The purpose of this research study was to evaluate pain, strength, balance, and function in subjects before and after total knee arthroplasty. Thirteen subjects were tested prior to total knee arthroplasty. Seven of the original subjects returned to the laboratory and were tested one month after knee replacement surgery. At each testing session subjects completed questionnaires including a pain visual analog scale (VAS), Falls questionnaire, global rating of knee function, Western Ontario McMaster Universities (WOMAC) osteoarthritis index, and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS). Strength was tested via unilateral, isometric squat. Knee range of motion was measured using a standard goniometer. Functional activities including walking, sit to stand transfers, and stepping on and off a curb were assessed using the Balance Master Force Plate system (Neurocom International). Balance activities including tandem walk, modified clinical test of sensory interaction on balance (mCTSIB), limits of stability (LOS), and sensory organization tests (SOT) were also assessed using the SMART Equitest (Neurocom International). There was a trend towards decreased pain on VAS post- surgery although the results were not significantly different (p = 0.0585). Subjective rating of function was improved on the composite WOMAC Osteoarthritis Index score (p = 0.0313). No differences were found after surgery for strength in the involved limb, balance tasks, or ability to perform functional activities. From this study we conclude that total knee arthroplasty does not have a deleterious effect on function or balance in the immediate post-operative period even through the knee is still in an acutely inflamed state. Further testing is needed to evaluate the effect of TKA on more strenuous functional activities and balance tasks and at larger post-operative intervals. / School of Physical Education, Sport, and Exercise Science

Touch--both touching another and being touched--is a primary form of communication. By old age, both the need and the desire for specific amounts and kinds of touching are well established for the individual. The present study was designed to obtain information about what elderly women in nursing and retirement homes report to be liked and disliked types of touching. Participants who volunteered for this study were 32 ambulatory females 65 years of age or older who were living in nursing or retirement homes. Each participant was shown a set of 20 photos and sketches depicting a staff person touching an elderly woman in various ways, and asked to rate their liking for the particular type of touching on a one to five scale ranging from "like very much" to "dislike very much." The set of photos and sketches included ten comparable scenes with one-half showing a male staff member and the other half showing a female staff member touching an elderly woman. Scenes included: foot massage, helping to stand, back rub, brushing hair, arm around shoulder, holding hand, helping to dress, stroking cheek, helping with toileting, and helping with a shower.

A personal health record (PHR) allows a patient to exert control over his/her healthcare by enhancing communication with healthcare providers. According to research, patients find value in having access to information contained in their medical records. Often a glossary is required to aid in interpreting the information and understanding the content. However, giving patients the ability to speak with providers about their medical conditions empowers them to participate as informed healthcare consumers. The majority of patients (75%) at Medical Specialists expressed their intention to adopt the PHR if it is made available to them. Although the perceived usefulness of a PHR was a significant determining factor, comfort level with technology, health literacy, and socioeconomic status were indirectly related to intention to adopt as well. Perceived health status was not found to be a significant factor in this population for determining intention to adopt a PHR. The majority of patients in each category of gender, age, marital status, and race/ethnicity (except American Indian/Alaska Native) expressed interest in adopting a PHR, with most categories being above 70%. Findings indicate a broad acceptance of this new technology by the patients of Medical Specialists. Improvement of adoption and use rates may depend on availability of office staff for hands-on training as well as assistance with interpretation of medical information. Hopefully, over time technology barriers will disappear, and usefulness of the information will promote increased demand.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Philosophy

The use of quality of life instruments to evaluate the effect of cancer and its treatment on individuals has increased but the process by which the patient comes to make these quality of life evaluations has not been addressed. Earlier studies have shown the reporting of physical symptoms and the evaluation of one's health to be related to negative affect. The purpose of this study was to investigate whether the relationship between negative affect and the evaluation of ones health would remain the same in a group of cancer patients, when a major disease and treatment symptom, fatigue was controlled for. The current study found no relationship between negative affect and the evaluation of health once fatigue was controlled for. Negative affect and fatigue were found to be moderately correlated and fatigue accounted for a large proportion of the variance in the quality of life domains of physical, functional and emotional well-being. Both empirical and theoretical issues are discussed. / Department of Counseling Psychology and Guidance Services

Health Locus of Control (HLOC) and other predictors of Quality of Life (QL) were examined for women with an initial versus recurrent breast cancer diagnosis. Twenty-eight women with an initial breast cancer (IBC) diagnoses and twenty-eight women with recurrent breast cancer (RBC) diagnoses were recruited from doctors' offices and cancer support groups. Correlational analyses were used to assess the relationships between variables. No significant differences were found between women with IBC and RBC on Psychological QL. Doctor HLOC and Psychological QL were related for women with RBC (r = .481, p = .01) and marginally so for women with IBC (r = .329, p = .09). A positive correlation was also found between Doctor HLOC and Functional QL for both women with IBC (r = .464, p = .01) and women with RBC (r = .390, p = .04). After controlling for stage of cancer, women with RBC reported higher Functional QL than did women with IBC. Advanced (stages III or IV) versus early (stages I or II) cancer stage related to lower Functional QL, controlling for initial versus recurrent diagnosis (r = -.283, p = .01). A marginally significant relationship was also found for cancer stage, regardless of initial versus recurrent diagnosis, with higher Overall QL for women with early stages of breast cancer (r = -.157, p = .09). No significant differences in Optimism or Overall QL were found between women with IBC versus RBC. No differences were found between married and single women. This research begins to explore differences in Quality of Life for women with a new versus a recurrent breast cancer diagnosis.

The primary aim of this study was to investigate the content and extent of psychotherapy patients’ disclosures to their spouses or significant others about their experiences in therapy, the perceived impact of disclosure about therapy on the spousal relationship, and its perceived impact on the therapeutic relationship and on treatment satisfaction. Adult psychotherapy patients (N = 84) in individual treatment, who identified themselves as either married or in a significant romantic relationship completed the Disclosure About Therapy Inventory – Revised (DATI-R; Khurgin-Bott & Farber, 2014), a revision of the Disclosure About Therapy Inventory (see Khurgin-Bott & Farber, 2011). This 52-question survey was designed to explore the extent and content of patients’ disclosures to their therapists, and the extent and content of their disclosures about therapy to their spouses or significant others (“partners”). The DATI-R also includes three outcome measures: the Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen, Crand, & Larson, 1995) measures the quality of participants’ relationships with their partners, the Working Alliance Inventory – Short Revised (WAI-SR; Hatcher & Gillaspy, 2006) assesses the quality of their relationships (alliances) with their therapists, and the outcome items of the Disclosure to Therapist Inventory-III (DTI-III) assess their satisfaction with their treatment. Findings indicate that overall, patients were very disclosing to their therapists and moderately disclosing to their partners about their therapy. No demographic variables (including gender, marital status, duration of psychotherapy, and duration of marriage/relationship) were significantly associated with or predictive of the extent of patients’ self-disclosure about therapy. A significant positive association was found between the extent of disclosure to partners about therapy and the extent of self-disclosure to therapists. Greater extent of disclosure about therapy to partners was also associated with better quality of therapeutic alliances and with higher relationship satisfaction (with partners). Additionally, the quality of therapeutic alliances was strongly predictive of better treatment outcomes. These findings suggest that married (or coupled) patients in individual psychotherapy may benefit from the open discussion of their experiences in therapy with their spouses or significant others, or at least that such openness is characteristic of patients in satisfactory relationships (both therapeutic and marital). These findings are discussed in the context of the methodological limitations of the current study and the particular characteristics of the sample, and clinical implications and directions for future research are explored.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences