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Biomedical subjects

Marie Johnston

Publications and source records attributed to Marie Johnston.

At least 19 recordsLinked to original sources
PubMed2007

Perceived control is a concurrent predictor of activity limitations in patients with chronic idiopathic axonal polyneuropathy.

OBJECTIVES: To investigate (1) whether control perceptions (person's perception of ease or difficulty of performing behavior) and emotions contribute to activity limitations and if so (2) whether these variables mediate the relation between impairment and activity limitations in patients with chronic idiopathic axonal polyneuropathy (CIAP). DESIGN: Cross-sectional study. SETTING: Outpatient clinics of a university medical center. PARTICIPANTS: Fifty-six patients diagnosed with CIAP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Control perceptions about performing activities (questionnaire based on the theory of planned behavior), emotions (Hospital Anxiety and Depression Scale), activity limitations (performance: Shuttle Walk Test [SWT]; self-report: Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] physical functioning subscale, self-reported ability to walk), and physical impairments (muscle strength, sensory function). RESULTS: Control perceptions significantly (P<.01) correlated with all measures of activity limitations (r range, .58-.69). Hierarchical multiple regression analyses showed that perceived control explained 9% of the variance in the SWT (beta=.34, P<.01), 12% in the SF-36 (beta=.40, P<.01), and 24% in ability to walk (beta=.54, P<.01). In all measures of activity limitations, perceived control significantly mediated the effect of impairment. CONCLUSIONS: Perceived control explained and mediated variance in activity limitations, whereas emotions did not. This suggests that increasing patients' perceptions of control might enhance performance of activities, even without changes in impairment.

Activities of Daily Living↗
PubMed2006

Do self- reported intentions predict clinicians' behaviour: a systematic review.

BACKGROUND: Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice. Several interventions have been shown to be effective in changing health care professionals' behaviour, but heterogeneity within interventions, targeted behaviours, and study settings make generalisation difficult. Therefore, it is necessary to identify the 'active ingredients' in professional behaviour change strategies. Theories of human behaviour that feature an individual's "intention" to do something as the most immediate predictor of their behaviour have proved to be useful in non-clinical populations. As clinical practice is a form of human behaviour such theories may offer a basis for developing a scientific rationale for the choice of intervention to use in the implementation of new practice. The aim of this review was to explore the relationship between intention and behaviour in clinicians and how this compares to the intention-behaviour relationship in studies of non-clinicians. METHODS: We searched: PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Science/Social science citation index, Current contents (social & behavioural med/clinical med), ISI conference proceedings, and Index to Theses. The reference lists of all included papers were checked manually. Studies were eligible for inclusion if they had: examined a clinical behaviour within a clinical context, included measures of both intention and behaviour, measured behaviour after intention, and explored this relationship quantitatively. All titles and abstracts retrieved by electronic searching were screened independently by two reviewers, with disagreements resolved by discussion. DISCUSSION: Ten studies were found that examined the relationship between intention and clinical behaviours in 1623 health professionals. The proportion of variance in behaviour explained by intention was of a similar magnitude to that found in the literature relating to non-health professionals. This was more consistently the case for studies in which intention-behaviour correspondence was good and behaviour was self-reported. Though firm conclusions are limited by a smaller literature, our findings are consistent with that of the non-health professional literature. This review, viewed in the context of the larger populations of studies, provides encouragement for the contention that there is a predictable relationship between the intentions of a health professional and their subsequent behaviour. However, there remain significant methodological challenges.

Journal Article↗
PubMed2006

Recovery of hand function through mental practice: a study protocol.

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 non-motor 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.

Hand↗
PubMed2006

Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs.

This study applies psychological theory to the implementation of evidence-based clinical practice. The first objective was to see if variables from psychological frameworks (developed to understand, predict and influence behaviour) could predict an evidence-based clinical behaviour. The second objective was to develop a scientific rationale to design or choose an implementation intervention. Variables from the Theory of Planned Behaviour, Social Cognitive Theory, Self-Regulation Model, Operant Conditioning, Implementation Intentions and the Precaution Adoption Process were measured, with data collection by postal survey. The primary outcome was the number of intra-oral radiographs taken per course of treatment collected from a central fee claims database. Participants were 214 Scottish General Dental Practitioners. At the theory level, the Theory of Planned Behaviour explained 13% variance in the number of radiographs taken, Social Cognitive Theory explained 7%, Operant Conditioning explained 8%, Implementation Intentions explained 11%. Self-Regulation and Stage Theory did not predict significant variance in radiographs taken. Perceived behavioural control, action planning and risk perception explained 16% of the variance in number of radiographs taken. Knowledge did not predict the number of radiographs taken. The results suggest an intervention targeting predictive psychological variables could increase the implementation of this evidence-based practice, while influencing knowledge is unlikely to do so. Measures which predicted number of radiographs taken also predicted intention to take radiographs, and intention accounted for significant variance in behaviour (adjusted R(2)=5%: F(1,166)=10.28, p<.01), suggesting intention may be a possible proxy for behavioural data when testing an intervention prior to a service-level trial. Since psychological frameworks incorporate methodologies to measure and change component variables, taking a theory-based approach enabled the creation of a methodology that can be replicated for identifying factors predictive of clinical behaviour and for the design and choice of interventions to modify practice as new evidence emerges.

