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Dan V Blalock,1,2 Patrick E McKnight,3 Todd B Kashdan,3 Simone C Franz3,4 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; 3Department of Psychology, George Mason University, Fairfax, VA, USA; 4Humanproof, LLC, Arlington, VA, USA Objective: The present study examined the proposition that patients need to focus on something beyond simply “getting better”. In a sample of arthritis sufferers, we distinguished individuals by the goals that motivated them – moving toward aspirational goals and maximizing gains (promotion focus) rather than obligations and minimizing losses (prevention focus) – and how these motivational styles influenced treatment. Methods: Patients (N=254) participated in a randomized controlled trial of resistance training and self-management, providing 6 time points of data over 2 years. Promotion and prevention focus at baseline were used to predict the course (compliance and changes in coping self-efficacy) and outcome (changes in physical functioning) of treatment. Results: Arthritis sufferers with strong promotion orientations showed significant improvements in physical functioning (a direct positive impact on physical health); there were no significant associations with treatment compliance and coping self-efficacy. Arthritis sufferers with strong prevention orientations complied less with the treatment and showed little change in coping self-efficacy during treatment, which, in turn, predicted worse physical functioning over time (a pernicious, indirect influence on treatment outcome). Conclusion: A focus on positive approach-oriented goals may improve overall treatment response, whereas a focus on negative avoidance-oriented goals may degrade treatment response through reduced compliance and self-efficacy. Keywords: treatment, promotion and prevention, self-efficacy, physical functioning, arthritis

The purpose of this study was to assess the relative effects of coping self-efficacy and catastrophizing on physical functioning. Over a 9-month period, studying changes in self-efficacy as possible mediator between catastrophizing changes and physical functioning changes might provide evidence for the most promising treatment target. Data came from a randomized, longitudinal controlled trial comparing exercise, self-management and the two combined to treat 254 individuals with early knee osteoarthritis. A secondary analysis using a bootstrapped linear mixed-effects mediational model produced estimates of both the direct and indirect effects. Results indicated that self-efficacy partially mediated the effect between catastrophizing and physical functioning suggesting that self-efficacy was the more direct treatment target compared to catastrophizing. Treatments targeting both self-efficacy and catastrophizing may have greater impact on physical functioning compared to treatments that focus on only one. [ABSTRACT FROM AUTHOR]

This study assessed the psychometric properties and evaluated the compatibility of two blind and low-vision rehabilitation outcome instruments, the VA-13 and the Functional Assessment of Self-Reliance on Tasks (FAST). Legally blind veterans (N = 190) from a Department of Veterans Affairs inpatient blind rehabilitation center completed the VA-13 (a retrospective pretest and posttest) at 6 weeks postdischarge. Clinicians rated veterans on the FAST at admission and discharge. The psychometric properties of the two instruments and their compatibility were evaluated with the use of a Rasch model analysis. The two instruments functioned consistently as screens and showed a ceiling effect at posttest; however, the VA-13 showed poor sensitivity to change. In contrast, the FAST showed more reliable change, hut a few items changed in unexpected ways. Our conclusions show that the two instruments are currently not compatible for calibration; however, this can he improved with proper attention to scaling inadequacies, test administration times, and content coverage. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the plausibility of self-control depletion, or ego-depletion, as the underlying cognitive resource responsible for performance decrements on the sustained attention to response task., Background: Researchers suggested that self-control is a limited cognitive resource used to complete a myriad of processes, including sustained attention. Past research showed that trait self-control affects some sustained attention tasks. However, little research has investigated the effect of self-control as a limited cognitive resource that varies over time (i.e., as a state-dependent variable)., Methods: This experiment investigated the effect of self-control (trait and state) on a sustained motor-inhibition task (e.g., sustained attention to response task; SART). State self-control was manipulated using a between-subjects design-participants in the experimental condition completed a task designed to deplete state self-control prior to performing the SART while the control condition completed a modified version that did not deplete self-control., Results: Trait self-control predicted performance on the SART, but the depletion task (state self-control) had no detectable effect., Conclusion: Given the evidence, it is unlikely that state self-control plays a causal role in performance decrements in the SART, but there appears to be some association between performance on the SART and trait self-control., Application: Trait self-control ought to be considered in future work for personnel selection in real-world tasks that the SART models such as long-distance driving, air traffic control, and TSA operations.

