in MAS and MMT scores. Type of MS and the use of antispasticity medications, disease-modifying therapies, or dalfampridine did not seem to influence response to training. There were no adverse events. CONCLUSIONS: Functional electrical stimulation cycling may be a viable and effective exercise option for people with moderate-to-severe MS. Further study is required to examine the parameters of FES cycling that are most effective for people with different MS symptoms and to fully explore the potential benefits of optimizing function and improving health in people with MS.

Impact of Massage Therapy on Fatigue, Pain, and Spasticity in People with Multiple Sclerosis: a Pilot Study.

BACKGROUND: Multiple sclerosis (MS) is a chronic, immune-mediated, inflammatory disease that leads to fatigue, pain, and spasticity, as well as other sensorimotor and cognitive changes. Often traditional medical approaches are ineffective in alleviating these disruptive symptoms. Although about one-third of surveyed individuals report they use massage therapy (MT) as an adjunct to medical treatment, there is little empirical evidence that MT is effective for symptom management in people with MS. PURPOSE: To measure the effects of MT on fatigue, pain, spasticity, perception of health, and quality of life in people with MS. SETTING: Not-for-profit long-term care facility. PARTICIPANTS: Twenty-four of 28 enrolled individuals with MS (average age = 47.38, SD = 13.05; 22 female) completed all MT sessions and outcome assessments. RESEARCH DESIGN: Nonrandomized, pre-post pilot study. INTERVENTION: Standardized MT routine one time a week for six weeks. MAIN OUTCOME MEASURES: Modified Fatigue Index Scale (MFIS), MOS Pain Effects Scale (MOS Pain), and Modified Ashworth Scale (MAS). Secondary outcome measures: Mental Health Inventory (MHI) and Health Status Questionnaire (HSQ). RESULTS: There was a significant improvement in MFIS (p < .01), MOS Pain (p < .01), MHI (p < .01), and HSQ (p < .01), all with a large effect size (ES) (Cohen's d = -0.76, 1.25, 0.93, -1.01, respectively). There was a significant correlation between change scores on the MFIS and the MOS Pain (r = 0.532, p < .01), MHI (r = -0.647, p < .01), and subscales of the HSQ (ranging from r = -0.519, to -0.619, p < .01). CONCLUSIONS: MT as delivered in this study is a safe and beneficial intervention for management of fatigue and pain in people with MS. Decreasing fatigue and pain appears to correlate with improvement in quality of life, which is meaningful for people with MS who have a chronic disease resulting in long-term health care needs.

Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial.

OBJECTIVE: To examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. DESIGN: Randomized controlled trial with delayed treatment design. SETTING: Outpatient program in a private, nonprofit rehabilitation hospital. PARTICIPANTS: Volunteer sample of adults (N=48; 37 men and 11 women; age, 18-66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI). INTERVENTIONS: A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. MAIN OUTCOME MEASURES: Neurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check). RESULTS: Significant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs -0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002). CONCLUSIONS: ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.

Activity-based therapy for recovery of walking in chronic spinal cord injury: results from a secondary analysis to determine responsiveness to therapy.

OBJECTIVE: To gain insight into who is likely to benefit from activity-based therapy (ABT), as assessed by secondary analysis of data obtained from a clinical trial. DESIGN: Secondary analysis of results from a randomized controlled trial with delayed treatment design. SETTING: Outpatient program in a private, nonprofit rehabilitation hospital. PARTICIPANTS: Volunteer sample of adults (N=38; 27 men; 11 women; age, 22-63y) with chronic (≥12mo postinjury), motor-incomplete (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade C or D) spinal cord injury (SCI). INTERVENTIONS: A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. MAIN OUTCOME MEASURES: Walking speed and endurance (10-meter walk test and 6-minute walk test) and functional ambulation (timed Up and Go test). RESULTS: This secondary analysis identified likely responders to ABT on the basis of injury characteristics: AIS classification, time since injury, and initial walking ability. Training effects were the most clinically significant in AIS grade D participants with injuries <3 years in duration. This information, along with information about preliminary responsiveness to therapy (gains after 12wk), can help predict the degree of recovery likely from participation in an ABT program. CONCLUSIONS: ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, not everyone with goals of walking recovery will benefit. Individuals with SCI should be advised of the time, effort, and resources required to undertake ABT. Practitioners are encouraged to use the findings from this trial to assist prospective participants in establishing realistic expectations for recovery.

"They Are the Reason I Come to Work": The Meaning of Resident-Staff Relationships in Assisted Living.

This article aims to provide understanding of how direct care workers (DCWs) in assisted living facilities (ALFs) interpret their relationships with residents and to identify factors that influence the development, maintenance, quality, and meaning of these relationships. Qualitative methods were used to study two ALFs (35 and 75 beds) sequentially over seven months. Researchers conducted in-depth interviews with 5 administrative staff and 38 DCWs and conducted 243 hours of participant observation during a total of 99 visits. Data were analyzed using a grounded theory approach. Results showed that the emotional aspect of caregiving provides meaning to DCWs through both the satisfaction inherent in relationships and through the effect of relationships on care outcomes. Within the context of the wider community and society, multiple individual- and facility-level factors influence DCW strategies to create and manage relationships and carry out care tasks and ultimately find meaning in their work. These meanings affect their job satisfaction and retention.