Adult↗
PubMed2006

Protocol for stage 1 of the GaP study (Genetic testing acceptability for Paget's disease of bone): an interview study about genetic testing and preventive treatment: would relatives of people with Paget's disease want testing and treatment if they were available?

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? 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.

Adult↗
PubMed2006

A trial platform to develop a tailored theory-based intervention to improve professional practice in the disclosure of a diagnosis of dementia: study protocol [ISRCTN15871014].

BACKGROUND: For people with dementia, care should include an explanation of the diagnosis to individuals and their carers, and information about the likely prognosis and possible packages of care. However, this is neither routine nor inevitable, and there is wide variation in the practice of disclosure. The aim of this study is to develop a tailored theory-based intervention to promote appropriate disclosure of diagnosis of dementia. METHODS: There are three objectives. Objective 1 is to define and develop an appropriate model of disclosure; this will be addressed using a multidisciplinary consensus development process. Objective 2 is to identify factors that influence disclosure of diagnosis; a questionnaire based upon theoretical constructs from a range of behavioural theories will be developed and members of old age mental health teams will be surveyed. The analysis will identify those factors that best predict intention to disclose a diagnosis to a person with dementia. Objective 3 is to develop and pilot test a theory-based intervention to promote disclosure of diagnosis that targets attitudes, beliefs and actions most amenable to change. Objective 3 will use the results of Objectives 1&2 to design and pilot test an intervention to improve the process of and increase the proportion of individuals receiving a diagnosis of dementia, for members of old age mental health teams. This work will lead to a proposal for a randomised controlled trial of the intervention.

Journal Article↗
PubMed2006

The assessment of disability associated with osteoarthritis.

PURPOSE OF REVIEW: Disability (activity limitation) is an important and common health outcome for patients with osteoarthritis, making accurate measures essential. This paper explores self-report measures of activity limitation associated with osteoarthritis and reports on recent conceptual advances that impact on the measurement of activity limitation. RECENT FINDINGS: The Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form-36, the most commonly used measures to assess activity limitation, continue to be validated in osteoarthritis. There has been little consensus, however, about which measure to use across different types of osteoarthritis. While new measures have been developed to assess activity limitation, it remains unclear whether or not these are an improvement over existing measures. The International Classification of Functioning, Disability and Health is becoming an important consideration. Commonly used measures do not map directly onto individual constructs of this classification, however a new measure for Japanese people with knee osteoarthritis was developed based on these constructs. SUMMARY: There have been significant developments in the conceptual approach to measuring activity limitation. Measures are needed that operationalize activity limitation as defined by the International Classification of Functioning, Disability and Health (within or ideally across cultures), providing a common underlying construct for measures and hence facilitating comparability across studies.

Disability Evaluation↗
PubMed2005

What do osteoarthritis health outcome instruments measure? Impairment, activity limitation, or participation restriction?

OBJECTIVE: To explore whether commonly used osteoarthritis (OA) health outcome instruments (and items) are measuring single or multiple health outcomes using the International Classification of Functioning, Disability and Health (ICF) definitions. METHODS: Ten expert judges allocated 342 items from 13 instruments to one or more ICF construct, i.e., Impairment (I), Activity Limitation (A), and Participation Restriction (P). One-sample t tests were used to classify each item as measuring uniquely I, A, or P or some combination (i.e., IA, IP, AP, or IAP). RESULTS: Overall, 12 of the 13 instruments had items that measured a combination of outcome domains (i.e., IA, IP, AP, or IAP). Only the American Knee Society Score (AKS) had all items uniquely measuring either I or A. The instrument with the best representation of items for Impairment was the AKS, for Activity Limitation the WOMAC and Lequesne knee index, and for Participation Restriction the Disease Repercussion Profile. CONCLUSION: All the existing OA outcome instruments, except one, had some items that were assessing more than one health outcome. Use of these instruments may either mask true treatment effects or make an effect difficult to attribute if the content is unclear. We determined which instruments were the best for measuring each health outcome. To improve the assessment of health outcomes in OA, new instruments that uniquely measure the 3 ICF constructs should be developed and all 3 should be included in relevant studies.

