Rehabilitation Psychology

Question 1

What are the moderator variables of the Williams and Anderson model and what are some examples?

Answer 1

moderator variables affects the intensity of the stress response

• history of stressors: experience with previous injury, fear of another injury
• coping resources: amount of social support received ability to cope with stressors

Question 2

(Williams and Anderson model) what happens when an athlete encounters a potentially stressful situation?

Answer 2

the athlete gives a stress response when demands of a situation exceed the coping resources leading to a stress response
(ex, physiological affects like increase blood pressure, more sweat or muscle tension)
(ex 2, attention is narrowed or unfocused)

Question 3

how do the affects from the stress response affect athletes?

Answer 3

these physiological affects and attentional demands increase vulnerability of injury

Question 4

do all individuals demonstrate a stress response?

Answer 4

no, some individuals might not show any stress response even in a stressful situation depending on moderating factors

Question 5

moderator variable

Answer 5

is a quantitative variable that affects the nature, direction or the strength of a relation between an independent or predictor variable (life stress) and dependent variable (this case injury)

Question 6

life stress, coping skills, social support vs time loss (smith)

Answer 6

• measured the life stress, social support and coping skills at the start of the high school sport season.
• then recorded injury data collected over the season and time loss due to injury.
• research assistants were trained to record injury and the amount of exposure the athletes had in the season
• athletes with low-low (social support and coping skills) had a 22% more risk of being injured

Question 7

how can we reduce the stress response?

Answer 7

1) alteration of cognitive appraisal of potentially stressful situations
2) modifying the physiological and attentional aspects of the stress response
- > interventions can also be used to directly influence the moderator variables (coping resources and personality factors)

Question 8

design of stress intervention vs injury occurrence? (Gerr and Koss)

Answer 8

• 2 arm randomized trial (randomly get selected for no treatment arm or treatment arm)

time period of the study:
- time 1 - pre-season and pre-intervention measures (athletic stress)

• time 2 - four months after time 1 (mid-season)
• time 3 - four months after time 2 (peak season, national championships)

dependent variable: injury occurrence

Question 9

what was stress intervention vs injury occurrence study? (Gerr and Koss)

Answer 9

• > the experimental group (stress management program) decreased in negative stress as the season progressed
• > the control group (no treatment) increased in stress as the season progressed
• > the incidence of injury can be reduced in athletes (gymnasts) when negative athletic stress is reduced

Question 10

what information did Tranaeus reveal from the meta-analysis?

Answer 10

• looked at injury vs intervention relationships in 7 studies
• most of the articles favored the intervention
• the total Hedges’ g effect was 0.82
• the result indicates that psychological injury prevention interventions have a large effect on reducing injury
• diamond = the average of all the studies
• 0.8 or higher Hedges’ g effect is a large effect

Question 11

findings of intervention and knee strength, pain, re-injury anxiety?

Answer 11

by cupal and brewer

knee strength - treatment group greater strength than control and treatment

re-injury anxiety - treatment group less anxiety in re-injury

pain - treatment group lesser pain

• > knee strength was correlated with both re-injury anxiety (r = -.53, p > .003) and pain reduction (r = -.46, p < .01)
• psychological-based interventions can enhance functional and related cognitive outcomes during rehabilitation

Question 12

why does guided imagery work? (cupal and brewer)

Answer 12

• our bodies do not discern whether an image is real or imagined

psychological mechanisms - personal control, motivation

physiological - reduced stress -> better immume-inflammatory response

-> promotes tissue regeneration and repair

Question 13

Bandura’s model

Answer 13

modeled act -> attention -> retention -> production -> motivation -> response

• emphasizes the importance of observing, modelling, and imitating the behaviors, attitudes, and emotional reactions of others

Question 14

what are some examples of outcome measures in modeling rehab psychology?