Objectives: We investigated the effects of auditory cues of varying reliability levels on response inhibition performance using a target detection task to determine if external cues offer performance benefits. Further, we examined how the slope of the speed accuracy trade-off changes as a function of auditory cue reliability and used the trade-off to understand where any performance gains may be realized., Background: Researchers have proposed that the sustained attention to response task (SART) can be used to study the mechanisms causing failures of response inhibition. External cues may mitigate the results of motor inhibition failure. The extent to which external cues can effectively aid performance depends on the level of cue reliability., Method: Ninety-one participants performed three SARTs with auditory cue assistance at three different levels of reliability (i.e. 0%, 60% and 100% reliable at cueing imminent No-Go stimuli)., Results: We observed fewer errors of commission and faster reaction time in conditions with higher cue reliability. The slope of speed-accuracy trade-off relationship was impacted by cue reliability and was not a simple linear function., Conclusion: Reliable auditory cues aid performance by reducing reaction time and errors of commission. Auditory cues also impact the relationship between speed and accuracy trade-off., Application: Insights of cue effectiveness at different reliability levels help people make informed decisions in developing automation interfaces or sensors based on expected performance. Reliable cues mitigate the risk of impulsive errors; however, the reliability has to be high to have a noticeable impact on the speed-accuracy trade-off., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Detecting a pattern within a sequence of ordered units, defined as patterning, is a cognitive ability that is important in learning mathematics and influential in learning to read. The present study was designed to examine relations between first-grade children's executive functions, patterning, and reading abilities, and to examine whether these relations differ by the type of pattern. The results showed that working memory correlated with reading fluency, and comprehension measures. Inhibition correlated only with the latter. Cognitive flexibility was correlated with patterning performance and with performance on object size patterns, whereas working memory was correlated with performance on symmetrical patterns and growing number patterns. These results suggest that the cognition required for completing patterns differs depending on the pattern type. Teachers may find it beneficial to place emphasis on the switching and working memory components of completing patterning tasks, depending on the type of patterns used in instruction.

Although a large body of research shows that general cognitive ability is heritable and stable in young adults, there is recent evidence that fluid intelligence can be heightened with cognitive training. Many researchers, however, have questioned the methodology of the cognitive-training studies reporting improvements in fluid intelligence: specifically, the role of placebo effects. We designed a procedure to intentionally induce a placebo effect via overt recruitment in an effort to evaluate the role of placebo effects in fluid intelligence gains from cognitive training. Individuals who self-selected into the placebo group by responding to a suggestive flyer showed improvements after a single, 1-h session of cognitive training that equates to a 5- to 10-point increase on a standard IQ test. Controls responding to a nonsuggestive flyer showed no improvement. These findings provide an alternative explanation for effects observed in the cognitive-training literature and the brain-training industry, revealing the need to account for confounds in future research.

This study developed and evaluated a brief training program for grant reviewers that aimed to increase inter-rater reliability, rating scale knowledge, and effort to read the grant review criteria. Enhancing reviewer training may improve the reliability and accuracy of research grant proposal scoring and funding recommendations. Seventy-five Public Health professors from U.S. research universities watched the training video we produced and assigned scores to the National Institutes of Health scoring criteria proposal summary descriptions. For both novice and experienced reviewers, the training video increased scoring accuracy (the percentage of scores that reflect the true rating scale values), inter-rater reliability, and the amount of time reading the review criteria compared to the no video condition. The increase in reliability for experienced reviewers is notable because it is commonly assumed that reviewers--especially those with experience--have good understanding of the grant review rating scale. The findings suggest that both experienced and novice reviewers who had not received the type of training developed in this study may not have appropriate understanding of the definitions and meaning for each value of the rating scale and that experienced reviewers may overestimate their knowledge of the rating scale. The results underscore the benefits of and need for specialized peer reviewer training.

Background: Prescription of resistance training (RT) exercises is an essential aspect of management for knee osteoarthritis (OA). However, whether patients with knee OA who are randomly assigned to receive RT simply substitute RT for other modes of physical activity remains unclear., Objective: The aim of this study was to determine the effect of a structured RT intervention on overall levels of moderate- and vigorous-intensity physical activity (MVPA) in patients with early-onset knee OA. The study compared patients with early-onset OA who participated in an RT program, those who participated in a self-management (SM) program, and those who participated in both RT and SM. Because participants randomly assigned to receive the RT intervention may simply switch activity modes, resulting in little net effect, we assessed total MVPA in addition to tracking changes in strength (force-generating capacity)., Design and Intervention: This study was a randomized controlled trial comparing the effectiveness of SM alone, RT alone, and combined RT+SM on MVPA in patients with early OA of the knee., Setting: The study was conducted on a university campus, with patient recruitment from the local community., Participants: The participants in this study were 171 patients (74% women, 26% men) with knee OA. They had a mean age of 55.1 (SD=7.1) years, a mean body mass index of 27.6 (SD=4.2) kg/m(2), and radiographic status of grade II OA (and no higher) in at least one knee, as defined by the Kellgren and Lawrence classification. They wore an accelerometer while awake (X=14.2 [SD=2.2] hours) for 5 to 7 contiguous days (X=6.8 [SD=0.5] days) at baseline and at 3 and 9 months of intervention., Results: The participants engaged in MVPA a mean of 26.2 (SD=19.3) minutes per day at baseline. Both groups significantly increased their MVPA from baseline to 3 months (RT group by 18% [effect size (d)=0.26]; SM group by 22% [effect size (d)=0.25]), but only the RT group sustained those changes at 9 months (RT group maintained a 10% increase [effect size (d)=0.15]; SM group maintained a 2% increase [effect size (d)=0.03]). A significant group x time interaction for MVPA indicated that the RT group maintained higher MVPA levels than the SM group., Limitations: Lack of direct measures of energy expenditure and physical function was a limitation of the study., Conclusions: Patients with early-onset OA of the knee can engage in an RT program without sacrificing their overall MVPA levels. These results support the value of RT for management of knee OA.