Activities of Daily Living↗
PubMed2005

A causal modelling approach to the development of theory-based behaviour change programmes for trial evaluation.

Theory-based intervention programmes to support health-related behaviour change aim to increase health impact and improve understanding of mechanisms of behaviour change. However, the science of intervention development remains at an early stage. We present a causal modelling approach to developing complex interventions for evaluation in randomized trials. In this approach a generic model links behavioural determinants, causally through behaviour, to physiological and biochemical variables, and health outcomes. It is tailored to context, target population, behaviours and health outcomes. The development of a specific causal model based on theory and evidence is illustrated by the ProActive programme, supporting increased physical activity among individuals at risk of Type 2 diabetes. The model provides a rational guide to appropriate measures, intervention points and intervention techniques, and can be tested quantitatively. Causal modelling is critically compared to other approaches to intervention development and evaluation, and research directions are indicated.

Behavioral Research↗
PubMed2005

Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings.

OBJECTIVE: The uptake of research findings into routine health care is a haphazard and unpredictable process. The usefulness of the results of implementation studies is limited, due in part to the lack of an underlying framework of the important dimensions of research studies in this area and the healthcare settings within which they are conducted and may subsequently be used. STUDY DESIGN AND SETTING: We explore the role for a theory-based framework and suggest some of the methods that would be needed to operationalize the framework in the context of designing and conducting interventions aimed at improving the use of research findings by individual healthcare professionals or teams. CONCLUSIONS: This research offers a framework for those who would seek to use the results of such studies in routine healthcare settings.

Diffusion of Innovation↗
PubMed2005

Extending the demand-control model to informal caregiving.

OBJECTIVE: Karasek's demand-control model of job strain was used in an attempt to extend previous work examining the psychological impact of informal caregiving in stroke. METHOD: Data were gathered from 138 informal caregivers/patient dyads at two time points. The dependent variables were the caregiver's anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. The predictor variables were caregiver demand (stroke survivor's assessment of their physical and psychosocial functional limitations) and control (caregiver's perceived control over stroke survivor's recovery). RESULTS: In a cross-sectional analysis of Times 1 and 2 data, main effects for demand and/or control were detected for anxiety and depression. Contrary to prediction, in longitudinal analysis of change, it was found that decreasing control, along with increasing demand, was associated with reduced distress. CONCLUSION: The model was moderately successful in predicting emotional distress. The relative importance of caregiver demand and control in predicting outcomes changed over time in these data. Attempts to replicate these findings are recommended.

Adaptation, Psychological↗
PubMed2005

Anxiety and depression 3 years following stroke: demographic, clinical, and psychological predictors.

OBJECTIVES: Our earlier work had established that moderate depression significantly decreased over the first 6 months after stroke, whereas anxiety levels remained moderate but stable. This study examines the factors predictive of anxiety and depression to 3 years. METHODS: Patients were assessed on six occasions: on hospital admission, 10-20 days following admission, 1 and 6 months following discharge, and 1 and 3 years poststroke, with 38 of the original sample of 101 taking part at Year 3. Demographic and clinical variables, disability, handicap, and psychological measures were used to predict 3-year anxiety and depression, controlling for earlier levels of anxiety or depression. RESULTS: Multiple regression analyses of anxiety at 3 years, controlling for gender and previous anxiety, demonstrated that neither of the significant partial correlates of 6-month depression or satisfaction with treatment persisted. Gender effects persisted when controlling for previous anxiety. Multiple regression analyses of depression at 3 years, controlling for early depression, found that exercise, treatment satisfaction, anxiety, and handicap added significantly to the prediction of lower depression. CONCLUSIONS: Anxiety remains stable over 3 years poststroke and is best explained by prior, early, anxiety, and female gender. Depression reduces over time and was explained by modifiable cognitions and behaviours, which replicates previous findings.

Aged↗
PubMed2004

Guiding the design and selection of interventions to influence the implementation of evidence-based practice: an experimental simulation of a complex intervention trial.

