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Biomedical subjects

M A McColl

Publications and source records attributed to M A McColl.

30 records · Page 2Linked to original sources
PubMed1997

Expectations of life and health among spinal cord injured adults.

While our understanding of aging and mortality in spinal cord injury is evolving, precise estimates are still not available for expectations of life and health following a spinal cord injury. In order to derive these estimates, information about mortality and health must be combined into a single estimate. Health expectancy estimates have been widely used in the literature of the last decade to try to understand the relationship between population health and survival, both in the general population and in special populations. This study brought the benefit of this methodology to the question of long-term survival following spinal cord injury. Specifically, the study aimed to calculate life and health expectancy in a population of spinal cord injured individuals; and to estimate the effect of factors associated with survival and health. The study involved a retrospective cohort, all of whom sustained a spinal cord injury between the ages of 25 and 34 years, and between 1945 and 1990. The study predicted a median survival time of 38 years post-injury, with 43% surviving at least 40 years. These findings suggest an increase in life expectancy of about 5 years over previous research on the same cohort. Factors affecting survival were age at injury, level and completeness of lesion. Expectations of health found in the present study are similar to those found in studies of the general population. This study showed seven remaining years of poor health expected at injury, and five remaining years expected at 40 years post injury, presumably occurring at the end of life.

Adult↗
PubMed1995

Structural relationships between social support and coping.

Relationships between social support and coping were examined over a one-year period in a sample (n = 120) exposed to a specific stressor (i.e. a spinal cord injury). Two issues were evaluated: (1) patterns of social support and coping over time; and (2) the direction of the effects of coping on social support or vice versa. Subjects had incurred a spinal cord injury within the preceding year, completed their rehabilitation, and returned to the community. They were assessed at 1, 4 and 12 months post-discharge to capture possible changes in patterns of social support and coping. Covariance structure modelling indicated a single-factor construct based on three measured subscales for social support (instrumental/informational/emotional), and for coping (problem-oriented/perception-oriented/emotion-oriented). While the factor structure of coping was invariant over time, the structure of social support changed from a high concentration of informational support at one month to a higher saturation of emotional support at 4 and 12 months, potentially reflecting changes in the salience of different components of the network. The perceived availability of social support was seen to have direct effects on future coping. At one month, social support had a direct positive effect on coping at four months. However, at four months social support had a negative effect on coping at 12 months, which may reflect a change in the structure of the social support construct itself. That is, as the factor structure of social support varied with time, coping may also have been influenced by differing perception of one's needs and circumstances. Thus, the study provides evidence for the dynamic effects of social support on coping, depending on one's stage in the process of long-term adjustment. The findings underscore the interplay between social support and coping, and the need for future research and practical applications to recognize temporal effects on the relationships between these two complex constructs.

Activities of Daily Living↗
PubMed1995

The effect of aging and duration of disability on long term health outcomes following spinal cord injury.

The purpose of the study was to discover the independent and combined effects of age and duration of injury on selected long term health outcomes of 83 spinal cord injured (SCI) men (age range 21-79 years; duration of spinal cord injury 3-52 years). Specifically, the study examined a multivariate model which specified that age, duration, the interaction of age and duration, and level of lesion were related to the following health outcomes: pain, fatigue, functional independence, mobility, illness and symptomatology, perceived overall health, social support, life satisfaction, and economic stability. Age had significant main effects on three outcomes. With increasing age, the sample experienced more fatigue, decreased activity (due to pain), and more overall satisfaction with their lives. Duration of SCI showed significant main effects on two outcomes. As subjects lived longer with their SCI, they felt less financially secure and experienced more symptoms and illnesses. Significant interaction effects of age and duration of SCI were found for two outcomes. Older age combined with longer duration of SCI amplified subjects' perceptions of financial insecurity, and threats to health. The findings send a clear message to service-providers and policy makers about the added vulnerability of older disabled individuals, about the need for extra vigilance in health care issues, and about the necessity of a social-economic safety net for already disadvantaged individuals.

Activities of Daily Living↗
PubMed1995

Assessing inter- and intrapersonal resources: social support and coping among adults with a disability.

A promising model for addressing community reintegration and adjustment following disability is the stress-outcome model. In spite of demonstrated applicability, this model has found little support among clinicians and researchers in the rehabilitation field. One reason for this may be the lack of explicit conceptual and operational definitions for the central constructs of the model. This paper presents theoretical and measurement models for two such constructs which are considered buffers or mediators in the stress-outcome relationship: social support and coping. Issues associated with each construct are explored, with reference particularly to people with disabilities. Following a synthesis of the literature, models for each construct were proposed that represented the two constructs as each having a parallel three-factor structure. Using a sample of 120 spinal cord-injured adults from across Ontario, data were collected on existing instruments which measure the two constructs of interest (Interpersonal Support Evaluation List, Ways of Coping Questionnaire). Face-to-face interviews were conducted in participants' homes at 1, 4, and 12 months post-discharge from rehabilitation, in order to capture the period of initial community readjustment and reintegration. Psychometric evaluation of the measurement models included item analysis, factor analysis, and reliability assessment. These analyses provided empirical support for the three-factor structure for both constructs, as well as a second-order general factor for social support. Recommendations for revisions of the scales and further development of the measurement models were made, and the revised measures were discussed in terms of theoretical and research implications.

Adaptation, Psychological↗
PubMed1994

A model of resource needs of aging spinal cord injured men.

It has always been understood that those who deal effectively with a disability call upon special resources that members of the able bodied population are not required to develop. However, the nature and relationship of these resources to aging outcomes is as yet only superficially understood. The present study provides further information and clarification about the resources needed for aging with a spinal cord injury. The sample consists of 70 individuals who have had a spinal cord injury for at least 15 years, and who are currently over the age of 45, and are therefore either anticipating or experiencing aging. Data from the sample were examined to produce a model of resources empirically associated with positive outcomes in aging. Emotional support was found to be positively related to the outcomes of life satisfaction, adjustment to disability and the absence of depressive symptomatology. Further, health concerns, financial security and instrumental support were also related to specific outcomes. These findings send a clear message to rehabilitation and community service providers to be watchful of survivors with limited social support, concerns about their health and an apparent lack of financial resources. The findings underline the need for better access to health services, and improved knowledge and attitudes of community health care providers working with older disabled individuals.

Adaptation, Psychological↗
PubMed1994

Pilot testing of the Canadian Occupational Performance Measure: clinical and measurement issues.

The Canadian Occupational Performance Measure (COPM) is a measure of a client's self-perception of occupational performance in the areas of self-care, productivity and leisure. The COPM is administered using a semi-structured interview in which the client identifies significant issues in daily activities which are causing difficulty. Extensive pilot testing of the COPM has been completed with 268 clients in communities across Canada and in New Zealand, Greece and Britain. Results indicate the COPM has a median administration time of 30 minutes, is able to identify a wide range of occupational performance issues and appears to be responsive to changes in measurement issues centering around the interview, test construction, scoring, timing of the assessment, respondents, and the assessment process are discussed.

Activities of Daily Living↗
PubMed1994

Theory and practice in the occupational therapy guidelines for client-centred practice.

A model for occupational therapy has evolved and has come to be referred to as the "Guidelines" model or the Canadian Occupational Performance model. This paper attempts to reformulate information relating to the Guidelines model, to support its use as a conceptual model and a model of practice. Both the conceptual model and model of practice are described in terms of their domain of concern, underlying values and assumptions, concepts and principles. The conceptual model provides a means of understanding occupational performance, while the model of practice offers a way of understanding the relationship between occupational therapy interventions and occupational performance. Both models are evaluated relative to nine criteria derived from the literature. The conceptual model is found to be largely consistent, supportable, comprehensive and useful. The model of practice, however, proves more problematic, with technical, structural and conceptual variances. The paper is intended as a stimulus for discussion and study of this central model of Canadian occupational therapy.

Canada↗
PubMed1990

Occupational performance measures: a review based on the guidelines for the client-centred practice of occupational therapy.

In 1987, Health and Welfare Canada and the Canadian Association of Occupational Therapists Task Force recommended that work go forward to develop an outcome measure for occupational therapy which reflects the Occupational Performance Model. The first step in this process was to review critically those outcome measures which assess occupational performance and that are currently available in the literature. This paper will present the review process, describe in more detail eight assessments that fulfilled many of the review criteria, discuss the limitations of these measures using the "Guidelines for the Client-centred Practice of Occupational Therapy as the framework, and make recommendations for the development of a new outcome measure for use in occupational therapy.

Activities of Daily Living↗
PubMed1985

A quality assurance method for community occupational therapy.

Fiscal constraints, service withdrawal, and litigation in the health care sector have created an unquestionable need for accountability in health services. Therefore, this paper presents a method of quality assurance for use in community occupational therapy. Detailed attention is given to methodological issues, particularly those related to selecting an approach. A process audit approach was chosen for this study, and the results of its pilot application to a sample of depressed patients are presented and discussed. In addition, preliminary work on reliability and validity of the method are presented. Test-retest and interrater reliabilities were found to be .734 and .728, respectively, and assertions of normative and criterion validity were supported. The results of the audit are presented to illuminate aspects of the method that need further refinement.

Community Health Services↗
PubMedDate not supplied

Expectations of independence and life satisfaction among ageing spinal cord injured adults.

PURPOSE: The present study offers information about independence and life satisfaction over the lifespan for individuals with traumatic spinal cord injuries. METHODS: The study uses the health expectancy methodology to estimate expectations of the remaining years of life that may be spent in states of independence and satisfaction with life. SUBJECTS: The cohort studied had all incurred a spinal cord injury between the ages of 25 and 34, between the years 1945 and 1990 in central and south-eastern Ontario. RESULTS AND CONCLUSIONS: The study found that levels of independence and quality of life in the sample conformed closely to those found in other similar studies with the spinal cord injured population: 22% reported their own functional status as dependent, and 22% reported fair to poor life satisfaction. Expectations of independence appeared to decline steadily over the five decades studied, while expectations of modified independence increased proportionally. Estimates varied significantly for those with paraplegia vs. quadriplegia, and those with complete vs. incomplete lesions. Expectations of life satisfaction appeared to change after the 30 year mark; at that point, the balance changed so that expectations of dissatisfaction outweighed expectations of satisfaction. Multiple regression showed that independence was related to lesion level, completeness and recency of injury, and both independence and satisfaction were related to marriage and employment.

Activities of Daily Living↗
PubMedDate not supplied

Measuring psychological outcomes following rehabilitation.

Recent literature leaves little doubt that people with disabilities experience depressive and adjustment disorders at a greater rate that those in the general population. Differences between rates detected in different studies, however, prompt researchers to explore the definition of depression as applied to people with a disability, and to challenge the long-held notions that everyone with a disability undergoes depression at one time or another as part of the process of adjustment to disability. The present study measures the two related, but theoretically distinct, constructs of depression and adjustment to disability in a sample of spinal cord injured adults interviewed at one, four and twelve months post-rehabilitation. On the basis of these data, a two-dimensional measurement model is empirically developed for psychological outcomes, with the two dimensions representing adjustment and depression. The measurement model is supported by data at all three time intervals and by a number of different analyses. These findings underline the importance of distinguishing between depression and adjustment both in clinical applications and in research.

Adaptation, Psychological↗