Objective: To assess the relative effectiveness of combining self-management and strength training for improving functional outcomes in patients with early knee osteoarthritis., Methods: We conducted a randomized intervention trial lasting 24 months at an academic medical center. Community-dwelling middle-aged adults (n = 273) ages 35-64 years with knee osteoarthritis, pain, and self-reported physical disability completed a strength training program, a self-management program, or a combined program. Outcomes included 5 physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and 2 self-reported measures of pain and disability., Results: A total of 201 participants (73.6%) completed the 2-year trial. Overall, compliance was modest for the strength training (55.8%), self-management (69.1%), and combined (59.6%) programs. The 3 groups showed a significant and large increase from pre- to posttreatment in all of the physical functioning measures, including leg press (d = 0.85), range of motion (d = 1.00), work capacity (d = 0.60), balance (d = 0.59), and stair climbing (d = 0.59). Additionally, all 3 groups showed decreased self-reported pain (d = -0.51) and disability (d = -0.55). There were no significant differences among the groups., Conclusion: Middle-aged, sedentary persons with mild early knee osteoarthritis benefited from strength training, self-management, and the combination program. These results suggest that both strength training and self-management are suitable treatments for the early onset of knee osteoarthritis in middle-aged adults. Self-management alone may offer the least burdensome treatment for early osteoarthritis.

Objective: Supportive close relationships are important for health. Mutuality, the reciprocal sharing of thoughts and feelings in close relationships, is linked with better outcomes for patients with rheumatoid arthritis (RA) in cross-sectional data. Hypothesizing that mutuality has a beneficial impact on inflammation, we tested potentially causal relations of couple mutuality with erythrocyte sedimentation rate (ESR) in prospective data., Methods: Female patients with RA (n = 70; mean age 57 years, mean RA disease duration 5 years) completed questionnaires at baseline, 6 months, and 12 months, including measures of mutuality, RA flares, and negative affect. ESR laboratory values available near questionnaire dates were collected from medical charts. Using regression, we examined cross-lagged effects of mutuality and ESR over the two 6-month time spans (baseline to 6 months, 6 months to 12 months). We anticipated that mutuality would exert lagged inverse effects on subsequent ESR levels, and that ESR would have no effect on subsequent mutuality levels., Results: After controlling for lagged effects of earlier inflammation, disease-modifying antirheumatic drugs, antiinflammatory drugs, RA flares, and negative affect, mutuality's lagged inverse effects over both time spans accounted for unique variance in subsequent levels of ESR, explaining 9% at 6 months and 12.5% at 12 months. Concomitantly, earlier ESR had no effect on subsequent mutuality., Conclusion: Patients with RA reporting more mutuality had less inflammation at subsequent time points, but inflammation had no effect on subsequent reports of mutuality. This suggests that mutuality exerts a beneficial effect on inflammation. Clinical implications and potential applications are discussed.

Unlabelled: The Roland-Morris Disability Scale has been shown to be a reliable and valid measure of disability in persons with chronic pain. A short form with psychometric properties similar to the full scale would have numerous benefits, including decreased patient assessment burden and scoring time. On the basis of data obtained from 993 individuals with chronic pain screened for admission to a multidisciplinary pain management program, an 11-item short form of the Roland scale was developed using procedures and models from item response theory. This short form was found to be a good predictor of the 24-item parent scale and a previously published 18-item short form. The 11-item scale also demonstrated concurrent validity with measures of pain intensity and depression. Item content reflected limitations in specific functional behaviors., Perspective: Brief measures of important pain-related variables can be created using item response theory (IRT). In this study, a reliable and valid 11-item version of the Roland-Morris Disability Scale was created using IRT. Clinicians and researchers might consider using this scale when patient or subject assessment burden is an issue.