Answer 14

performance - adherence, errors, outcome, form

cognitive and affective psychological responses - anxiety, mood, self-efficacy, RPE

Question 15

Research and applications of modeling in rehab psychology

Answer 15

Question 16

types of modeling interventions

Answer 16

• mastery vs coping model
• imagery vs modeling as a vicarious experience (experienced in the imagination through the feelings or actions of another person)
• self-modeling

Question 17

mastery models

Answer 17

• demonstrate errorless performance
• verbalize confidence
• demonstrate positive attitude
• verbalize low task difficulty

Question 18

coping models

Answer 18

• display decreasing distress as they struggle with difficulties or threats
• demonstrate strategies for dealing with different situations
• voice progressively self-efficacious beliefs
• approach or achieve mastery

Question 19

how modeling is used in medical settings

Answer 19

• preparing patients for non-surgical procedures
• preparing patients for surgical procedures
• using video for patient education and skill development

Question 20

what is a problem with individuals in “medical” settings

Answer 20

many individuals are prone to exhibit high anxiety

“white coat phenomenon”

ex) increase in b

Question 21

what did Kulik and Mahler find in their study?

Answer 21

• pre-operative patients had less anxiety with a post-operative patient
• the exposure to postoperative sensations and events through a coping model better prepares the observer by providing accurate information on which cognitivie appraisal of the situation can be made

(the patients knew how the results of other patient’s surgery went)

Question 22

what did flint examine and study?

Answer 22

examined the role of coping models compared to no models on psychological factors and functional outcomes following a rehabilitation program for anterior cruciate ligament reconstruction (ACL) among ten female basketball players.

Question 23

what was the procedure for flint’s study?

Answer 23

Players were assigned to watch a coping model video of peers participating in rehabilitation from ACL surgery

The coping model video showed female athletes similar in age, basketball position, and type of injury progressing through the rehabilitation process to full recovery

Question 24

what did flint find from his study?

Answer 24

At 3-weeks post-surgery, athletes who watched the modelling video had greater self-efficacy (belief that they can achieve their goals) than the control group.

At 2-months post-surgery the intervention group had higher perceived athletic competence (ability to do something successfully)

Question 25

what were the limitations of flint's study?

Answer 25

- the sample size was very small and hence underpowering - the modeling intervention was only introduced post-operatively and pre-operative benefits weren't studied

Question 26

what were the psychological measure of prapvessis' study?

Answer 26

Perceptions of expected pain Perceptions of actual pain Anxiety - Participants rated levels of state anxiety Self-efficacy - Participants rated their confidence to perform specific tasks over increasing duration and frequency: Walk with crutches (post-op) Walk without crutches (post-op, 2-weeks) Perform rehabilitation exercises (post-op, 2- and 6-weeks)

Question 27

what were the functional measures of prapavessis' study?

Answer 27

- International Knee Documentation Committee Form (IKDC) - Objective component (surgeon): Knee laxity, swelling, ROM - Subjective component (patient): Symptoms, difficulty performing tasks (baseline and 6-weeks) - Range of Motion (Baseline, 2- and 6-weeks using a goniometer) - Time walking without crutches (in days)

Question 28

what was the procedure of prapavessis' research?

Answer 28

Question 29

psychological intervention for ACL reconstruction (prapavessis)

Answer 29

- psychological intervention was a DVD the patients watched a succesful ACL reconstruction - made them think it would be successful for them too

Question 30

how did the intervention affect patient's expected pain? (prapavessis)

Answer 30

- intervention group had a lower expectation of pain

Question 31

how did the intervention affect patient's clutch self-efficacy? (prapavessis)

Answer 31

- intervention group had more self-efficacy (confidence to walk in crutches)

Question 32

how did the intervention affect patient's walking self-efficacy? (prapavessis)

Answer 32

- only differences at pre-discharge where intervention group had more confidence

Question 33

how did the intervention affect the amount of days patients walked with crutches? (prapavessis)

Answer 33

- intervention group got off the crutches at average of 5 and a half days - where control got off 9 and a half days

Question 34

how did the intervention affect patient's excersize self-efficacy? (prapavessis)

Answer 34

- intervention group had more confidence only at pre-discharge

Question 35

how were the IKDC objective scores? (prapavessis)

Answer 35

- done by the surgeon, they didn't know which patient was in the intervention group - intervention group was in better condition (closer to 0 means better function)

Question 36

how were the IKDC subjective scores? (prapavessis)

Answer 36

- intervention group rated themselves higher in condition than the control group (higher means better condition)

Question 37

what conclusions are made in prapavessis' study?

Answer 37

**(psychological)** - Preoperative anxiety, **no effect** - _Perceptions of expected pain_, **positive effect** - Perceptions of actual pain, **no effect** - _Self-efficacy measures_, **early effect** **(functional)** - _Crutch walking_, **positive effect** - _IKDC_, **positive effect** - ROM (range of motion), **no effect**

Question 38

how can prapavessis' research be used in the future?

