The College Adjustment Scales (CAS) are a multidimensional psychological measure designed specifically for use in college and university settings. The purpose of this study was to assess the ability of the College Adjustment Scales (CAS) to function as outcome measures in university counseling centers. Study 1 assessed the ability of the CAS to track change following brief therapy using a nonequivalent control group design. Study 2 assessed the convergent validity of the CAS by correlating two of the nine CAS scales with two established measures. The results of a three-factor MANOV A revealed that the CAS were able to track change very well for undergraduate students. Results for graduate students showed that three of the CAS scales tracked change quite well, two scales did not track change, and four scales did not track change for graduate males. Convergent validity results were mixed for the two scales assessed. The Self-Esteem scale was determined to be a fairly good measure of global self-esteem. The CAS Anxiety scale did not correlate well with an instrument that is a good measure of anxiety characterized by physiological symptoms. Recommendations for future research are discussed.

Purpose: This study had three objectives. The first objective was to develop the contents of a continuing professional development module (CPDM) for physical therapists geared toward increasing the use of standardized balance measures examine patients with balance dysfunction. The second objective was to assess the impact of the CPDM by measuring change in the clinicians' choice of measures using a patient case as well as the degree to which they changed their practice. The final purpose was to identify barriers and facilitators of knowledge translation using a CPDM. Subjects: A sample of convenience was used to recruit therapists through two home care agencies. Forty therapists participated in a one-day continuing professional development module (CPDM) regarding the use of standardized balance measures for patients with balance dysfunction. Method: A CPDM was designed based on the literature on adult learning, knowledge translation, and continuing professional development formats. Overlapping themes derived from this literature were combined to develop and present the module. Balance measures chosen for the content of the course were based on the literature and clinical relevance. Several tools were developed and administered to collect data on four levels of evaluation including: 1) participation using return rate of commitment to change forms, 2) satisfaction using a 5-point Likert evaluation form, 3) change in learning using change in pre/post case study scoring and a self assessment tool, and 4) change in performance using a commitment to change form and interview themes. Statistical tests used included descriptive, paired t-tests, and wilcoxon ranked sign test. In addition, semi-structured interviews were utilized. Results: Subjects satisfaction in the module was excellent and there was an 80% return rate of the commitment to change (CTC) forms. Statistically significant change scores were found in pre/post case study testing and self-assessment questions in regards to learning occurring following the module. Commitment to change forms and interview themes supported an actual change in clinicians' performance. Conclusion: Knowledge transfer can occur in a CPDM. The changes appeared to result from utilizing principles including accountability, multiple teaching strategies and facility support. The results of this study support the development of a CPDM to facilitate knowledge transfer in this specific area of physical therapy practice, as well as provide a model for other knowledge translation studies in the profession of physical therapy.

No description available.

The Outcome Questionnaire-45 (OQ-45) is a 45-item instrument designed to be used by psychotherapists to track their clients' distress over time. The OQ-45 is composed of three factors: symptomatic distress, interpersonal relations, and social role performance. Numerous researchers have attempted to replicate this intended three-factor structure in their own data, only to find poor fit. Attempts to find a factor structure that does show adequate fit have been met with mixed, but generally poor, results. Additionally, very little work has been done to establish that the OQ-45 exhibits sufficient longitudinal measurement invariance to allow comparison of OQ-45 scores over time. Notwithstanding these known issues regarding the fit of the OQ-45, it has been adopted widely in many countries and translated into several dozen languages. This study sought to identify a factor structure of the OQ-45 that did exhibit longitudinal measurement invariance. Using a sample of 7,751 clients who made 56,353 visits to Brigham Young University's Counseling and Psychological Services between 1996 and 2017, three factor structures were analyzed using Mplus 8.2 through confirmatory factor analysis: (a) single-factor, (b) intended three-factor, and (c) bifactor models. The bifactor model fit the data best, as determined by standard fit statistics (CFI, TLI, RMSEA, SRMR). However, this bifactor model still had inadequate fit. At this point, exploratory structural equation modeling (ESEM) using target rotation was applied to the bifactor model. This ESEM bifactor model had a dominant general factor and did have good fit to the data. Having selected the ESEM bifactor model, it was then tested to see if it showed longitudinal measurement invariance over five time points (the initial OQ-45 score at the intake appointment, followed by four subsequent appointments). The OQ-45 items were treated as categorical and analyzed using the WLSMV estimator. Four time sequences were examined for configural, metric, and scalar longitudinal invariance: Time 1 to Time 2, Time 1 to Time 3 (inclusive of Time 2), Time 1 to Time 4 (inclusive of Times 2 and 3), and Time 1 to Time 5 (inclusive of Times 2, 3, and 4). The OQ-45, when modeled as an ESEM bifactor model, does exhibit scalar longitudinal measurement invariance. Using a new method developed by Clark (2020), ΔSRMR between adjacent models (configural to metric, metric to scalar) were all below his recommended guideline of .01. This is the first study to find a good fitting model of the OQ- 45 that can be used to assess changes in clients' psychological functioning over time. Total OQ- 45 scores can continue to be used by therapists to monitor their patients with confidence in its longitudinal psychometric properties.

No description available.

Background: Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease characterized by the loss of motor neurons. Preference-based measures (PBMs) of health-related quality of life (HRQL) can be utilized for cost-effectiveness analyses of interventions in individuals with ALS. However, current measures are generic (GPBMs) and the psychometric properties of these measures have not yet been evaluated in ALS. Purpose: The purpose of this thesis was to evaluate the psychometric properties of GPBMs in ALS by 1) conducting a systematic review of the psychometric properties of GPBMs, and 2) assessing the content and convergent validity of GPBMs in ALS. Methods: Two studies were conducted. First, a systematic review was performed, and four databases were searched to identify studies that used and reported on the psychometric properties of GPBMs in ALS. Second, participants were recruited from three clinical sites across Canada and outcome measures were administered through an online or hardcopy survey. Areas of importance to the HRQL of individuals with ALS were identified using the Patient Generated Index (PGI), mapped against GPBMs to determine their coverage and scores were compared to determine convergent validity. Results: For the first study, the EQ-5D-3L was found to be the most commonly used GPBMs in ALS. It demonstrated convergent and known-groups validity however, significant floor effects were observed. For the second study, results indicated that the majority of GPBMs identified approximately half of the areas impacted by ALS. In addition, there were several domains not identified by GPBMs. Conclusion: This thesis highlights the importance of complete psychometric evaluation of measures in ALS. There is the need for the development of an ALS specific preference-based measures that reflects the health concerns of individuals with ALS; as GPBMs used in ALS were evaluated and deemed to be lacking in support for their usage in ALS. / Thesis / Master of Science Rehabilitation Science (MSc) / Amyotrophic Lateral Sclerosis (ALS) is a fatal disease that causes individuals to lose their strength and eventually the ability to speak, eat, move and breathe. Questionnaires can be used to understand the health-related quality of life (HRQL) of individuals with ALS however these measures do not always reflect the experiences of these individuals. The goal of this dissertation was to identify whether measures truly capture areas important to individuals with ALS. In our studies, we found that there is little proof in the accuracy of measures used. In addition, the measures do not fully capture the areas of life important to individuals with ALS. This is important to help researchers and health care professionals understand the effects of ALS on HRQL. These results will help them determine which treatments are worthwhile and the best to use in practice and provide recommendations for future research.

Measurement Based Care (MBC) is considered to be an evidence-based practice. Despite its well-documented efficacy, it is underutilized in the clinical community for various reasons, including clinician and patient buy-in. A key component to the successful implementation of MBC is the routine administration of Patient Reported Outcome Measures (PROMs). There is a lack of research describing the utilization of MBC in a telehealth setting. As technological innovations continue, a greater number of clinics are offering telemental health services. Additionally, the COVID-19 pandemic caused a majority of underprepared clinics to begin implementing telehealth. The present study sought to evaluate patient compliance with PROMs in MBC after an abrupt shift to telehealth due to the COVID-19 pandemic. Participants were collected from a clinical population at a community based psychological training clinic. The participants were separated into groups: modality 1 (in-person services, n = 17), modality 2 (telehealth services, n = 17), and modality 3 (hybrid of modalities 1 and 2, n = 10), to assess the effect of modality on mean PROM compliance. The participants were separated into groups adult (≥18 years of age, n = 23) and child (<18 years of age, n = 17), to assess the effect of maturity on mean PROM compliance. Results showed that mean PROM compliance was significantly higher in the in-person modality than the telehealth modality. Results also showed that PROM compliance was significantly higher in adults than in children. There was not a significant interaction effect of modality and maturity on PROM compliance. Additionally, results showed that PROM compliance decreased significantly after the switch from in-person services to telehealth services in the hybrid modality. These findings show that clinics may face significant barriers to the implementation of MBC after a sudden shift to telehealth caused by an unforeseen stressful event. / M.S. / Measurement-Based Care (MBC) is an effective practice for the treatment of patients in psychological practices. It is a collaborative process that involves the clinician and patient tracking treatment progress and outcomes through the use of consistently administered measures known as Patient Reported Outcome Measures (PROMs). Although MBC has been shown to be effective, there is little literature regarding its use in a telehealth setting. As a greater number of clinics begin offering telehealth services, questions regarding patient adherence to interventions have arisen. Furthermore, the global COVID-19 pandemic forced a majority of underprepared clinics to offer telehealth services. The current study sought to better understand potential barriers to the implementation of MBC in a telehealth setting. Participants were collected from patients receiving therapy at a community based psychological training clinic. The participants were separated into the groups: in-person services (n = 17), telehealth services (n = 17), and hybrid of in-person and telehealth (n = 10), to assess the effect of modality on mean PROM compliance. The participants were separated into groups adult (≥18 years of age, n = 23) and child (<18 years of age, n = 17), to assess the effect of maturity on mean PROM compliance. Results showed that patients in the in-person therapy group were more likely to complete their measures than patients in the telehealth therapy group, regardless of their maturity. Additionally, adult patients were more likely to complete their measures than child patients, regardless of the modality. Results also showed that patients who experienced both in-person and telehealth services were more likely to complete their measures before the switch to telehealth. These findings show that clinics may face significant barriers to the implementation of MBC after a sudden shift to telehealth caused by an unforeseen stressful event.