A consistent finding in health services research is the report of uneven uptake of research findings. Implementation trials have a variable record of success in effectively influencing clinicians' behaviour. A more systematic approach may be to conduct Intervention Modelling Experiments before service-level trials, examining intervention effects on 'interim endpoints' representing clinical behaviour, derived from empirically supported psychological theories. The objectives were to: (1) Design Intervention Modelling Experiments by backward engineering a 'real-world' randomised controlled trial (NEXUS); (2) examine the applicability of psychological theories to clinical decision-making; (3) explore whether psychological theories can illuminate how interventions achieve their effects. A 2 x 2 factorial randomised controlled trial was designed with pre- and post-intervention data collection by postal questionnaire surveys. The first survey was used to generate feedback data and the interventions were delivered in the second survey. General medical practitioners (GPs) in England and Scotland participated. First survey respondents were randomised twice to receive or not audit and feedback and educational reminder messages. The main outcome measures included behavioural intention (general plan to refer for lumbar X-rays) and simulated behaviour (specific, scenario-based, decisions to refer for lumbar X-ray). Predictors were attitude, subjective norm, perceived behavioural control (theory of planned behaviour), self-efficacy (social cognitive theory) and decision difficulty. Both interventions significantly influenced simulated behaviour, but neither influenced behavioural intention. There were no interaction effects. All theoretically derived cognitions significantly predicted simulated behaviour. Only subjective norm was not predictive of behavioural intention. The effect of audit and feedback on simulated behaviour was mediated through perceived behavioural control. The results of this study suggest that Intervention Modelling Experiments, using psychological models to help isolate mediators of clinical decision-making, may be a means of developing more potent interventions, and selecting implementation interventions with a greater likelihood of success in a service-level randomised controlled trial.

Analysis of Variance↗
PubMed2004

Motivation is not enough: prediction of risk behavior following diagnosis of coronary heart disease from the theory of planned behavior.

Perceived behavioral control (PBC) and intention, the proximal predictors from the theory of planned behavior (TPB), were used to predict cardiovascular risk behaviors in 597 patients 1 year after diagnosis with coronary heart disease. The outcome measures were self-report measures of exercise plus objective measures of fitness (distance walked in 6 min) and cotinine-confirmed smoking cessation. In multivariate analyses incorporating both PBC and intention, PBC predicted exercise, distance walked, and smoking cessation, but intention was not a reliable independent predictor of any health behavior measured. Thus, the effective theoretical component of the TPB was PBC. Similar predictions could derive from social-cognitive theory. In coronary patients, behavioral change needs to address issues of action implementation rather than motivational factors alone.

Aged↗
PubMed2004

The intensive care experience: development of the ICE questionnaire.

BACKGROUND: Previous research has shown that patients' reported memories of intensive care are often of unpleasant events which are described as frightening and persecutory in nature. Currently, there is no standardized way of assessing perceptions of such an experience or relating it to long-term outcome. AIMS: This paper describes the development of an intensive care experience questionnaire which aims to (a) identify the domains of such an experience, (b) assess and quantify that experience, and (c) explore its impact on short- and long-term emotional outcome. METHODS: Data from two studies are reported. Participants were non-elective patients and > or =18 years of age with an ICU stay > or =24 hours. Study 1 (n = 34) generated and developed items. Study 2 (n = 109) allowed evaluation of the factor analytic structure and psychometrics of the questionnaire. RESULTS: From a set of 31 items, exploratory factor analysis identified four components of the intensive care experience: 'awareness of surroundings' (nine items), 'frightening experiences' (six items), 'recall of experience' (five items), and 'satisfaction with care' (four items). Cronbach's alpha statistics were acceptable for each component (0.71-0.93). Correlational analysis with the subscales of the Hospital Anxiety and Depression Scale and Impact of Event Scale demonstrated concurrent and univariate predictive validity. The intensive care experience was associated with adverse emotional outcome in both the short- and long-term. DISCUSSION: The intensive care experience questionnaire identified four dimensions of experience and performed satisfactorily in these developmental analyses. Further study of an independent intensive care unit data set is necessary to confirm these findings, including the four-component structure. Development of a standardized measure provides the opportunity to increase our understanding of the intensive care experience. The questionnaire may be useful to inform the development of effective interventions to improve subsequent outcomes for these patients.

Adaptation, Psychological↗
PubMed2004

Functional limitations and survival following stroke: psychological and clinical predictors of 3-year outcome.

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.

Activities of Daily Living↗