Answer 38

- The use of interactive modeling techniques in specific rehabilitation exercises - Non-pharmacological pain-management techniques used during pain focusing and pain reduction might be presented using a modeling format - Use of modeling techniques could be employed to alter psychological variables previously shown to affect adherence behavior (i.e., motivation, intention and perceived behavioral control)

Question 39

Placebo

Answer 39

Improvement in health not attributable to treatment. (Sham surgery) Subjects believe that they are getting better without knowing there was no treatment Attenuated: Effects are reduced. Placebos cause brain to release endorphins that reduce pain. Attention, care and affection triggers physical reactions in human body to hea

Question 40

nocebo

Answer 40

if an individual does not expect the drug to work, or expects there to be side effects, the placebo can generate negative outcomes, the placebo is instead refered to as a **nocebo**

Question 41

the process of treatment theory

Answer 41

- placebos cause the brain to release endogenous opioids, or endorphins that reduce pain - showing attention, care, affection, etc. to the patient/subject triggers physical reactions in the body which reduce stress and promote healing (ex, better immune system response)

Question 42

A controlled trial of Arthroscopic surgery for Osteoarthritis of the knee

Answer 42

By Moseley. Lavage (Flush damaged cartilage out), Debridement (Scrapping) or Placebo. Patients with placebo got similar results to the patients with real surgery (even after 2 years). Ethical issues: Deceit of sham surgery vs false benefits of actual surgery. Will insurance stop covering the surgery

Question 43

knee surgery vs sham surgery (moseley)

Answer 43

- osteoarthritis - Arthroscopic surgery-damaged cartilage is scraped (debridement) or flushed out (lavage) with the aid of a viewing scope is a common option - sham surgery is faked, where incision is made and movements are made to make the surgery feel as believable as possible

Question 44

psychological reaction to injury

Answer 44

**injury-relevant processing**: information about pain, extent of injury, how it happened, negative consquences **emotional upheaval and reactive behaviour**: agitation, emotional depletion, isolation, shock, disbelief, denial, self-pity **positive outlook and coping**: acceptance, coping efforts, optimism, relief with progress **identity loss**: especially if no longer able to participate **fear and anxiety**: recovery? reinjury? be replaced? **lack of confidence**: decreased physical status **performance decrements**: less confidence, lack of practice, deconditioning expectations

Question 45

stress

Answer 45

- substantial imbalance between demand and response capability - underconditions where failure to meet demands has important consequences

Question 46

prehabilitation

Answer 46

training/treatment in preparation for an anticipated stressor can be physical (for physical stressors), psychological (for psych. stressors) or both question: can we deal with the stressors in the prehab time to optimize the recovery

Question 47

theory of prehabilitation affects

Answer 47

by topp et al. prehab. and non-prehab patients start at the same level of function prehab patients increase function during prehab phase while non-prehab. patients maintain or decrease in function similar decrease in response to the stressor for prehab and non-prehab patients **p****rehab. patients spent a**s**horter time below the minimum function level than non-prehab patients** similar recovery, but prehab. patients are quicker (higher in function levels) to pre-operation levels

Question 48

why might prehabilitation work?

Answer 48

traing specific systems that will be affected by the stressor (specifically) ex) build muscle strength if the stressor will cause strength loss build up a functional reserve to compensate for depletion by the stressor

Question 49

sport injury vs chronic condition

Answer 49

**sport injury** - acute injury - shorter surgical wait time - performance goals - return-to-play timeline **chronic condition** - gradual onset - longer wait time - daily living / health goals - no defined recovery timeline

Question 50

crochane review

Answer 50

systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care

Question 51

total joint replacement and rehabilitation, systematic review and meta-analysis

Answer 51

by Wang et al. prehab interventions - physiotherapy supervised exercise vs. usual care main measures: **pain & function** **conclusion**: evidence suggests prehab may **slightly improve** early post-operative pain and function, however effects remain **too small and short-term to be considered clinically-imporant**, and **did not** affect key outcomes of interest (length of stay, quality of life, cost) **strength**: converted outcomes to a standardized measurement of WOMAC **limitation**: compliance was not reported in a number of studies no physical measure of function