Introduction: Conversation treatment for individuals with aphasia (IwAs) aims to enhance language and communication skills within naturalistic settings. Group dynamics, including psychosocial support (PSS) and vicarious learning (VL), are important components of this treatment. However, the lack of established aphasia-friendly methods for quantifying group dynamics impedes understanding of its contribution to treatment efficacy. This study addresses three key research goals: (1) Can group dynamics be reliably quantified? (2) Do measures of group dynamics vary with group size or time? (3) Are group dynamics linked to changes in self-reported psychosocial health measures? Methods: IwAs were assigned to participate in either a large group or dyadic condition as part of a larger study. Participants completed multiple standardized assessments before and after receiving conversation treatment for one hour twice a week for ten weeks. A coding system was developed to track PSS and VL during sessions. Video recordings of sessions at the start (Session 2) and end (Session 19) of the treatment period were analyzed for five large groups and six dyads, with seven additional dyads coded for Session 19 after reliability was confirmed. Intrarater and interrater reliability were assessed by recoding 21% of the videos randomly. Results: To address the first research goal, group dynamics were defined and then a code was created to represent occurrences of PSS and VL. After establishing a reliable coding system, instances of PSS and VL were compared across size conditions to address the second research goal. The results suggested that PSS differed between conditions later in treatment, but VL did not. For research goal three, the data suggest that large groups experience larger gains in quality of life measures, possibly due to increased exposure to PSS. Conclusion: Findings indicate that group dynamics can be reliably tracked and used for quantitative analysis. PSS was more common in groups than dyads later in the 10 week treatment period, but VL did not vary across conditions or at the start or end of treatment. Further, there is some evidence that PSS in larger groups contributes to improvements in quality of life measures. / Communication Sciences

Yes / Fundus-controlled perimetry (FCP, also called 'microperimetry') allows for spatially-resolved mapping of visual sensitivity and measurement of fixation stability, both in clinical practice as well as research. The accurate spatial characterization of visual function enabled by FCP can provide insightful information about disease severity and progression not reflected by best-corrected visual acuity in a large range of disorders. This is especially important for monitoring of retinal diseases that initially spare the central retina in earlier disease stages. Improved intra- and inter-session retest-variability through fundus-tracking and precise point-wise follow-up examinations even in patients with unstable fixation represent key advantages of these technique. The design of disease-specific test patterns and protocols reduces the burden of extensive and time-consuming FCP testing, permitting a more meaningful and focused application. Recent developments also allow for photoreceptor-specific testing through implementation of dark-adapted chromatic and photopic testing. A detailed understanding of the variety of available devices and test settings is a key prerequisite for the design and optimization of FCP protocols in future natural history studies and clinical trials. Accordingly, this review describes the theoretical and technical background of FCP, its prior application in clinical and research settings, data that qualify the application of FCP as an outcome measure in clinical trials as well as ongoing and future developments.

No / Aims and This analysis paper describes a comparative evaluation of service deliverables within the Service Level Agreements (SLA) of two acute psychiatric services; one inclusive and the other exclusive of occupational therapy. Methods: Six SLA agreements provided the standards by which the two services were evaluated. The SLAs were evaluated because they are used by the service managers and commissioners to measure performance and clinical effectiveness. The role of the occupational therapists and their contribution to the planning and delivery of the performance indicators is also considered. An evaluation framework was applied to explore the potential role occupational therapy may have had in any performance difference between the two sites. In doing so it is hoped to provide some evidence to support and inform occupational therapists and service managers on the role and of occupational therapy in acute mental health services. This comparative evaluation followed the first three of the five audit stages: 1. Preparing for audit; 2. Selecting criteria; and 3. Measuring performance level. Findings: The service with occupational therapy performed better on home leave day use, ward occupancy and less than 3-day admissions. Conclusions: By delivering their key roles of individual assessment, therapeutic groups, individual treatment and discharge planning occupational therapist were able to contribute to the overall efficiency of service delivery. These findings support the role of the occupational therapist in an acute psychiatric setting and provide guidance for managers on how to utilise occupational therapy in the delivery of service outcomes.